Do Cases Regarding Fraudulent Schemes Exceed the Scope of the Apprisal Clause ?
In Travis v. American Manufacturers Mutual Insurance Co., 335 Ill. App. 3d 1171, 782 N.E.2d 322, 270 Ill. Dec. 128 (2002), the plaintiff alleged a fraudulent scheme in that the defendant insurance company contracted with an outside company to provide biased, below-market estimates of total-loss-vehicle values.
The Court concluded that these types of claims presented more than a disagreement between the parties concerning the actual cash value of the vehicle and that therefore the dispute was not covered by the appraisal clause of the insurance contract. Travis, 335 Ill. App. 3d at 1177, 782 N.E.2d at 327.
In Hanke v. American International South Insurance Co., 335 Ill. App. 3d 1164, 782 N.E.2d 328, 270 Ill. Dec. 134 (2002), the plaintiff alleged that as a part of the fraudulent scheme, the insurance company required all the parties to submit to an appraisal process if they could not agree on the value of the loss.
As in Travis, we found that the allegations of the complaint exceeded the scope of the appraisal clause. Hanke, 335 Ill. App. 3d at 1169, 782 N.E.2d at 332.
And in v. Illinois Farmers Insurance Co. 351 Ill. App. 3d 931, 815 N.E.2d 435, 287 Ill. Dec. 32 (2004), the insured brought an action against the automobile insurer to recover for an allegedly fraudulent scheme to keep medical-payments claims to a certain percentage or amount by utilizing third-party reviewers.