News & Resources

Most people — and especially in Florida, where tropical storms and hurricanes are a regular threat — purchase home insurance under the assumption that their insurer will make reasonable attempts to compensate them when something goes wrong and they suffer property damage.  The unfortunate reality, however, is that insurers (even in the homeowner insurance context) are in the business of minimizing their claim payouts.  If you’ve suffered property losses to your home, you may find that your insurer makes you a lowball offer, or denies your claim entirely.  In some (rare) cases, your insurer may even fail to make payments after reaching a settlement. A number of different factors can negatively affect the likelihood that an insurer will settle a claim for a reasonable value.  Consider the following non-exhaustive list. Failure to Mitigate Homeowners have a responsibility to make reasonable efforts to mitigate damages and protect their home from suffering further damages, where possible.  This may involve repairs.  For example, a homeowner cannot knowingly allow wood rot to destroy their home without making reasonable efforts to prevent the spread (perhaps by hiring a contractor to treat the rot and repair the damaged areas). Partial or Non-Disclosure of Facts Your homeowner insurance policy application should have contained a full disclosure of all material facts pertaining to the property.  If certain relevant facts were not disclosed in the application, the insurer may use that as justification to deny your claim. Event is Not Covered by the Policy Whether a given event is […]

In Florida, as is the case in other states, disability benefits may be denied for a number of different reasons.  Insurers often act wrongfully when denying benefits, however.  If you believe that you have legitimate reason to challenge the denial of your benefits, you may appeal the denial and — having exhausted the administrative process — you may even bring a lawsuit against your insurer for wrongful denial. On what basis do insurers justify the denial of disability benefits?  Consider the following non-exhaustive list. Disability Does Not Satisfy Plan Requirements The definition of a “disability” that qualifies for benefits can vary significantly depending on the policy.  Under some policies, specific illnesses, injuries, and conditions are outlined, with full/partial exclusions listed (for example, subjective conditions are often limited to temporary benefits). Most policies apply an occupational standard: either own occupation or any occupation.  If your disability benefits plan is an own occupation plan, then you will be considered disabled if your condition renders you incapable of working in your current occupation.  If your disability benefits plan is an any occupation plan, then you will be considered disabled if your condition renders you incapable of working in any reasonable alternative occupation — the condition must therefore be severe enough that it prevents you from seeking a different career path. Medical Record Evidence is Lacking Your insurer may deny disability benefits if certain aspects of your medical record relating to the disability at-issue are missing or inadequate.  For example, if you are attempting […]

By Matt Dixon 10/02/2017 04:30 PM EDT The Florida Justice Association, which represents state trial attorneys, has set up an insurance task force to provide information about policies after Hurricane Irma. “Hurricane Irma has resulted in chaos, confusion, and concern for too many homeowners,” FJA President Dale Swope said. “Consumers need straight answers about how they should proceed with their claims.” In the statement, he said members of the Emergency Response Task Force will be available to provide information at town halls and other events “where constituents can raise questions related to insurance claims.” It is chaired by Stephen Marino, an attorney with the firm Ver Ploeg & Marino. All task force members are serving on a volunteer basis.

  As a result of Hurricane Irma, people and businesses will begin to take stock of the damage suffered and evaluate potential recovery assistance promised by property insurance. We urge those affected to seek professional help and guidance; insurance policies are complicated documents. We suggest some simple steps that should be followed in finding the right help and guidance, and to assist in getting paid fairly and promptly. Make your claim: Insurance policies have time limits on when and how a claim should be made. More than 50 years ago, the Florida Supreme Court observed that most folks don’t read their insurance policies until disaster strikes – get the policy and review it now. If you need help interpreting what you need to do and when, check with your agent or broker. A good agent or broker can and will help you with the mechanics of providing notice of a claim. Document your claim: Always keep careful track of the extent and expense of your claim. All insurance policies require you to mitigate your damage to prevent more loss, but don’t try to fix anything unless lots of pictures are taken. If paying in cash, get a receipt. Insurance companies expected to make a large claim payment need an equally large amount of paper to justify the payment. Even if something is not covered by the policy or there is a large deductible, there may be tax reasons to keep all of that paper – consult a professional to tell […]

Bad faith has now become part of the American landscape and an accepted tool to balance the playing field between insurers and policyholders. In 1982, Florida’s Legislature became the first in the United States to create the right to bring a private lawsuit for an insurance company’s violations of the Unfair Insurance Trade Practices Act (UITPA). UITPA, on the books since the mid-’70s, described and prohibited many unfair claims practices but saw them enforced only by the limited staff employed in the Insurance Commissioner’s office. The 1982 law (Florida statute 624.155) commonly known as Florida’s Bad Faith Statute, provides outside-the-contract remedies for consumers with a Florida claim. It promised much, but in its infancy brought little and was sparsely used. Though uninsured motorist claimants at the trial level were quick to benefit from the statute’s plain effort to include them, appellate cases were slow to come, scattered and inconsistent. Even the basic procedural and substantive issues, undefined by either the statute or its legislative history, went largely begging for resolution. The Bad Faith Statute is now into adolescence, and like most teenagers approaching their 16th birthday, is experiencing not only rapid growth but the confusion that comes from false starts. Here, we review some of both threads. The underlying bad faith disputes: Chickens and eggs One of the threshold issues in insurance bad faith law around the country is whether an insured can maintain a bad faith suit at the same time he pursues relief under the underlying insurance contract. […]