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We were denied coverage by our insurance company for a workers

We were denied coverage by...
We were denied coverage by our insurance company for a worker's comp incident because the definition of "Domestic Employee" does not pertain to a home health aide we hired to take care of my husband's aged parents who could no longer care for themselves without some help. The aide we hired hurt herself at home, does not have health insurance, and claimed that she her herself pulling up my mother-in-laws underwear. Prior to hiring her, I was told by my co-worker (who happens to work in the Claims Department for the Insurance Company that insures our home) that our homeowners insurance has a Worker's Comp endorsement which would cover any help we had for my in-laws. Since my co-worker is the Manager of the Critical Claims Unit, I didn't question the statement. At that time I was getting advice from my co-worker for coverage on our new home we just moved into. My emails to our insurance agent (my insurance company does not sell directly) clearly state that my in-laws lived with us and we provided LNA's to take care of them. The agent never questioned whether we had worker's comp insurance for them. (We assumed that we were covered under the endorsement.) Would we have a legitimate errors & omission case against our homeowners insurance agent for not questioning us about this?
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Answered in 12 minutes by:
8/22/2013
Law Educator, Esq.
Category: Legal
Satisfied Customers: 119,583
Experience: JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
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Thank you for your question. I look forward to working with you to provide you the information you are seeking.

I am sorry to hear that you are going through this. If your insurance agent whom you purchased the policy from was made aware of the situation and advised you this policy would care for your needs and provide coverage, then YES you do have a legitimate E&O claim against your insurance AGENT, not your co-worker.

Your agent should have known when you told him the situation about what coverage you required and his failure to do so despite you telling him is a violation covered by E&O.



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Customer reply replied 4 years ago

The agent was asking us about a car insurance quote while working on our homeowner insurance coverages, so the agent asked the question, "5 cars, 3 drivers? No other licensed drivers?" My answer was, "correct. Although my in-laws live with us, and we provide LNA's for their care, they are both unable to drive (dad has alheimer's and mom has Parkinsons and unable to walk). Clearly the agent had knowledge of my in-laws needs, and when determining coverage for the house, I think the agent should have questioned worker's comp coverage knowing we had people in taking care of them. Do you still think we have a case?

Thank you for your response.

You say, "clearly the agent had knowledge" and if you told him you had 3 drivers that just means he knew there were 3 people driving, but that does not prove that you told him you had a household employee working in the house, which is what you have to prove to have his E&O cover. He did not have to ask about the workers compensation unless he knew the person was not an independent contractor or an LNA working for some company and knew the exact situation. If you can prove he knew the exact situation then you could make a case for the E&O claim.
Law Educator, Esq.
Category: Legal
Satisfied Customers: 119,583
Experience: JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
Verified
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