Re: does your insurance company have to pay you?
Freddyray, I think the major problem here is that you apparently don't understand much about contract law. An insurance policy is nothing more than an agreement between two people/entities to do certain things under certain circumstances. As such, both parties have a responsibility to "perform" as stipulated in the agreement.
The problems arise when one party disputes the performance of the other. In the case that you have been referring to, the insurance company is assuming that the insured is in violation of the terms of the agreement, by stealing his own boat. The problem is that they have no legitimate reason to believe that, and have no evidence to support their supposition.
So, we get to the question of whether or not they "have" to pay the insured. Unless he has failed to meet the legitimate terms of the agreement, yes, they do have to pay. Notice that I said legitimate terms of the agreement. Insurance companies are famous for putting all sorts of BS into contracts so that they can avoid payment of claims. They do it all the time. The problem, however, is that mere inclusion of something in a contract does not make it enforceable. If any given clause in contrary to law in the applicable state, its worthless.
If a clause is overly vague, it can also be worthless. In the case you have been referring to, the insurance company has said that the insured has to "cooperate" in an investigation of a claim. What does that mean? What is the exact definition of cooperate? Where is the line between reasonable investigation and intrusion into personal information v. having an insurance company going on a fishing expedition for the purpose of avoiding a rightful claim.
The answer to those questions is not provided by either party, if they are not able to reach it jointly. Since we are talking about a civil matter, it goes to civil court. At that point, the insurance company will either try to settle the matter out of court, which is a joint resolution of the problem, or it will attempt to obtain a summary judgement in its own favor. Failing resolution in one of these two ways, the matter will most likely end up in front of a jury. In that case, the person who "has" to do something, will most likely be the one who is seen by the jury as being unreasonable and not in compliance with the agreement. As I said in the other thread, if it is the insurance company that is seen as being "the bad guy," their obstinance will most likely cost them dearly. They won't end up just paying the claim because the norm in such situations, is for the plaintiff to go for cost of legal representation, court costs, expenses, and damages.
The bottom line is that the insurer doesn't get to just decide it isn't going to pay, and it doesn't matter what nifty little trap doors they've written into the contract. The insured has a right to sue, and if the matter gets that far, he has a right to put the issue in front of a jury. If that jury agrees that the insurance company has not met its obligations, they will find in favor of the plaintiff and the insurance company will have to pay. Barring an appeal, its a done deal - they insurance company must pay up.
