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Yearly Archives: 2020

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5 Common Reasons Why Disability Insurers Deny Claims

Fri Jul 31st, 2020 on     Insurance Law,    

Experienced Insurance Law Firm in Miami, FL If you’ve submitted a claim for disability benefits in Florida and have had your claim denied (or if you are planning on submitting a claim for benefits), then you may be feeling confused and overwhelmed.  In truth, policyholders are not powerless — so long as they understand the strategies that the insurer is likely to employ. Let’s take a look at some of the common reasons for a disability claim denial. Insurer Believes That You Can Still Work Definitions of “disability” vary from plan-to-plan.  Generally, a policyholder will be considered disabled if they cannot perform the primary responsibilities of a job. Some plans have a narrower construction of “disability,” requiring that you show that you cannot perform the primary responsibilities of any-occupation.  In other words, you must prove that you cannot do any sort of work for which you’re reasonably qualified. Other plans have a broader construction of “disability,” requiring that you show that you cannot perform the primary responsibilities of your own-occupation.  In other words, you must prove that you cannot continue to work in your chosen career path. Failure to Follow-Through on Medical Care As a disabled policyholder, it’s critical that you follow-through with medical care, and that you do so in a timely manner.  Failure to do so could lead to a denial of your claim for benefits, and such denial would likely be upheld by a Florida court. How does this justification work? Suppose that you are injured in […]

Business Interruption Insurance Disputes — Frequently Asked Questions

Fri Jul 17th, 2020 on     Insurance Law,    

Experienced Insurance Law Firm in Miami, FL Business interruption (BI) coverage is an essential form of insurance that is meant to shield businesses from the inherent risks associated with a disruptive event (however that is defined by the policy).  For example, if a natural disaster impacts your community’s economy, and as a consequence disrupts the business, then your BI coverage might pay out benefits to cover the associated losses. Still, there are a number of challenges that policyholders face when attempting to secure a payout under their BI policy.  In many cases, policyholders are led to believe that the insurance has broader coverage, when there are actually multiple exclusions (or the existence of policy language meant to be interpreted narrowly).  This can be rather confusing for those policyholders who were not expecting a hostile claim process. As BI insurance coverage can be quite complicated — and unintuitive — it’s worth exploring some of the more commonly-encountered complexities in more detail.  This will hopefully give you a deeper appreciation of the issues, and insight into how your BI dispute is likely to develop. Let’s take a closer look. Frequently Asked Questions (FAQs) Q: What is a covered peril, and how does it relate to my BI insurance coverage? A: In Florida, and elsewhere, the typical BI insurance plan covers losses that occur due to a cessation in normal business operations.  The cessation may require a complete shutdown, a partial shutdown, or may even only require a slowdown in business operations — […]

Insurers Have a Duty to Defend Covered Claims

Tue Jun 30th, 2020 on     Insurance Law,    

Leading Insurance Law Firm in Miami, FL Policyholders — in Florida and throughout the country — often do not realize the extent of their legal rights accorded by their insurance coverage.  If you have been sued by a third-party pursuant to a claim that is (potentially) covered by your policy, then Florida law may require that your insurer step in and defend you in the litigation at issue. This is a very useful mechanism, of course, as it shields you from the substantial out-of-pocket costs associated with defending a complex legal dispute.  When the insurer steps in to defend you a lawsuit, they take on the costs of such litigation. Perhaps unsurprisingly, many insurers refuse to make good on their “duty to defend” the policyholder, and instead reject the duty altogether on several bases — for example, they may attempt to argue that the allegations do not involve a claim covered by the insured’s actual policy. There’s no need to accept this outcome, however — we encourage you to get in touch with the team here at Ver Ploeg & Marino for assistance.  We are an experienced Miami insurance law firm that will help you move forward and secure the defense that you are entitled to under Florida law. What is the Duty to Defend, and When Does it Activate? Insurers have a duty to defend an insured in litigation when the “alleged basis of the action against the insurer” falls within the policy’s coverage.  It’s important to understand that […]

Common Roadblocks to Securing a Payout Under Your Disability Insurance Policy

Fri Jun 19th, 2020 on     Disability Insurance,    

Experienced Disability Insurance Lawyer in Miami, FL If you have suffered an injury, illness, or other condition that has rendered you disabled, then it’s likely you are entitled to benefits pursuant to your disability insurance policy.  In reality, however, most insurers attempt to avoid having to payout disability benefits (even if you are reasonably entitled to such benefits) by rejecting initial claims. To successfully obtain disability benefits, then, we encourage you to consult with an experienced Miami disability insurance lawyer here at Ver Ploeg & Marino for guidance. We understand the challenges facing disability claimants, and the steps necessary for securing the benefits to which you’re entitled.  When a disability insurer denies your claim, we work tirelessly to challenge the adverse outcome and go through the processes — both internal and litigation-based — to resolve the matter favorably. Pre-Existing Condition Issues Perhaps the most common roadblock to securing disability benefits is the limitation on pre-existing conditions.  If you had a pre-existing condition linked to the disability at-issue when you signed on for disability insurance coverage, then that will preclude you from the receipt of benefits for the disability at-issue. Further, if you did not disclose the presence of a pre-existing condition, insurers will look back (from six months to a year, or more) at your medical records prior to the insurance coverage to determine whether you had the pre-existing condition and simply did not report it when signing on to the disability insurance policy. If they discover that you were […]

Cyber Liability Insurance Coverage — the Basics

Fri May 29th, 2020 on     Insurance Law,    

Leading Insurance Law Firm in Miami, FL In today’s technologically-driven world, cybersecurity has become an increasingly critical concern for businesses that store, manage, and distribute consumer data — sensitive and otherwise. Over the past decade, a number of significant data breaches — including the infamous “Sony hack” and the “Equifax incident” — have disseminated the data of hundreds of millions of customers to the world, exposing said customers to both privacy violations and potential personal/financial risks. Though companies are increasingly developing internal mechanisms to prevent large-scale breaches (and subsequent cyber liability), they are also taking steps to insure themselves against liability should another event occur. Unfortunately — as is typical of insurance coverage — companies are finding that their policies may not be as comprehensive as they originally thought.  In many cases, insurers are denying claims on the basis of complicated policy exceptions and ambiguous coverage language. Here at Ver Ploeg & Marino, P.A., our team of attorneys works closely with policyholders who have submitted claims and were unfairly denied or who received a payout that is less than expected under their policy.  We encourage you to contact our Miami insurance law firm directly to learn more about how we can assist your business. Commercial General Liability (CGL) Policies and Cyber Liability Most companies do not have specific cyber insurance policies and instead rely on patchwork CGL and E&O coverage.  This can lead to several challenges, as insurers may deny claims due to certain coverage ambiguities built into the plan. […]

Boat Insurance — Common Coverage Issues

Thu Apr 30th, 2020 on     Insurance Claims,    

Experienced Insurance Law Firm in Miami, FL Florida has the second-longest coastline in the United States, and — in conjunction with its year-round warm weather — has become a hotspot of marine activity, particularly personal watercraft: small boats, yachts, and more. The high volume of seaborne traffic, as well as the nature of watercraft use in Florida (i.e., highly tourist-oriented) makes it rather dangerous to operate a boat without sufficient insurance coverage. Despite the fact that responsible Florida boat owners may purchase and maintain boat insurance coverage, they often find that the policy once marketed as “comprehensive” is more limited than they originally thought.  This is certainly not helped by the fact that boat insurance providers are known to engage in underhanded tactics to avoid having to payout — they will interpret ambiguous language in a way that narrows coverage, or will underestimate the damages. Given the financial risks posed to boat insurance policyholders by an insurance denial (or even an underpaid claim), it’s important that they consult with a leading firm for guidance on how to secure the benefits they are owed under their policy. We encourage you to contact Ver Ploeg & Marino, P.A. for assistance.  We are a Miami insurance law firm with extensive experience helping boat insurance policyholders fight back against insurance companies. Specific “Perils” May Not Be Covered Boat insurance coverage can differ significantly from plan-to-plan.  Though some plans are considered “all risk” plans — in other words, they cover all perils that could potentially […]

What Qualifies as a “Business Interruption” for Insurance Purposes?

Tue Mar 31st, 2020 on     Insurance Claims,    

If you’ve purchased business interruption (BI) insurance and are planning to submit a claim for benefits — or have already submitted a claim and have been denied — then you may be feeling somewhat confused by the ambiguity of coverage, and how that can be used by the insurance company to deny your claim. For example, you might have initially believed that your insurance covered you for man-made disasters (i.e., an arsonist-caused fire), only to discover that the plan only covers natural disasters. Quite simply, when policyholders sign up to business interruption insurance plans, they often perceive the coverage to be broader and more comprehensive than the narrow definitions that the insurance company later applies.  In part, this information disparity is intentional.  By marketing basic plans as more comprehensive than they actually are, the insurance company can sell a plan to budget-strapped customer. It’s important to recognize that you do not have to accept the adverse determinations made by an insurance company.  In many cases, insurers deny, delay, or undervalue claims in the hopes that the policyholder will be too pre-occupied (recovering from the disaster and the business interruption itself) and will therefore resign themselves to the decision. We can help you secure the benefits you’re owed.  Here at Ver Ploeg & Marino, P.A., our team is committed to pursuing any and all potential avenues for benefits recovery, whether through an internal claims appeal process or trial litigation.  Contact our experienced Miami insurance law firm for guidance. Business interruption coverage […]

Construction Defects Must Trigger Property Damage for Coverage Under Florida Insurance Law

Tue Mar 17th, 2020 on     Homeowners Insurance,    

Leading Insurance Law Firm in Miami, FL Homeowners’ insurance coverage can often lead to confusion down the line when policyholders are attempting to secure a payout after having experienced property damage to their home.  As with other types of insurance plans, homeowner’s insurance payouts are manipulated cleverly by insurance companies to minimize their liabilities — wherever possible (so long as the language of the plan supports it, and even when it doesn’t), the insurance company will attempt to argue against coverage. Here at Ver Ploeg & Marino, P.A., our attorneys can help.  We are highly engaged with clients throughout the claims process, from submitting an initial claim to navigating the internal appeals hearing, to litigating the case in Florida courts.  Over the years, we have seen how insurance companies bully policyholders into accepting a denial, delay, or undervalued claim payout.  Homeowners are already under significant pressure when they are dealing with property damage, and the additional problems created by an adverse insurance decision can lead many policyholders to simply “give up.”  It’s natural to feel overwhelmed, but it’s important that you keep your head held high and that you work with a Miami insurance law firm that will doggedly pursue your rights. Among the many arguments put forth by insurance companies — in the homeowners’ insurance context — is that they do not have to payout because the “property damage” at issue does not qualify as such pursuant to the plan language.  Instead, they may argue that the damage is […]

What are “Endorsements” in a Homeowner’s Insurance Policy?

Fri Feb 28th, 2020 on     Homeowners Insurance,    

When you buy homeowner’s insurance, you don’t expect it to cover everything. But, you might expect it to cover more than it actually does. While homeowner’s policies often start with broad coverage language, this language is subject to a laundry list of exclusions; and, in order to have these excluded perils covered, homeowners must pay extra for “endorsements.” Which Endorsements Should Florida Homeowners Choose? In the context of insurance, an endorsement is additional coverage for something that falls outside of the standard policy language. Endorsements are available for many (but not all) exclusions, and individual homeowners’ needs will vary. The following are examples of common exclusions for which endorsements are available: Scheduled Personal Property – If the value of your personal property (the items in your home) exceeds the standard coverage under your policy, then you may need a scheduled personal property endorsement. The term “scheduled” references the fact that the types of personal property covered will be listed as a schedule to the standard policy (homeowners should be sure to review this schedule carefully). Personal Property Replacement Cost – Standard homeowner’s insurance policies pay the “actual cash value” of personal property damaged in storms and other casualty events. The personal property replacement cost endorsement provides coverage for the cost of repair or replacement without a depreciation reduction. Inflation Guard – As inflation increases the cost of rebuilding your home, your standard policy limits can become insufficient. As its name implies, the inflation guard endorsement is designed to ensure that […]

Hurricane Preparedness: State and Federal Government Resources

Fri Feb 21st, 2020 on     Homeowners Insurance,    

The 2020 Atlantic hurricane season will soon be upon us and it is important for homeowners to be prepared. As we’ve learned in past years, it only takes one storm to cause widespread devastation, and homeowners who take steps to get ready will be in the best position to begin the recovery process as quickly possible. Are you ready? Here are seven hurricane preparedness resources from the State of Florida, various U.S. federal government agencies and the National Hurricane Survival Initiative: 7 Free Hurricane Preparedness Resources 1. Federal Emergency Management Administration (FEMA) Hurricane Preparedness Tools FEMA’s website provides a number of tools that homeowners can use to prepare for hurricane season. From creating an emergency communication plan to checking your insurance coverage, these tools provide practical tips for making sure you are ready. 2. National Weather Service Hurricane Preparedness Information The National Weather Service maintains current hurricane forecast information on its website as well as information about hurricane safety and resources for putting together a personalized disaster preparedness plan. 3. U.S. Coast Guard: Make Your Safety Plans in Advance The U.S. Coast Guard is urging all homeowners to make safety plans in advance, and has published a number of useful, easy-to-ready graphics that homeowners can use to make sure they have taken the necessary steps to prepare for a potential hurricane. 4. Ready.gov Hurricane Seasonal Preparedness Digital Toolkit Ready.gov is the official disaster preparedness website of the U.S. Department of Homeland Security. Here, you will find a comprehensive toolkit which […]

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