FIRST-PARTY PROPERTY DAMAGE DEMAND LETTER
State of New York
[LAW FIRM LETTERHEAD]
PRIVILEGED AND CONFIDENTIAL
SETTLEMENT COMMUNICATION - FOR RESOLUTION PURPOSES ONLY
PROTECTED UNDER NY RULES OF EVIDENCE AND F.R.E. 408
VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED
AND VIA EMAIL TO: [ADJUSTER_EMAIL]
Date: [DATE]
[INSURANCE_COMPANY_NAME]
[PROPERTY_CLAIMS_DEPARTMENT_ADDRESS]
[CITY], [STATE] [ZIP]
Attention: [ADJUSTER_NAME], [ADJUSTER_TITLE]
Re: FORMAL DEMAND FOR PROPERTY DAMAGE CLAIM - NEW YORK LAW
Insured: [INSURED_NAME]
Property Address: [PROPERTY_ADDRESS]
Policy Number: [POLICY_NUMBER]
Claim Number: [CLAIM_NUMBER]
Date of Loss: [DATE_OF_LOSS]
Type of Loss: [LOSS_TYPE]
Coverage Limits: [COVERAGE_LIMITS]
Response Deadline: [RESPONSE_DEADLINE]
Dear [ADJUSTER_NAME]:
I. INTRODUCTION AND NATURE OF DEMAND
This firm represents [CLIENT_NAME] ("our client") in connection with the above-referenced property damage insurance claim arising under New York law. This letter constitutes a formal demand for payment of all policy benefits owed for covered losses sustained at [PROPERTY_ADDRESS].
Having represented policyholders in New York for decades, the pattern in this case is all too familiar: a legitimate claim, a covered loss, and an insurer that has [DELAYED PAYMENT/UNDERVALUED THE LOSS/DENIED COVERAGE WITHOUT JUSTIFICATION].
II. NEW YORK PROPERTY INSURANCE LAW
A. Prompt Payment Requirements
Under New York law:
N.Y. Ins. Law 2601 - Unfair claims settlement practices; 11 NYCRR 216.7
B. Appraisal Provisions
N.Y. Ins. Law 3408 (standard fire policy includes appraisal)
C. Bad Faith Standard
New York has limited recognition of first-party bad faith. Traditional view is that bad faith for coverage denial is merely breach of contract. However, insured may recover consequential damages if foreseeable and natural consequence. Bi-Economy Market v. Harleysville Ins. Co., 886 N.E.2d 127 (N.Y. 2008). Punitive damages require egregious conduct aimed at public.
D. Available Remedies
Contract damages plus foreseeable consequential damages; punitive damages in extreme cases
III. POLICY INFORMATION AND COVERAGE
A. Policy Details
| Item | Information |
|---|---|
| Named Insured | [INSURED_NAME] |
| Policy Number | [POLICY_NUMBER] |
| Policy Type | [POLICY_TYPE] |
| Policy Period | [POLICY_PERIOD_START] to [POLICY_PERIOD_END] |
| Property Address | [PROPERTY_ADDRESS] |
| Property Type | [PROPERTY_TYPE] |
B. Applicable Coverage and Limits
| Coverage | Limit | Deductible |
|---|---|---|
| Dwelling (Coverage A) | $[DWELLING_LIMIT] | $[DEDUCTIBLE] |
| Other Structures (Coverage B) | $[OTHER_STRUCTURES_LIMIT] | |
| Personal Property (Coverage C) | $[PERSONAL_PROPERTY_LIMIT] | |
| Loss of Use (Coverage D) | $[LOSS_OF_USE_LIMIT] |
C. Coverage Analysis
The loss is clearly covered under New York law interpretation principles because:
- The cause of loss is a covered peril
- The damage occurred during the policy period
- The property is covered property
- No exclusions apply
- All policy conditions have been satisfied
IV. THE LOSS EVENT
A. Description of Loss
On [DATE_OF_LOSS], the insured property at [PROPERTY_ADDRESS] sustained significant damage due to [DESCRIBE_LOSS_EVENT].
[DETAILED_NARRATIVE]
B. Cause and Origin
The cause of the loss was:
- Fire (accidental/electrical/HVAC/other)
- Water damage (plumbing/appliance/roof/storm)
- Wind/Windstorm
- Hail
- Hurricane/Named Storm
- Tornado
- Lightning
- Theft/Vandalism
- [OTHER_CAUSE]
C. Mitigation Efforts
Our client took immediate steps to mitigate damage as required under New York law:
| Date | Action | Provider | Cost |
|---|---|---|---|
| [DATE_1] | [ACTION_1] | [PROVIDER_1] | $[COST_1] |
| [DATE_2] | [ACTION_2] | [PROVIDER_2] | $[COST_2] |
V. CLAIM HISTORY AND INSURER'S RESPONSE
A. Claim Timeline
| Date | Event |
|---|---|
| [DATE_OF_LOSS] | Date of loss |
| [CLAIM_REPORT_DATE] | Loss reported |
| [INSPECTION_DATE] | Property inspected |
| [ESTIMATE_DATE] | Estimate issued |
| [PAYMENT_DATE] | Payment issued: $[INITIAL_PAYMENT] |
B. Insurer's Position and Our Response
[CARRIER_SHORT_NAME] has [DESCRIBE_INSURER_POSITION].
This position is unreasonable under New York law because [EXPLAIN_WHY_WRONG].
VI. DAMAGES AND CLAIMED AMOUNTS
A. Dwelling Damage (Coverage A)
| Category | Amount |
|---|---|
| Structural Damage | $[STRUCTURAL] |
| Systems (Electrical/Plumbing/HVAC) | $[SYSTEMS] |
| Interior Finishes | $[INTERIOR] |
| Overhead & Profit | $[O_AND_P] |
| TOTAL DWELLING | $[TOTAL_DWELLING] |
B. Other Structures (Coverage B)
$[TOTAL_OTHER_STRUCTURES]
C. Personal Property (Coverage C)
| Category | Replacement Cost |
|---|---|
| Furniture | $[FURNITURE] |
| Electronics | $[ELECTRONICS] |
| Appliances | $[APPLIANCES] |
| Clothing | $[CLOTHING] |
| Other | $[OTHER] |
| TOTAL | $[TOTAL_PP] |
D. Loss of Use (Coverage D)
| Category | Amount |
|---|---|
| Temporary Housing | $[HOUSING] |
| Increased Expenses | $[EXPENSES] |
| TOTAL | $[TOTAL_ALE] |
E. Claim Summary
| Coverage | Claimed | Paid | Balance Due |
|---|---|---|---|
| Coverage A | $[A_CLAIMED] | $[A_PAID] | $[A_DUE] |
| Coverage B | $[B_CLAIMED] | $[B_PAID] | $[B_DUE] |
| Coverage C | $[C_CLAIMED] | $[C_PAID] | $[C_DUE] |
| Coverage D | $[D_CLAIMED] | $[D_PAID] | $[D_DUE] |
| Mitigation | $[MIT_CLAIMED] | $[MIT_PAID] | $[MIT_DUE] |
| SUBTOTAL | $[SUBTOTAL_DUE] | ||
| Less Deductible | ($[DEDUCTIBLE]) | ||
| TOTAL DUE | $[TOTAL_DUE] |
VII. OVERHEAD AND PROFIT
Our client is entitled to general contractor overhead and profit because:
- The repairs require coordination of multiple trades
- The scope and complexity exceeds simple repairs
- A general contractor is reasonably necessary
- Industry standard is [___]% overhead and [___]% profit
[CARRIER_SHORT_NAME]'s refusal to include O&P is contrary to New York law and industry standards.
VIII. APPRAISAL DEMAND (IF APPLICABLE)
A. Invoking Appraisal
Due to [CARRIER_SHORT_NAME]'s failure to fairly evaluate this claim, we hereby invoke the appraisal process under the policy and New York law.
We appoint [APPRAISER_NAME] as our client's appraiser.
Please provide [CARRIER_SHORT_NAME]'s appraiser within [NUMBER] days.
B. Scope of Appraisal
The following items are submitted to appraisal:
- Amount of loss to dwelling (Coverage A)
- Amount of loss to other structures (Coverage B)
- Amount of loss to personal property (Coverage C)
- [SPECIFIC_DISPUTED_ITEMS]
Note: Coverage questions are reserved for litigation.
IX. STATUTORY VIOLATIONS AND BAD FAITH
A. New York Prompt Payment Violations
[CARRIER_SHORT_NAME] has violated N.Y. Ins. Law 2601 - Unfair claims settlement practices; 11 NYCRR 216.7 by:
- [VIOLATION_1]
- [VIOLATION_2]
- [VIOLATION_3]
B. Unfair Claims Settlement Practices
[CARRIER_SHORT_NAME] has violated N.Y. Ins. Law 2601 by:
- Misrepresenting pertinent facts or policy provisions
- Failing to acknowledge and act promptly on communications
- Failing to adopt reasonable investigation standards
- Not attempting good faith settlement when liability is clear
- Compelling litigation by offering substantially less than owed
- Failing to provide reasonable explanation for denial/delay
C. Bad Faith
Under New York law:
New York has limited recognition of first-party bad faith. Traditional view is that bad faith for coverage denial is merely breach of contract. However, insured may recover consequential damages if foreseeable and natural consequence. Bi-Economy Market v. Harleysville Ins. Co., 886 N.E.2d 127 (N.Y. 2008). Punitive damages require egregious conduct aimed at public.
Available remedies include: Contract damages plus foreseeable consequential damages; punitive damages in extreme cases
X. DEMAND
A. Monetary Demand
We demand payment of $[TOTAL_DEMAND]:
| Item | Amount |
|---|---|
| Dwelling (Coverage A) | $[A_AMOUNT] |
| Other Structures (Coverage B) | $[B_AMOUNT] |
| Personal Property (Coverage C) | $[C_AMOUNT] |
| Loss of Use (Coverage D) | $[D_AMOUNT] |
| Mitigation | $[MIT_AMOUNT] |
| Statutory Interest/Penalties | $[PENALTIES] |
| SUBTOTAL | $[SUBTOTAL] |
| Less Deductible | ($[DEDUCTIBLE]) |
| Less Prior Payments | ($[PRIOR_PAYMENTS]) |
| TOTAL DUE | $[TOTAL_DUE] |
XI. RESPONSE DEADLINE AND CONSEQUENCES
This demand must be accepted by 5:00 p.m. [TIME_ZONE] on [RESPONSE_DEADLINE].
Consequences of Non-Response
If [CARRIER_SHORT_NAME] fails to accept this demand:
-
Litigation will be filed in New York seeking:
- All policy benefits
- Statutory penalties and interest
- Bad faith damages
- Punitive damages (where available)
- Attorney's fees and costs -
Regulatory complaints will be filed with:
- New York Department of Financial Services, One State Street, New York, NY 10004
- National Association of Insurance Commissioners -
Appraisal will be invoked (if not already)
XII. DOCUMENT PRESERVATION NOTICE
This letter serves as notice to preserve all documents and ESI related to this claim.
XIII. CONCLUSION
[CARRIER_SHORT_NAME] sold our client a policy promising protection against property losses. That loss has occurred. The coverage is clear. The only thing missing is payment.
Respectfully submitted,
[LAW_FIRM_NAME]
By: _______________________________
[ATTORNEY_NAME]
[BAR_NUMBER]
[ADDRESS]
[CITY], NY [ZIP]
[PHONE]
[EMAIL]
Counsel for [CLIENT_NAME]
ENCLOSURES:
- Policy declarations page
- Relevant policy provisions
- Contractor estimates
- Photographs of damage
- Personal property inventory
- Supporting documentation
CC:
- [CLIENT_NAME]
- [MORTGAGEE_NAME] (if applicable)
- New York Department of Financial Services, One State Street, New York, NY 10004
NEW YORK PROPERTY INSURANCE LAW QUICK REFERENCE
| Element | New York Law |
|---|---|
| Prompt Payment | N.Y. Ins. Law 2601 - Unfair claims settlement practices; 11 NYCRR 216.7 |
| Appraisal | N.Y. Ins. Law 3408 (standard fire policy includes appraisal) |
| Bad Faith Type | Common Law (Limited) |
| Bad Faith Damages | Contract damages plus foreseeable consequential damages; punitive damages in extreme cases |
| Unfair Practices Act | N.Y. Ins. Law 2601 |
| Attorney Fees | Generally follows American Rule |
| DOI Address | New York Department of Financial Services, One State Street, New York, NY 10004 |