Alexander S. Polsky, FCIArb

T: 714-939-1300
F: 714-939-8710
Insurance

Mr. Polsky has worked closely with the insurance industry when he handled insurance related claims. As a result, he is widely regarded as an authority on insurance policy interpretation and has lectured on the topic. He has mediated hundreds of matters involving life, health, disability, earthquake, fire, UIM and UM claims both from the point of view of policy interpretation and also bad faith. He also has extensive experience in the resolution of life, health, disability first party claims against insurer relating to claims handling. Both sides regularly seek his services to mediate and to a lesser extent arbitrate bad faith claims. When coverage is inadequate, E&O claims also often result.

Representative Matters

  • Allegation of bad faith in seeking reimbursement of med pay payments and unilateral suspension of med pay payments to medical providers. Lack of payments to medical providers discovered after settlement of third party claim. Case challenges utilization of in house nurse consultants. (Settlement $60 k)
  • Arbitration of issue of whether ‘impact’ occurred involving an ‘uninsured motor vehicle’ within the meaning of the uninsured motorist provision of an auto liability policy. Claimant fell on fluid in front of her vehicle while at a gas station. Claimant contended that since the fluid was left by a vehicle, coverage was triggered.
  • Assertion of bad faith adjusting of fire loss case. Insured is a diamond cutter. Loss included 500 lbcs of gold shavings, uncut stones, and business interruption. Issue of proof of loss and valuation.
  • Assertion of post claim underwriting in denial of wrongful death benefits.
  • Bad faith and construction defect and negligent repair case involving damage to plaintiff’s home secondary to Northridge earthquake. Repair contractor, recommended by insurer, allegedly performed negligent and substandard repairs. Insurer then refused to pay amounts needed to cure original damage plus damage caused by repair contractor. (Settlement of bad faith claim for $225 k)
  • Bad faith claim arising out of insurer’s refusal to pay insured’s stated value or to accept insured’s stated losses of personal property stolen from a U-Haul during plaintiff’s relocation to California from Utah. (Claimed valuation $145 k. Settlement $300 k)
  • Bad faith denial of coverage in construction defect claim and cross actions against insured homeowner’s association. Specific allegation of bad faith in retaining “approved law firm” to handle defense of insured in manner which could defeat coverage. (Settlement $2.0 mm)
  • Broker Errors and Omissions: Claim involving shortfall of approximately $600 k after a fire destroyed a manufacturing plant. Suit filed against broker for failing to secure adequate coverage for content and business interruption. Defense alleged it relied on the information provided by claimant. (Arbitration)
  • Broker Errors and Omissions: Numerous claims alleging failure to advise of and place adequate levels of insurance.
  • Broker Errors and Omissions: Publisher of magazine obtained a CGL policy through a brokerage firm. Coverage was to include trademark infringement and other publishing issues. A third party sued the publication and the insurer denied defense and indemnity asserting exclusion for personal and advertising injuries committed by an insured “whose business is advertising.” Insured defended and settled the claim and asserted losses relating to legal fees, lost profits due to the relinquishment of a territory as part of the settlement and general and punitive damages. (Settled at mediation)
  • Claim against government employee benefit plan (insurer) for refusal to pay hospital charges for repair of detached retina. Plan contended that prior authorization is not a guarantee of coverage and where, as here, the charges and treatment do not meet standards set by review board, they will not be paid. Plaintiff alleged bad faith and failure to pay for treatment to a life threatening condition. (Settled with payment of benefits plus attorney fees)
  • Claim against homeowner insurer for failure to investigate and respond to complaints of water intrusion. Initial determination was water coming through an AC condensate line with damage within the deductible. During repairs extensive mold contamination was discovered. Insurer denied based on pre-existing conditions and advised insured to seek recovery from the sellers of the home. (Settlement $675,000 and policy buyback)
  • Claim against UIM carrier for failure to defend claim arising from intersectional accident between pick-up truck and automobile. Driver who violated right of way was convicted of DUI and was residing in a Salvation Army rehabilitation center. Mediation was of UIM claim, BI claim filed by adverse driver and anticipator bad faith claim for failure to defend. (Settlement $200 k on BI claim under the UIM policy and $100 k on the first party claim)
  • Claim arising from insurers refusal to provide wrongful eviction coverage. Claimant, a 16-year insured of respondent, was sued for wrongfully evicting a tenant. One division of the respondent company denied the claim based on its standard form policy without advising claimant that he was clearly covered under a policy issued by a separate division, which contained much broader coverage. Claimant, age 76, spent $12 k in legal fees and $4 k in settlement of the eviction claim. (Settlement $900 k)
  • Claim by schoolteacher against school board and benefit plan administrator for not covering $30,000 in emergency medical care for detached retina. Claim of bad faith by school board against plan administrator. Defense of lack of pre-certification for the procedure asserted by the administrator. (Settled at mediation for payment of medical expenses, legal fees, and collateral damages)
  • Claim for bad faith denial of life insurance benefits. On April 18 petitioner applied for life insurance. He was issued a conditional receipt and advised that coverage would not be placed until all conditions were met. On April 21 petitioner failed his medical exam for the policy. On May 11 respondent issued a denial of coverage letter. On May 7 petitioner died. Estate brought claim. (Settled)
  • Claim involving shortfall of approximately $600 k after a fire destroyed a manufacturing plant. Suit filed against broker for failing to secure adequate coverage for content and business interruption. Defense alleged it relied on the information provided by the claimant. (Arbitration)
  • Claim that carrier acted in bad faith by wasting benefits of a depleting policy for a developer of residential real estate by: Failure to notify the client that it was providing a defense to another insured under the depleting policy, failing to give insured opportunity to appoint a single counsel, failure to pursue a potential primary carrier, disparate treatment in fees paid to counsel, appointment of incompetent counsel leading to a $3.7 mm award in a construction defect case involving two homes valued at $350 k each. (Settled)
  • Coverage dispute following sinking of vessel in calm seas. Insurer asserted that vessel not seaworthy at the time of the sinking due to rust out of drain plug. Jury ruled against insurer and mediation utilized to resolve bad faith claim and insurer's errors and omissions claim against counsel at the underlying trial.
  • Declaratory relief and bad faith actions arising out of insurer’s refusal to pay damages after arising from allegations that petitioner shot another while at a café. The insurer provided a defense under a reservation of rights. The policy was a homeowner’s policy issued to the parents of petitioner. Denial was based on the resident relative exclusion and the intentional acts exclusion. There was a dispute as to whether petitioner was the shooter. Petitioner was with a group of persons who were denied access to the café and who returned in their vehicle and fired over 50 high caliber rounds at the café entrance, critically injuring a patron. At the underlying trial, petitioner stipulated to a finding that he was a negligent cause of the injury. (Settlement $475 k)
  • Delay and incomplete payment following fire loss. Claimant was an 89-year-old continuous insured of respondent for 35 years and had never submitted a claim. Disputes over the applicability of a policy rider covering additions to the property and the estimates for restoration. (Settlement $200 k)
  • Dispute between primary insurer, re-insurers and agents in connection with Warehouseman’s Legal Liability Policies.
  • Dispute over proceeds of a whole life insurance policy issued in 1995 in the face amount of $50,000. The policy was rescinded after the insurer discovered a non-disclosed criminal record. Policyholder was shot and killed in December1996. (Settlement ($15 k)
  • Failure to properly remediate mold by homeowner’s insurance carrier. Family contracted mold related allergy symptoms. Alternative housing provided for one year while parties disputed scope of covered repairs. (Settlement $1.5 mm)
  • Failure to timely pay UIM benefits to 73-year-old roofer who was the victim of an attempted car jacking. Allegation of improper negotiation wherein $12 k was initially offered then increased to the policy benefits of $15 k with no new facts. Thereafter, the settlement agreement included a release of Bad Faith claims. (Settlement $75 k)
  • In excess of 25 cases involving failure to remediate or provide coverage for remediation of mold.
  • Insurance bad faith and agent errors & omissions/fraud in connection with sales of replacement life insurance and lapse of original coverage.
  • Insurance bad faith in connection with delay in payment of uninsured motorist benefits. Arbitration award was in excess of policy benefits. In-house counsel wrote pejorative remarks on letters placed in file that were discovered when documents were produced suggested willful delay. (Settlement $250 k)
  • Insurance bad faith in connection with denial of disability benefits to ophthalmologist who could no longer perform complex surgeries for which he was specifically insured (but could still practice medicine). (Settlement $5 mm)
  • Insurance broker errors and omissions: Claim involving shortfall of approximately $600 k after a fire destroyed a manufacturing plant. Suit filed against broker for failing to secure adequate coverage for content and business interruption. Defense alleged it relied on the information provided by claimant. (Arbitration)
  • Maritime insurance bad faith claimed following denial of post yacht sinking while in port. Denial predicated on issue of sea worthiness as a condition precedent for stating a claim. (Settlement $425 k)
  • Mediation of claim filed in Federal Court in Nevada alleging bad faith failure to cover damages, including mold intrusion, secondary to the discharge of water from a kitchen appliance. Insurer provided repair contractor to repair the covered claim. Insured hired this repair contractor. The contractor set up fans to blow hot air to affected area, and applied a fungicide to the area. An odor developed throughout the property and claimant became ill. It was determined that the blowers released mold spores throughout the residence and that claimant suffered mold related illnesses and allergic reaction. The insurer denied this claim as falling within the pollution exclusion. Claimant asserted that the mold was a covered resultant damage from the lead and improper repair. (Settlement $450 k)
  • Numerous claims alleging failure to advise of and place adequate levels of insurance.
  • Numerous coverage disputes in connection with construction defect/delay in responding to rotted pipe under foundation coupled with incomplete/faulty repair and failure to fully pay claim.
  • Numerous insurance bad faith and coverage cases where Mr. Polsky has served as a discovery referee and special master, and has monitored depositions.
  • Numerous insurance broker errors and omissions claims alleging failure to advise of and place adequate levels of insurance.
  • Plaintiff entered onto the land of another to cut down a stand of trees. Plaintiff believed that the trees were on his property. The aggrieved homeowner sued plaintiff. Plaintiff’s insurer refused to defend or indemnify. Plaintiff asserted that the denial amounted to bad faith. Respondent asserted that the act of entering onto the land was not ‘accidental’ as contemplated by the policy of insurance. (Arbitration)
  • Pre suit mediation of claim alleging bad faith delay and negotiation and claim evaluation tactics arising out of a first party claim secondary to a hit and run accident. Special damages exceeded $425 k including $70 k for past medical and $230 k for future medical. No offer was made. No independent medical examination was requested until three weeks prior to the arbitration. Insurer changed law firms three times, cancelled scheduled depositions of insured’s experts, and brought motions to continue the arbitration and re-open discovery. The motions were granted, testing occurred, and an offer of $250 k was made 13 months after the claim was initiated. The arbitrator awarded $574 k but the insurer paid only $550 k asserting that the arbitrator erred by not deducting med pay payments of $25 k. (Settlement $450 k)
  • Pre suit mediation of claim of insurance bad faith arising out of insurer’s delay and low offer (relative to arbitration award) in uninsured motorist case. Insurer argued delay caused by difficulty in evaluation plus need to investigate and therefore there was no bad faith. (Settlement $100 k)
  • Primary vs. secondary coverage for loading dock injury.
  • Publisher of magazine obtained a CGL policy through a brokerage firm. Coverage was to include trademark infringement and other publishing issues. A third party sued the publication and the insurer denied defense and indemnity asserting exclusion for personal and advertising injuries committed by an insured “whose business is advertising.” Insured defended and settled the claim and asserted losses relating to legal fees, lost profits due to the relinquishment of a territory as part of the settlement, and general and punitive damages. (Settled at mediation)
  • Subrogation claim by insurer after paying property damage, lost profits and loss of use on behalf of insured secondary to water damage from improperly applied roof. Related insurers argued coverage issues negated obligation to indemnify. (Settled in low seven figures)
  • Suit against government benefits plan administrator and school district by 31-year employee arising out of failure to cover costs associated with emergency medical treatment secondary to a heart attack. As a result of the failure to pay a claim was presented to plaintiff for $40 k in medical costs. (Settled with payment of medical bills and attorney fees)
  • Under-valuation uninsured motorist claim and asserted failure to investigate following an award that was four times the highest offer. Asserted offer based on computer analysis and not actual factual issues. (Settlement $85 k)
  • Use of neutral case evaluation to settle a suit involving failure to properly adjust an earthquake claim. Litigation was protracted and negotiation at a standstill with a demand starting at $620 k and an offer of $100 k. (Case settled at neutral recommended $300 k)
  • Wrongful denial of first party property claim arising out of incident where the tow bar of plaintiff’s trailer became detached while being towed by plaintiff’s commercial dump truck. Insurer asserted that the damage to the tow bar was excluded under a business auto policy, which provided exclusion for wear and tear. (Settlement for actual property damage plus attorney fees)

Honors, Memberships, and Professional Activities

  • Recognized as a Best Lawyer, Alternative Dispute Resolution category, Best Lawyers in America, 2008-2018
  • Recognized as a SuperLawyer, Alternative Dispute Resolution category, SuperLawyers, 2006-2016
  • Recognized as a Top Master, Daily Journal
  • Recognized with AV Preeminent Status as a Top Rated Lawyer in Alternative Dispute Resolution, Martindale-Hubbell
  • Recognized as a Top California Neutral, Daily Journal, 2006-2010, 2012
  • Speaker, "What Real Estate Attorneys Can Learn From Mediators—And Vice Versa," Tokyo Annual Conference of the International Bar Association, 2014
  • Panelist, U.S. District Court for the Central District of California Mediation Panel
  • Successfully completed "Accelerated Route to Fellowship International Arbitration Program with Award Writing Examination, Chartered Institute of Arbitrators, North American Branch, 2014
  • Fellow, International Academy of Mediators
  • Adjunct Professor of Law, University of Southern California School of Law and Straus Institute for Dispute Resolution at Pepperdine University School of Law
  • Lecturer (partial list): California Bar Association, American Bar Association, Association of Southern and Northern California Defense Counsel; Consumer Attorneys of California, Los Angeles and Orange County; Los Angeles, Orange County and San Francisco Bar Associations; Pepperdine University Law School; Building Industry Association
  • Past Director: Orange County Bar Association, Orange County Trial Lawyer's Association, Southern California Adjuster's Association
  • Past Chairperson, Orange County Bar Association Committee on ADR
  • Delegate, State Bar of California, Conference of Delegates
  • National Institute of Forensic Studies, Professional Advisory Board
  • Publications on ADR and Attorney Fee Disputes for State and Local Bar Associations, firms, trade associations, and newspapers. Author: "A System for Cost Effective Management of Construction Defect and Complex Litigation." Author: "ADR, Why Does it Work?" Author: "Use of the Special Master in Complex Litigation." Author: "Use of Risk Based Facilitative Dispute Resolution."
  • Mr. Polsky is a sought after negotiation skills trainer and has lectured throughout the United States. He is an adjunct Professor of Law at the University of Southern California, where he teaches a course he designed on ADR and negotiation, and at the Straus Institute for Dispute Resolution at Pepperdine University School of Law, where he teaches courses in the LLM program. He is available to provide training in negotiation and mediation skill development to corporations and professional organizations.
  • Pro bono activities include Dispute Resolution Services (DRS) Board of Directors; Los Angeles/Long Beach Legal Aid Grand Cru Board of Directors; Public Law Center of Orange County Board of Directors; Los Angeles County Bar Association volunteer mediation program volunteer

    Comprehensive Overview

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    This page is for general information purposes.  JAMS makes no representations or warranties regarding its accuracy or completeness.  Interested persons should conduct their own research regarding information on this website before deciding to use JAMS, including investigation and research of JAMS neutrals. See More

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