I usually obtain calls from policyholders or their contractors saying that an insurance coverage firm won’t transfer ahead with the declare adjustment or fee course of until they’re supplied with documentation such because the contractor’s materials provider receipts, worker labor charges, or revenue margin particulars.
Is an insurance coverage firm entitled to this third-party documentation?
Many insurance coverage insurance policies include cooperation clauses that require the insured to supply information and paperwork requested by the insurer, so long as the request is related and made in good religion. For instance, monetary paperwork could also be requested when the insurer suspects fraud in reference to a declare; in such situations, the insurer wants solely a great religion perception that fraud is feasible to justify the request. Nonetheless, the cooperation clause doesn’t mechanically prolong to paperwork exterior the insured’s possession, custody, or management, until the insured has a authorized proper to acquire them from a 3rd occasion. 1
Understandably and justifiably so, from a enterprise perspective, a contractor doesn’t wish to share their proprietary or trade-secret info exterior their firm. Offering detailed enterprise information might result in aggressive disadvantages and even unfair denials based mostly on an insurance coverage firm’s arbitrary pricing thresholds. A contractor’s markups, margins, and provider agreements are a part of their enterprise mannequin and are usually not topic to third-party audits, particularly from a non-client insurance coverage provider.
So why are some insurance coverage carriers attempting to demand this kind of proprietary info from contractors?
From the provider’s perspective, they’re obligated to indemnify the insured and keep away from overpaying. They might argue that they want proof of “affordable and mandatory” prices beneath the coverage and want to stop value gouging, overinflated estimates, or potential fraud. By scrutinizing provider invoices, labor charges, and revenue margins, insurers could imagine they will confirm that proposed repairs replicate honest market worth and trade requirements. Some carriers might also level to regulatory necessities or inside auditing pressures that demand thorough documentation for declare funds. Whereas the provider could have a justifiable argument, it should even be balanced towards contractors’ rights to confidentiality and policyholders’ want for immediate, equitable declare decision.
When insurers delay adjustment or fee as a result of a contractor refuses to reveal inside enterprise information, it’s the policyholder, not the contractor, who’s harmed. Policyholders need their property fastened by the contractor of their selection, wish to be correctly indemnified by their insurance coverage coverage, and wish well timed completion. They shouldn’t be held hostage over the submission of irrelevant paperwork.
What’s the easiest way to take care of this case?
Stay prepared to reply clarifying questions that don’t breach confidentiality or transcend authorized or contractual necessities. Nonetheless, you aren’t required to reveal inside enterprise bills until your contract requires it. You possibly can (and will) present detailed estimates of scope and value, however that’s completely different from handing over your monetary books.
Whereas due diligence is suitable, demanding proprietary information from third events could also be seen as overreach and unhealthy religion, particularly if it leads to declare delays. The cooperation clause doesn’t entitle an insurance coverage firm to info exterior of the policyholder’s possession. If sure documentation is unavailable, settle for affordable alternate options, equivalent to itemized estimates, summaries, or consultant invoices—particularly when these are supported by trade requirements and market charges.
Push again on pointless delays. Your insurer’s obligation is to you—to not micromanage your contractor’s inside accounting. In case your insurer calls for third-party paperwork, require them to determine the exact coverage provision or authorized foundation for his or her request and to clarify why the knowledge is related to your declare. In the event you imagine your insurer is asking for info exterior your settlement, take into account consulting a public adjuster or contacting our workplace in the event you face resistance.
Most significantly, whereas contractors are usually not beholden to insurance coverage firms, the most effective outcomes occur when insurance coverage firms, contractors, and policyholders every respect correct boundaries whereas working collectively to rebuild lives, not obstacles.
1 See, e.g., Safeco Ins. Co. v. Blue Sky Innovation Grp., Inc., 230 N.E.3d 898, 907-08 (Ind. 2024) (holding that contractors and third events don’t have any obligation to protect or produce proof for others absent a particular relationship or contract, and rejecting broad duties based mostly solely on an insurer request); Templin v. Grange Mut. Cas. Co., 81 Ohio App.3d 572, 577-78 (Ohio Ct. App. 1992) (holding that the insured met the insurance coverage coverage’s cooperation clause the place he produced all paperwork in his possession and defined the absence of others not inside his management).
