So many people are
talking about ChatGPT -- the artificial intelligence content creator -- that
awareness of it has trickled down even to us attorneys, well-known to be late
adopters of all technology. I thought I'd give it a try. I signed
up for ChatGPT (which took several attempts, none of which were my fault, and
included one message that I would have to wait because traffic was heavy -- not
a great sign for the cuttingest-edge tech), and I input this question:
In Massachusetts what should you do if your
insurance carrier says that an exclusion applies to a claim against you?
ChatGPT generated this
response:
If
your insurance carrier says that an exclusion applies to a claim against you in
Massachusetts, you have several options:
1. Review the policy: Make sure you understand the
specific exclusion and its terms. You may want to review the policy documents
and any relevant laws or regulations.
2. Negotiate with the other party: If you believe
that the exclusion should not apply, you may try to negotiate with the other
party to reach a settlement.
3. Hire an attorney: If you are unable to resolve
the issue with the other party, you may want to consider hiring an attorney who
specializes in insurance law. An attorney can help you understand your rights
and options and represent you in negotiations or in court.
4. File a complaint with the Massachusetts Division
of Insurance: If you are dissatisfied with the insurance company's decision,
you may file a complaint with the Massachusetts Division of Insurance. This
agency can investigate the matter and take appropriate action, such as ordering
the insurance company to pay a claim or imposing fines.
If the exclusion is valid and the claim is not covered under your
policy, you may be personally responsible for paying any damages or legal costs
associated with the claim. In this situation, it's important to consider your
options and to consult with an attorney if necessary.
While this response has some okay isolated statements, overall I would rate it: malpractice. I’ll take it point by point:
1. Review the policy: Make sure you understand the
specific exclusion and its terms. You may want to review the policy documents
and any relevant laws or regulations.
This may work for the
simplest exclusions, but even then I wouldn’t bet on it. If you have a homeowner’s policy that excludes
– let me make up a good one here – “damages arising out of the ownership of dinosaurs,”
and you have a pet dinosaur that eats your plumbing, resulting in water damage,
it might seem obvious that the exclusion excludes coverage. Right?
Well, not
necessarily. What part of the policy lists
the exclusion? If the exclusion is
within your property coverage – which covers damage to your own house – it might
apply. But if it’s in your liability coverage
– which covers injuries or property damage you cause to someone else – it might
not apply.
Even if the exclusion is
in the relevant portion of the policy, are their any exceptions to the exclusion? Or any limitations to it? Or has it been removed altogether? Your policy may have thirty different forms
and endorsements, and language affecting the exclusion may be in a different
endorsement than the exclusion itself.
And what about the courts? Have they interpreted the exclusion? What have they concluded?
If you have been told that an exclusion applies, don’t try to figure it out yourself. Consult an attorney who specializes in insurance coverage issues.
2.
Negotiate with the other
party: If you believe that the exclusion should not apply, you may try to
negotiate with the other party to reach a settlement.
WRONG. This would only be correct if the “other party” is the insurance
company – but typically the other party is the party who is suing you, for
which you are seeking insurance coverage.
If you believe the exclusion does not apply, you need to deal with the
insurance company on coverage, not settle with the other party. Again, hire an attorney.
3. Hire an attorney: If you
are unable to resolve the issue with the other party, you may want to consider
hiring an attorney who specializes in insurance law. An attorney can help you
understand your rights and options and represent you in negotiations or in
court.
This
is good advice, except for the order.
Hire an attorney first.
4. File a complaint with the Massachusetts Division
of Insurance: If you are dissatisfied with the insurance company's decision,
you may file a complaint with the Massachusetts Division of Insurance. This
agency can investigate the matter and take appropriate action, such as ordering
the insurance company to pay a claim or imposing fines.
This
is technically true. I have known people
to have good results requesting the assistance of the Division of Insurance,
more often with health insurance than with liability insurance. If you file a complaint with the Division and
it catches the attention of a staffer who decides that they agree you have been
wronged, they may make a phone call or send a letter that will intimidate the
insurer into backing down. But the
Division will not get involved in a dispute over the meaning of an insurance exclusion
that is best left to the courts. Also, be aware that the Division will not
work with a policyholder who is represented by counsel. You can go to the Division and later, if you’re not satisfied with the results there, hire an attorney. But you can’t do it the other way
around.
If the exclusion is valid and the claim is not covered under your
policy, you may be personally responsible for paying any damages or legal costs
associated with the claim. In this situation, it's important to consider your
options and to consult with an attorney if necessary.
Agreed.
My verdict: The results from ChatGPT are significantly worse
than you would get from a Google search -- which will generally lead you to
coverage attorneys -- and may cause you to lose rights under your policy or pay
a claim that should be covered by insurance.
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