This is a summary of our claim denial story. Alan and Jill Wigginton purchased a Yacht and Liability policy for Dragonfly, a sailing vessel for the areas of Fiji, South Pacific, Hawaii and California. The policy was with LJJ Associates in the UK effective April 1, 2016 and purchased through Blue Water Insurance located in Jupiter FL. We understood that it was a Lloyd’s of London policy and were encouraged because we felt they had a very good reputation. We inquired about the need for a new survey due to the change of brokers. We were told that a survey was not required until 2018.
On May 1, 2016, Dragonfly was dismasted 400 miles south of Hawaii caused by a opposing-rogue wave. The wave violently thrust the vessel windward. The significant forces resulted in the mast buckling below the boom then falling. For safety reasons the rigging (mast and two furling sails, wires and lines) were cut and released. The vessel safely motored to Hawaii, without assistance and only minor scrapes.
Soon after arrival in Hawaii we worked with the local Lloyd’s agent, Larry Montgomery, to submit the claim and develop the scope of work and submit them to qualified repair companies. Soon after Al returned to Indianapolis, we were asked if Larry could return to the boat with John Koon, a ACMS surveyor and interested in submitting a bid, to inspect the boat so a a quality repair would be ensured. We discovered 10 weeks later after receiving a copy of the “survey report”, that the intent was to determine the cause of the dismasting. “best practice repair” was no where on the report. Plus, it was filled with lies, and baseless conclusions and suppositions. We were appalled!
Six 1/2 months after the loss In November 2016 it became clear that they intended to deny the claim in any way they could. They communicated that they were seeking an external review to “resolve, narrow any points in dispute, by an expert in the field”. However, they hired Hill Dickinson who were solicitors, not a marine or engineering experts. The resulting email from Hill Dickinson, made their intent obvious. They used questionable legal interpretations and cast doubt on anything said or done by those on the policyholder side. Hill Dickinson conjured up a factless basis to deny the claim.
To defend our claim, we were forced to hire our own surveyor who provided an accurate assessment regarding the cause of the dismasting. Unlike John Koon, our surveyor, Bill Trenkle is a Marine Engineer, Certified International Marine Damage Investigator, and Certified SAMS Surveyor and on the board of the Society of American Marine Surveyors (SAMS) organization. He conducted a thorough investigation and documented that Mr. Koon had no basis for the conclusions and was factually incorrect on the condition of the structure (beam, forward beam and saddle brackets) and remaining rigging. Mr. Trenkle clearly demonstrates thru pictures and his reports the inaccuracies and the false facts asserted by Mr. John Koon. Dragonfly was and is quite seaworthy.
On March 10, 2017, 10 months after the incident, we were informed that ProSight had denied our claim without prejudice. They stated that a fortuitous event was not proven and a breach of warranty existed. We believe the Underwriters inappropriately misinterpreted actions and statements and ignored facts by highly qualified experts to support their pre-determined intent to deny the claim.
We believe that all of this originated from a biased and factually incorrect report submitted by Mr. John Koon. He is a local surveyor whose qualifications/ intent are in question. Even though we were able to demonstrate the mistruths and fallacies in this report, the Underwriters still relied on it to deny the claim.
Mr. Larry Montgomery, the Hawaii Lloyds agent involved and a NAMS surveyor, was also present when Mr. Koon did his survey. However, he inspected the structure and rigging again after Mr. Trenkle and agreed with Mr. Trenkle’s observations and conclusions regarding the condition of the structure and remaining rigging. However, ProSight has chosen to ignore the findings of experts. They also ignored or never received Mr. Montgomery findings contradicting the initial report.
LJJ, ProSight and their representatives mishandled the case and acted unethically through significant delays in deciding the case while repeatedly reassuring us that the claim would be settled; not accumulating all requisite information from all involved in a timely manner then accusing us that we didn’t provide it, when in fact we were never asked for nor advised to provide it; misinterpreted statements or actions or took statements out of context to support their position and did not share all information presented to them allowing us to address it, but used it as justification for denying the claim.
They clearly did not act in good faith to collect all information and objectively come to a fair decision.
ProSight’s Underwriters ultimately took a position that they would deny the claim and had Hill Dickinson generate a claim denial response, full of twisted facts, statements and unjustified opinions to support their position. They also took the position that minor maintenance issues completely unrelated to the loss, justified a breach of contract. However this is “unreasonably denying the claim “according to both the ICOBS 8.1.2 and The Insurance Act of 2015.
Our lives have been put on hold causing significant emotional and financial strain unnecessarily over many many months. We have incurred over $100,000 in expenses, and additional damages and theft as a result of the unnecessary delays and ProSight’s unwillingness to settle an obviously justifiable claim. They were also unwilling to process a damages and theft claim incurred while we waited for the settlement. They have told us that we must pursue these through our solicitor, which forces us to have additional expenses.
We believe that from the beginning LJJ Associates and ProSight had no intent to settle our claim and used the delays and unethical actions to try to wear us down and continue to do so.
We are currently within the “complaint” process, pursuing our rightful payment. It started in July 2017 and has so far involved, ProSight Syndicate 1110, Indiana Department of Insurance, Financial Ombudsman Service, and the Society of Lloyds.
In our marine claim, the simple questions are:
- Was the vessel seaworthy? We are confident that it was. They have offered no proof that it wasn’t and they have the burden of proof in this situation.
- Was there a breach of warranty? No. We can prove that the hardware involved were within the industry guidelines.
- Was it a fortuitous event? Nothing else explains how the mast buckled as it did. Each crew member describes the rogue wave.
- Did the insurers handle the case promptly? Absolutely not. It was 13 months before there was a definitive claim denial and no communication that it was in jeopardy.
- Did the insurers handle the case fairly? Absolutely not. They discarded evidence of more highly qualified individuals for the lone person who supported their end goal. They or their representatives acted unethically, by making unqualified judgements, twisting the facts, and a lack of transparency.
- Was the claim unjustifiably denied? Absolutely! A claim can not be denied based on issues completely unrelated to the cause of the claim.
The blog posts provide more details and updates on our inexcusable experience, which is currently ongoing.
We believe they use the same strategy on others to avoid paying valid claims. The stories and tactics may be different, but the objective is still the same.
Our hope is that this blog is a place where we and others share stories which will bring the injustices forward and force a change.