Reserves are guesstimates

Insurance company claims handlers generally set a reserve on claims. In fact, many state insurance laws require them to. This reserve figure lets the insurer know the approximate dollar amount for which the claims handler believes the insurer may be liable. Reserve dollar amounts are, at best, an estimated guess – or a guesstimate – on the part of the claim handler as additional information needs to be collected and researched before a payment can be made.

Traditionally, an insurance company’s reserve estimates were not discoverable, or made known, to policyholders or their lawyers. Many have claimed that to do so would provide policyholders with an unfair advantage over insurers (i.e.; if the amount that a plaintiff requested was less than what the insurer was willing to pay, the plaintiff would surely ask for more). While that may be true to a certain extent, some courts have allowed these figures to be disclosed.

Not-so-secret reserves

A Louisiana court recently ordered an insurance company to disclose its reserves. In that situation, a policyholder submitted an insurance claim for damages related to Hurricane Katrina. The claim turned into a bad faith insurance lawsuit, Brothers Petroleum, LLC v. Underwriters at Lloyd's London, and the policyholder’s attorney requested the insurer’s reserve information. The insurer objected, but the court allowed it and reasoned:

A bad faith claim requires an analysis of whether the failure to pay the amount of a claim within 60 days after receipt of a satisfactory proof of loss was arbitrary, capricious or without probable cause, as determined by the facts and circumstances held by the insurer at the time of refusal. (La. Rev. Stat. 22:1220). The setting of reserves bears some relationship to the insurer's calculation of potential liability, and have [sic] been found to be discoverable when bad faith is asserted.

Some courts in other states (California, Pennsylvania and West Virginia to name three) have followed suit. In most cases, the theory is that if an insurer took the time to place reserves on a case and then refused to pay the claim or offered to pay far less than the actual damages, the reserve amount may be telling on whether the insurer acted in bad faith.

If your insurance company has treated you in bad faith), contact an attorney whose practice focuses in this area of the law. To contact an attorney about your situation, please click here. Consultations are free, without obligation and are strictly confidential.