Our homeowners insured sustained a loss, and it has taken a long time for the insurer to adjust the claim. We are wondering about additional living expense for this time, when the delay has been caused by a failure to reach settlement. If payment is "for the shortest time required to repair or replace the damage," who determines what the "shortest time" is?

Massachusetts Subscriber

There is no clear-cut answer to this question. It appears that a delay in beginning to rebuild that forces a lengthened timeframe for loss of use, unless for some reason the insured has been dragging his or her feet, allows for continued payment of additional living expense. Each situation, then, must be decided based on the facts of that situation.

We found two cases that addressed this. The first is Riethmiller v. Bedford County Grange Mutual Ins. Co., 52 Pa.D. & C. 4th 190 ( Pa. Com. Pl. 2001). Here, the insurer stated it calculated the additional living expense payment based on the time necessary to rebuild a home of the same size and quality. But the insureds contended that a longer time was in order. It took a month to arrange for financing, a month for the contractor to acquire tools and materials, and then four months to actually reconstruct the dwelling. The insurer moved for summary judgment, which was denied by the court, and the matter was remanded for further action on the plaintiffs' complaints.

 The second case is State Farm Lloyds v. Fitzgerald, 2000 WL 1125217 (Tex. App. 2000). We should note that this opinion was withdrawn from publication September 12, 2000, so it cannot be used as a precedent. In this case, the insureds spent considerable time negotiating settlement with the insurer's adjuster. Contractors who were approached to make the necessary repairs refused to work for the amount offered. Almost a year after the loss, and seven months after the insurer agreed to pay the claim, the insureds received a check for substantially less than any contractor agreed to accept. The insurer then terminated additional living expense payments. The insureds had to move back into the home while a contractor attempted repairs, but work ceased when the city inspectors found substandard methods and materials and "red-tagged" the home. At trial, the insurer said it presumed work had begun months earlier and that was the reason for denial of continued ALE, but the court noted the insurer's adjuster had visited the home on several occasions and knew when work began. Therefore, the court found for the insureds due to the contractual and statutory theories of liability.

 Both these cases illustrate the necessity of documentation and working with the insurer to achieve resolution.

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