Is My Insurance Company Supposed to Replace My Entire Roof?

June 7, 2024 | by Mehr Fairbanks Trial Lawyers

We receive a lot of questions from homeowners and commercial property owners about roof claims. One of the most common questions is whether the insurance company is required to pay for a full roof replacement or whether the insurance company can pay for only portions of the roof when shingles or other roofing materials are damaged.

Very rarely is your entire roof blown off during a storm. If the whole roof were damaged, then clearly the insurer would owe for the entirety of the roof. Still, most roof claims involve portions of the roof being damaged or sections of shingles being blown off. In those instances, with partial damage, what is a policyholder entitled to?

Fortunately, in Kentucky, we have an insurance regulation, 806 KAR 12:095, that addresses this question. It says:

Why is My Insurance Company Offering Too Little?

June 3, 2024 | by Mehr Fairbanks Trial Lawyers

Your insurance company may not be paying all the recoverable depreciation you are owed on your homeowners insurance claim.

If you have had property damage at your home and received an insurance claim payment from your insurance company, you may be wondering why this payment is significantly less than the cost to repair your property.

Insurers will often refer to the initial payment to you as “actual cash value” or a payment that has “depreciation” deducted. The term “actual cash value” simply means the cost to replace your roof minus the depreciation of your roof. This is often calculated by the insurance company using a computer estimating software called Xactimate.

Mehr Fairbanks Trial Lawyers Obtains a Settlement in Excess of $850,000 in a Bad Faith Case

May 28, 2024 | by Mehr Fairbanks Trial Lawyers

Mehr Fairbanks Trial Lawyers obtained a settlement in excess of $850,000 in a bad faith case against an insurer!

Call us today at (859) 225-3731 or visit us here to request a free consultation with one of Mehr Fairbanks’ attorneys.

*The information contained within this post should not be considered legal advice or legal representation.

Elizabeth Thornsbury Selected to the 2024 Kentucky Rising Stars List by Super Lawyers

December 21, 2023 | by Mehr Fairbanks Trial Lawyers

Congratulations to Mehr Fairbanks’ Partner, Elizabeth Thornsbury, on being selected to the 2024 Kentucky Rising Stars List by Super Lawyers!

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Elizabeth is listed as a top rated Employee Benefits attorney in Lexington, Kentucky. Selections are determined on 12 indicators of peer recognition and professional achievement on an annual, state-by-state basis. Being named to the Rising Stars list is a prestigious distinction that only the top 2.5% of attorneys receive.

Bartley Hagerman Selected as a National Trial Lawyer Top 40 Under 40 for Kentucky for 2024

December 19, 2023 | by Mehr Fairbanks Trial Lawyers

Congratulations to Mehr Fairbanks’ Partner, Bartley Hagerman, for being selected as a National Trial Lawyer Top 40 Under 40 for Kentucky for 2024!

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A Call for Mental Health Parity in Disability Policies

December 18, 2023 | by Mehr Fairbanks Trial Lawyers

It is common for employees to obtain long-term disability coverage through their employment as an employee benefit. These policies are typically governed by a federal law called ERISA (this stands for the Employee Retirement Income Security Act). Having access to this coverage should provide comfort to employees in case the unthinkable happens: some life altering event that leaves you disabled and unable to continue working – physically or mentally. However, typically insurance policies contain language that employees aren’t often aware. For example, most disability insurance policies limit how long benefits will be paid for any conditions that the insurance company considers to be a “mental illness” or “mental health condition.” Most disability policies limit the maximum disability benefit period for mental health conditions to a maximum period of 24 months of benefits (although it is possible some policies have a shorter, or even longer, benefit period – every policy is different). Opposite of this, most policies have a much longer disability benefit period for conditions that are considered “physical” conditions (for example, most policies pay benefits to ages 65 or 67 for physical conditions).

Why is there such a disparity in how physical and mental conditions are treated by disability insurance carriers? There shouldn’t be – and other types of coverage (such as health insurance) do not have this disparity. However, action is now being taken to try and make this change for disability policies. The 2023 ERISA Advisory Council has taken a focus on this very issue this year. Their goal has been to “study the scope and impact of employee benefit plans’ limitations on disability benefits for mental health and substance use conditions.”

The ERISA Advisory Council has now urged Congress to pass legislation for mental health parity in disability policies. And, since this news, a large disability insurance carrier – Sun Life – has vocalized support for mental health parity. Sun Life, in a press release, stated:

Mehr Fairbanks Receives Favorable Decision from the Kentucky Court of Appeals

April 25, 2023 | by Mehr Fairbanks Trial Lawyers

On April 21^st, the Kentucky Court of Appeals issued a unanimous opinion in favor of Mehr Fairbanks Trial Lawyers’ client, the Greenville Cumberland Presbyterian Church. The Court of Appeals opinion reverses and remands the Muhlenberg Circuit Court’s decision to enter summary judgment in favor of State Auto Property & Casualty Company. State Auto had issued an insurance policy to the church but when the church roof collapsed, State Auto denied the claim. The Court of Appeals ruled that there was in fact insurance coverage for the church’s loss under the State Auto policy.

Mehr Fairbanks partner Bartley Hagerman wrote the briefs and argued the case before the Court of Appeals.

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The Employee Retirement Income Security Act of 1974

March 24, 2023 | by Mehr Fairbanks Trial Lawyers

ERISA Disability

An experienced Kentucky ERISA disability lawyer can explain why disability insurance and other forms of insurance that are provided through your employer or union fall under a federal law known as The Employee Retirement Income Security Act of 1974, or “ERISA.”

Like many other employee benefits, ERISA disability law is designed to protect employees who have paid for or been promised these benefits through their employer. These benefits include:

Puzzling Pension Plans

March 24, 2023 | by Mehr Fairbanks Trial Lawyers

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A pension plan is an employee benefit plan established or maintained by an employer (or employee organization) that provides retirement income for employees. Primarily, pension plans are funded by the employer. More recently, traditional pension plans are becoming less available. Companies have replaced them with alternative plans (like 401(k) retirement savings plans) because they are less costly for employers. Some companies, like UPS, still have pension plans in place for their employees. However, when UPS reclassified some of their positions from nonunion to union it negatively impacted those employees’ pension plans. Consider the following:

Ralph Gragg worked for UPS as a driver hauling freight for approximately thirty years. When UPS decided to reclassify Mr. Gragg’s position, he transitioned from being a nonunion worker to a union worker. With his new classification status, his pension plan would then be funded by two distinctly different pension plans that existed within UPS. Each pension plan had a “Social Security Leveling Option” that would “increase the beneficiary’s monthly benefit before age 65 and thereafter reduce it by the amount of his Social Security benefit.” Gragg v. UPS Pension Plan, 55 F.4th 1059, 1061 (6th Cir. 2022). Mr. Gragg selected the “Social Security Leveling Option” for both of his pension plans. Each plan sent Mr. Gragg a letter that indicated what his payments would be before and after receiving his Social Security benefit. Each plan indicated that his monthly payment would be reduced by $1754 (the anticipated amount for his Social Security benefit).

However, when Mr. Gragg retired and began collecting his Social Security benefit each plan was reduced by his Social Security benefit for a combined total of $3508. When Mr. Gragg inquired about the discrepancy with each plan individually, they both responded with complicated messages that, in the end, indicated that the “reduced benefit amount was the correct amount.” Id. So, in November of 2020 Mr. Gragg filed a lawsuit against the UPS Pension Plan. He asserted a claim under the Employee Retirement Income Security Act, 29 U.S.C. § 1132 (a)(1)(B), that alleged that both pension plans paid him less than he was entitled to each month. Namely, $1754 less due to both plans being reduced by that exact amount.

The Shifting Future of ERISA Denial-of-Benefits Cases*

March 2, 2023 | by Mehr Fairbanks Trial Lawyers

The federal District Courts are beginning to adjust their views on how to best handle ERISA denial-of-benefits cases. Some courts use a modified summary judgment standard unique to ERISA denial-of-benefits cases that are based exclusively on an administrative record and the non-moving party is generally not entitled to the usual inferences in its favor (unlike the traditional summary judgment standard). In Anderson v. Liberty Lobby, Inc., the Supreme Court stated that “at the summary judgment stage the judge’s function is not himself to weigh the evidence… but to determine whether there is a genuine issue for trial.” Therefore, if material facts are in genuine dispute, then summary judgment may not be appropriate. Some courts have concluded that when fact-finding is required, or there is genuine issue related to material facts, then a bench trial is best. The 4^th Circuit has held that this situation may arise when there is a necessity “to resolve competing factual contentions within the administrative record about the cause, severity, or legitimacy of an individual’s impairment.” Tekmen v. Reliance Standard Life Ins., 55 F.4th 951, 960 (4th Cir. 2022) (citation omitted).

Of note, the 6^th Circuit, which is relevant Kentucky, has discussed not using summary judgment procedures or bench trials to decide ERISA actions, but instead reviewing the merits of the action based solely upon the administrative record with findings of fact and conclusions of law. It was suggested that the courts only consider evidence outside of the administrative record for limited exceptions. Wilkins v. Baptist Healthcare Sys., 150 F.3d 609, 619 (6th Cir. 1998) (Gilman, J., concurring).

For example, when insurance companies try to determine whether or not to award disability benefits, they may seek to hire their own physicians to review the medical records on file to reach a determination. This determination may or may not conflict with the medical opinions of the treating physicians. When there are conflicting opinions between the physicians hired by the insurance company and the treating physicians, however, this will likely lead to material facts in dispute. This is when a bench trial may be the most appropriate way for courts to rule on ERISA denial-of-benefits cases. Like in the example outlined below: