Merlin’s unambiguous opinion – MID report helps prove Judge Senter right about ambiguity of ACC clause

Sop posted the big slabbing Coast attorney Joe Sam Owen gave Commission Chaney after MID released the State Farm Market Conduct Exam. If I didn’t know he was commissioner of insurance, I would have thought he worked for State Farm.

Now, we have Insurance attorney Chip Merlin telling us I cursed and almost jumped out of my chair when the report indicated that the Department asked for information from policyholder attorneys.

Our firm had approximately 200 State Farm cases, with many of those litigated and testimony taken. While the Attorney General’s office contacted us and other policyholder attorneys, I don’t know any policyholder attorneys who were contacted by the Mississippi Insurance Department. (emphasis added)

MID should be getting Merlin’s message now – it couldn’t be any plainer.

State Farm attorneys will certainly not tell judges or others that State Farm employees had various and contradictory explanations as to what the anti-concurrent language means and how it worked in the adjustment of claims in Mississippi.

It has always seemed strange to me that conservative judges, insurance company lawyers, and the insurance industry can claim that the anti-concurrent language is not ambiguous when trained adjusters cannot agree as to the meaning of the clause. Those same adjusters make decisions on claims in different ways because of the ambiguity of the meaning applied to the facts of the loss.

In Leonard v. Nationwide, Judge Senter found the clause ambiguous enough to afford coverage. This report helps prove he was right, and the appellate judges wrong. Ambiguity is typically proven through a standard as to whether a “lay person” or “reasonable” person could read an insurance policy in more than one way. If so, the clause will be ruled ambiguous, and the meaning in favor of the policyholder will be given.

Is there any better proof of ambiguity than the insurance company’s own adjusters giving different interpretations, some of which favor the policyholder? The Mississippi Supreme Court has a case pending before it and should take this into consideration. Maybe there is some hope for policyholders on this issue and some good will come from the report. (emphasis added)

MID’s report directs so much goodwill toward State Farm that it would take overturning the ACC for the Commissioner to find any goodwill coming from those who experienced State Farm’s unfair claims practices. Merlin said he was surprised MID couldn’t document violations.

In the end, after finding problems and criticizing State Farm for its claims actions, the Mississippi Insurance Department somehow found that no unfair claims practices were violated. I was surprised by this finding. (emphasis added)

I was surprised, too, until I read the summary of the MID mediation included in the appendices of the report. It’s not that no violations were found, it’s that MID examiners worked hand-in-hand with State Farm on a daily basis and cleared them up before beginning the actual examination. Connect the dots and you get the picture of a mediation and examination processes designed to discredit the Rigsby sisters qui tam claim. What a surprise!


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