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Yearly Archives: 2017

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When is an Injury Deemed a Disability for the Purpose of Insurance?

Fri Dec 29th, 2017 on     Disability Insurance,    

In Florida, as in other states, there are a variety of private insurance plans for disability coverage, each with their own respective terms and provisions relating to such disability coverage.  If you are suffering from an injury or other health condition that has rendered you disabled (partial or full), however, then you may find that your insurer — despite having provided you “comprehensive” coverage — has wrongfully denied benefits to you on the basis that […]

Understanding the Duty to Defend

Fri Dec 22nd, 2017 on     Insurance Claims,    

As an insured defendant, the fact that the insurer will step in to provide a defense in claims (that fall within the applicable coverage) brought against the defendant is critical to effective litigation in many cases, particularly those where the defendant lacks personal financial assets necessary to pay for the expense of litigation.  Insurers owe a duty to their policyholders to step in and provide a defense in covered claims brought against their insured — […]

Insurance Benefits: Partial vs. Total Disability

Fri Dec 15th, 2017 on     Disability Insurance,    

Depending on your insurance coverage, you may be eligible to submit an insurance claim for either total or partial disability.  Too often, however, insurers wrongfully deny, delay, or undervalue disabled policyholders’ claims so as to minimize their liabilities.  In the disability insurance context, for example, an insurer might define your disability as merely partial, when in fact the disability is totally debilitating with respect to your ability to work and earn a living.  If your […]

How Does Insurance Adjustment Work?

Fri Dec 8th, 2017 on     Insurance Claims,    

If you are making or have filed an insurance claim (whether for health benefits, disability benefits, liability coverage, etc.), your claim will be evaluated and ultimately processed by an adjuster.  Insurance claims adjusters generally work with teams of specialists to evaluate claims from beginning-to-end — the adjuster will then deny the claim, delay processing, or make an offer. It’s important to note that insurance claims adjusters are not on your side.  In fact, one could […]

First Party and Third Party Bad Faith — What’s the Difference?

Fri Nov 24th, 2017 on     Bad Faith Insurance,    

If you believe that you have been wronged by your insurer in Florida, you may be entitled to bring a bad faith insurance claim against them and thus recover compensation for the losses you suffered.  In Florida, insurers have a duty to their policyholders to act in good faith in settling claims, and to act fairly and honestly (with due regard for the policyholder’s interests) when doing so. Bad faith insurance claims can be either […]

ERISA Fiduciary Duties

Fri Nov 17th, 2017 on     Insurance Claims,    

The Employment Retirement Income Security Act (ERISA) was enacted with the intention of protecting the fund assets of policyholders — in qualified, covered plans — from plan mismanagement and other violations of fiduciary duty by those with authority over the plan and its assets.  Fiduciaries include trustees, administrators, and investment committee members, among various other authority figures who are tasked with management of the plan and its assets. Fiduciary Duties ERISA plan fiduciaries owe a […]

Insurers Must Settle When They Have The Chance

Fri Nov 10th, 2017 on     Bad Faith Insurance,    

In Florida, if an insurer does not settle a claim within the insured’s policy limits (whether the claim is first-party or third-party), the insurer may be exposed to liability in excess of the policy limits on the basis of having violated their duty of good faith.  This mechanism lies at the center of some controversy in the state of Florida, as legislators have actively debated whether allowing claimants to bring a bad faith action against […]

What Is An ERISA Insurance Claim?

Fri Nov 3rd, 2017 on     Disability Insurance,    

If you are covered by an employee benefit plan (life insurance, pension, health, retirement benefits, etc.), and you work for a private industry employer, then in all likelihood, your plan is governed by ERISA regulation.  ERISA can have important ramifications for your insurance claims and the process by which you can seek proper recourse in the event that your claims are wrongfully denied. What is ERISA? The Employee Retirement Income Security Act (ERISA) was enacted […]

Insurers Have a Duty to Act in Good Faith

Fri Oct 20th, 2017 on     Bad Faith Insurance,    

In Florida, insurers owe their policyholders a duty of good faith to refrain from acting on exclusively on the basis of their own self-interest in handling a claim and in their decision-making surrounding a settlement.  The insurer is required by Florida law to handle claims brought against their policyholders with the degree of care and diligence that would have been exercised by a reasonably prudent person in managing their own business. If you are a […]

How a Pre-Existing Condition Affects Your Insurance Claim in an Accident

Wed Oct 18th, 2017 on     Health Insurance,    

Whether you are injured in an accident in which there is an at-fault third-party and are attempting to recover damages through the third-party’s liability insurance, or whether you’re making a first-party claim with your own health insurer, the presence of a pre-existing condition could complicate recovery somewhat. Injury Must Be Distinct or Aggravated In Florida, you may recover for injuries that are either distinct from a pre-existing injury, or that have simply aggravated a pre-existing […]

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