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Unique Health Insurance Coverage Issues

Fri Jan 31st, 2020 on     FAQs,    

Experienced Miami Health Insurance Lawyer   In the healthcare context, the insured are often surprised by the denial of their claims, and perhaps not unreasonably — when signing up for coverage, prospective policyholders are often sold an “ideal” of comprehensive coverage.  In essence, they are made to feel safe and secure.  The truth is substantially more complicated. Insurance companies will use any available justification to deny a claim.  This is particularly exacerbated in healthcare situations where the insured is seeking out alternative care, or even experimental care. We can help you secure the benefits you’re owed. Ver Ploeg & Marino, P.A. is a Miami-based insurance litigation firm with decades of experience representing the interests of policyholders, and in a variety of disputes — including those that center around healthcare claim denials.  We are a practical, detail-oriented firm that is relentless in securing a favorable result.  Over the years, we have obtained numerous multimillion dollar verdicts and settlements on behalf of clients. Unlike many of our insurance litigation competitors, we have spent a significant amount of time in the courtroom, navigating the hostile battlefield that characterizes a traditional lawsuit. As such, we have the reputation necessary to put pressure on insurance companies to resolve the dispute early (and in a manner that is satisfactory to our client).  Insurers understand that if they do not demonstrate good faith in attempting to resolve the dispute painlessly, then we have the willingness and ability to challenge them in the courtroom. Ready to speak to […]

Insurance Broker Malpractice FAQs

Fri Jan 17th, 2020 on     FAQs,    

Work With a Skilled Miami Insurance Litigation Lawyer   Insurance claim denials often come as a surprise to policyholders who were led to believe that their coverage is more comprehensive than it is in reality.  In fact, this is not an uncommon scenario — an insurance policyholder is attempting to secure benefits on a claim when they discover that some exclusion (or other provision) in the insurance plan prevents recovery.  If the policyholder obtained such coverage through an insurance agent or broker who misled them somehow, whether through an incorrect disclosure or through a failure to disclose certain information, then an actionable claim may arise under the law. As a policyholder — lacking a detailed understanding of the various plan offerings and how they differ from one another — it can be frustrating to put your trust into an insurance broker or agent, only to discover that they were negligent in their responsibilities, or worse, that they intentionally misrepresented information so as to induce you into signing up for an insurance plan. This informational asymmetry — whether created by mere negligence or out of an intentional desire to defraud the policyholder — happens a lot more often than the public may realize.  In the event that you find yourself having been taken advantage of by an insurance broker, it’s important to understand that you are not without legal options.  Florida law protects policyholders who have suffered losses (i.e., claim denial) due to the misconduct of an insurance broker or agent. […]

Commercial General Liability Policies and the Duty to Defend

Tue Dec 31st, 2019 on     Insurance Law,    

Experienced Insurance Litigation Lawyer in Miami, FL Many Commercial General Liability (CGL) policyholders assume that their insurer will necessarily jump to their defense and provide the services that are required under their CGL policy.  The reality can be sobering.  Insurers will do everything they can to avoid additional losses, and this includes aggressive attempts to avoid having to engage their duty to defend the policyholder against third-party claims.  If the insurer is successful, this can put the policyholder in an unenviable position, forcing them to pay out-of-pocket for their own defense in the ensuing lawsuit. CGL policies typically include a duty-to-defend provision that compels the insurer to step in and handle your defense in the event of third-party litigation.  But how do these obligations work, exactly? Understanding the Duty to Defend CGL insurers (where the policy includes a duty-to-defend) are obligated to handle their policyholder’s defense, and in some cases, to indemnify the policyholder if the case leads to damages. In many cases, however, insurers fail these obligations: The insurer may argue that the claims at-issue are not entitled to coverage under the policy, and may refrain from providing a defense on that basis; or The insurer may handle your defense but may not perform their obligations reasonably under the circumstances. With respect to (a), it’s worth noting that an insurer’s obligation to defend is based on the allegations in a lawsuit.  The insurer must provide a defense in the lawsuit even if there is only one allegation that is […]

Issues in Professional E&O Insurance Coverage

Fri Nov 15th, 2019 on     Insurance Law,    

Experienced Insurance Litigation Lawyer in Miami, FL If you’ve been sued for professional malpractice and are presumably covered by a professional errors & omissions (E&O) insurance plan, then you may be surprised to discover that — in the wake of the aforementioned third-party lawsuit — your insurer is engaged in various attempts to avoid having to payout for your liabilities, and to avoid having to possibly defend you in the underlying action.  This can put you in a rather vulnerable position, as the financial ramifications could put a serious damper on your continued professional success, and a loss in the malpractice suit could have long-term consequences for your reputation in your particular industry. It’s critical that you consult a qualified attorney for guidance on how to proceed, so that you can secure that which you are entitled to.  Contact an experienced Miami insurance litigation lawyer here at Ver Ploeg & Marino, P.A., who can help you take action against the insurance company and compel them to follow-through on their obligations under the E&O policy. As you explore the possibility of litigation, it’s worth exploring some of the more common issues faced by policyholders in E&O insurance disputes.  Identifying the issues will enable you and your attorney to develop a solid strategic plan at an early stage. Claim Timing and Reporting Conditions Most E&O policies require that the covered third-party malpractice claim be made during the policy period itself (and some require additional procedural conditions, such as serving notice to the […]

Challenges Facing Policyholders in the Context of Business Interruption Insurance

Thu Oct 31st, 2019 on     Insurance Law,    

Experienced Insurance Law Attorneys in Miami, FL Business Interruption (BI) insurance pays out for losses due to certain covered events, typically large-scale disasters, such as floods and fires.  BI coverage is absolutely critical for businesses operating in disaster-prone states like Florida — even where the risk of a natural or manmade disaster is low, however, comprehensive BI insurance coverage can protect you in the wake of an event that might otherwise have the cumulative effect of shuttering or relocating the business itself. As with all insurance coverage, BI providers are quick to look for “outs” in the policy language (or in the circumstances surrounding the disastrous event) so that they can avoid having to payout, or at the very least, so that they can minimize their expected payout.  This is particularly common in the BI insurance context, however, as the losses tend to be more ambiguous in nature — insurers attempt to gain leverage by underestimating their liabilities whenever possible. Here at Ver Ploeg & Marino, P.A., we have extensive experience handling BI insurance coverage disputes on behalf of policyholders.  We are detail-oriented litigators who invest significant time and attention towards investigating the circumstances central to the coverage dispute, which gives us a significant edge in the BI insurance context (where the determination of a business interruption loss demands a comprehensive assessment of financial records, tax returns, and projected income).  If you’d like to learn more about your case and what the next steps might be, we encourage you to […]

Product Liability Lawsuit FAQs

Mon Sep 30th, 2019 on     Insurance Law,    

Experienced Insurance Litigation Lawyer in Miami, FL If you are operating a business in which you could be sued, or have been sued, for distributing a defective product, then you may be facing significant liability.  In fact, product liability disputes are so disruptive that they can bring business to a standstill if you are unprepared for defending against potentially hundreds of claims. Typically, businesses purchase comprehensive insurance plans that cover their commercial products.  The mere fact that you’ve purchased such a plan is not necessarily a guarantee of real-world coverage, however.  Particularly in cases where the insurer could be exposed to significant costs for handling the defense, the insurer will look for various “outs” to avoid having to engage their duties under the policy.  They may argue that a coverage exclusion applies, for example, or that your policy was not active at the time of the incident. We understand that product liability disputes can be confusing, and as such, we encourage you to contact Ver Ploeg & Marino, P.A. to consult with an experienced Miami insurance litigation lawyer at our firm. Before you speak to one of our attorneys, however, you may have some questions about product liability and insurance denials.  Let’s take a brief look at some common concerns that clients have. Frequently Asked Questions Q: What is the difference between a Claims-Based and an Occurrence-Based policy? Your insurance policy will either be claims-based or occurrence-based, and this could have a significant impact on whether you are eligible for […]

Insuring the Gig Economy

Fri Aug 30th, 2019 on     Insurance Claims,    

Experienced Insurance Coverage Lawyer in Miami, FL On an annual basis, the “gig economy” is growing significantly across the United States and the world at-large, spearheaded by big-tech efforts such as Uber and Fiverr, among other applications that connect independent contractors with those in need of a one-time service.  In fact, industry observers estimate that nearly 40 percent of the United States will be employed as independent contractors by 2020 (though of course many will be engaged in longer-term project-based arrangements, and not necessarily the gig economy). Though “gigs” have created an incredible way for many Americans to supplement and grow their income, the work can be somewhat risky.  If you work “gigs” independently, whether through a specific app or not, then you may find yourself in a situation where you’re facing liability or other losses that are sufficiently extensive to warrant insurance coverage — even if you are covered by a pre-existing policy, however, there’s a good chance that your insurer will deny your claims.  They may use a number of justifications to explain the denial, such as a coverage exclusion. An insurance denial is not final.  You have the right to challenge the adverse decision and potentially even sue to recover compensation.  We therefore encourage gig workers to consult an attorney for details on how to proceed.  Contact us at Ver Ploeg & Marino, P.A. to learn more. Coverage-Related Issues Faced by Gig Economy Workers Commercial Policies vs. Personal Policies As a gig worker, your personal policy may […]

Insurance Coverage: Do Agents Have a Duty to Advise Customers on What They Should Buy?

Wed Jul 31st, 2019 on     Insurance Claims,    

Generally speaking, an insurance agent has no obligation to, on its own, evaluate a customer’s particular insurance needs or give the customer advice regarding the coverage the customer should purchase. That said, insurance agents do have a duty to take the appropriate steps to protect their policyholders from potential risks and liabilities. If you think you have a claim for insurance agent or broker malpractice, a Miami insurance coverage lawyer can assist you. Importantly, if you can show that a “special relationship” existed with your insurance agent, his or her duty may be expanded to include advice on the insurance necessary to fulfill your needs.  Basic Duties of Insurance Agents and Brokers Insurance brokers are required to exercise good faith and reasonable skill, care and diligence in procuring insurance requested in accordance with the client’s instructions.  They are also obligated to obtain: Coverage that is not materially deficient Coverage undertaken to be supplied at the requested limits Requested coverage within a reasonable time (or inform client of inability to do so). No General Duty to Advise Regarding Coverage Deficiencies or Needs If the agent has contracted to provide “standard” brokerage services, then the agent has not agreed to evaluate the customer’s needs or to give the customer advice regarding the coverage the customer should have. This is because insurance agents and brokers are not seen by the law as personal financial counselors or risk manages.  A general request for “full coverage” or the “best policy” does not broaden the broker’s […]

Challenges to the Insurance Industry in 2019

Wed Jul 17th, 2019 on     Insurance Claims,    

Over the past decade there has been an explosion of technological, economic and cultural innovation, dramatically changing how we do business and live our lives. Many of these developments have disrupted the traditional approach to insurance. As a Miami insurance law firm, we stay up-to-date on trends that impact our industry. From the gig economy to driverless cars and the internet of things, insurance companies are racing to find creative, cost-effective solutions that match the innovation of today. Gig Economy Essentially, the “gig economy” is a labor market based on short-term contracts or freelance work, as opposed to permanent jobs. Current examples include ride-sharing apps, food delivery services, and online marketplaces such as Airbnb and Rover. The underlying principle in the gig or “sharing” economy is that individuals can provide or obtain a paid personal service while operating outside of conventional business regulations and employment law. Because the agreements for these services do not fall exclusively into either the personal or commercial categories, insurance companies have had to determine whether personal liability plans will cover such services. Many insurers have responded to the challenge by excluding quasi-commercial uses from personal policies and replacing them with specific add-on options. For example, in the context of a standard personal auto policy insurance companies are requiring additional commercial coverage to provide protection when driving for a rideshare service.  Driverless Cars While the majority of “autonomous” cars today are still partially under driver control, the challenge for insurers will be the issue of who […]

Understanding Business Interruption Insurance

Fri May 31st, 2019 on     Insurance Claims,    

Many commercial property policies, as well as business owner’s policies (package policy for small businesses, often referred to as a “BOP”), include business interruption coverage.  It is designed to protect your business from a loss in income caused by an insurable event.  As Miami insurance coverage attorneys, we are experienced in helping our clients to maximize their recovery when a fire, hurricane or other disaster causes an interruption in business operations.  There are four important elements of business interruption insurance.  First, it is only triggered in three limited circumstances: Physical damages to the premises of such magnitude that the business must suspend its operations; Physical damage to other property caused by an insurable loss and that prevents customers or employees from gaining access to the business; or The government shuts down in an area due to property damage caused by an insurable event that prevents customers or employees from gaining access to the business. Most Policies Have a Waiting Period A second critical element is that even after a covered event occurs, most policies have a waiting period of several days before business interruption kicks in.  Once it does, coverage will not be retroactive to the day of the event. Business Interruption Coverage is Limited Third, after the waiting period ends, coverage will be provided for lost net income, temporary relocation expenses (designed to reduce overall costs), and ongoing expenses such as payroll that enable businesses to continue paying employees rather than laying them off. Importantly, business interruption coverage is […]

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