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Category: Insurance Claims

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5 Reasons for a Life Insurance Claim Denial

Wed Mar 31st, 2021 on     Insurance Claims,    

Our Miami Insurance Claim Lawyer Is Here to Assist If you’re the beneficiary of a life insurance policy and have had your life insurance claim denied by the insurer, then you may be entitled to challenge that denial by resubmitting a claim or by pursuing a lawsuit to secure compensation. Life insurance claim denials are infrequent, but when they do occur, they can cause a great deal of anxiety. After all, the beneficiary might have been expecting to receive a payout, and the denial can put them in an incredibly vulnerable position from a financial perspective. It’s important to understand that you need not accept the adverse decision of the life insurance company.  Though the insurer may have denied the application on one of several different bases, these justifications are not always supported by the facts of the case. If you’d like to speak to an experienced Miami insurance claim lawyer (about the denial of what you believe to be a legitimate life insurance claim), we encourage you to contact our team here at Ver Ploeg & Marino, P.A.  We look forward to speaking to you about what you can do to obtain the benefits you deserve. For now, let’s take a closer look at some of the reasons used by insurers to deny a life insurance claim.  Consider the following. 1) Misrepresentations on the Insurance Application If the life insurance policyholder misrepresented the facts on their insurance application, the insurer could deny a claim made by the beneficiaries.  It’s […]

Insurance Contract Interpretation: Is Your Policy Fair?

Wed Mar 17th, 2021 on     Insurance Claims,    

Work With an Experienced Miami Insurance Claim Lawyer   Insurers often deny or undervalue claims on the basis of provisions in the insurance contract that are written ambiguously, or that are written in a way that significantly advantages the insurance company.  As the policyholder, it may feel as though you have been put in an incredibly vulnerable position due to the way that the contract was written. Fortunately, all is not lost.  Under Florida law, there are a number of mechanisms through which unfair or ambiguous insurance contracts can be interpreted in your favor (as the policyholder). If you believe that your insurer is incorrectly interpreting the policy, or has created a fundamentally unfair policy, then you may be entitled to challenge that — but you’ll need the assistance of an experienced attorney to navigate the dispute effectively and put forth an effective legal argument.  Here at Ver Ploeg & Marino, P.A., we encourage you to contact a skilled Miami insurance claim lawyer at our firm for guidance on how to proceed. Let’s take a closer look. Ambiguity is Interpreted in Favor of the Policyholder In Florida, ambiguous contract provisions — including provisions in insurance contracts — are interpreted in favor of the policyholder. How does this work? Suppose that you have signed onto health insurance coverage that has an extremely vague definition of “medically necessary.”  If your insurer refuses to cover a particular treatment on the basis that your treatment was not medically necessary, you might be able to […]

Medical Necessity in Florida Health Insurance

Fri Feb 26th, 2021 on     Health Insurance,    

Let an Experienced Miami Insurance Claim Lawyer Help Oftentimes, people acquire health insurance coverage thinking that they can rest easy knowing that they won’t have to worry about their insurer “paying out” in the event of serious illness or injury.  This is unfortunately not the case in reality, however — insurers are incentivized to avoid acknowledging coverage in borderline cases, and they may write in ambiguous terms and provisions to give themselves the opportunity to deny otherwise legitimate claims. Nowhere is this more of an obvious problem than with alternative medicine and experimental medicine treatment options. Simply put, health insurance policies do not cover every possible type of treatment that you could receive.  Instead, they define the borders of coverage with a term: “medical necessity.”  If treatment is not medically necessary, then it will not be covered by the policy. This can lead to some adverse results.  Even if you receive alternative medicine treatment that significantly benefits you and improves your quality of life, your insurer might decide that it was not “medically necessary” and may deny coverage, putting you in a financially vulnerable position. Here at Ver Ploeg & Marino, P.A., our team is experienced in handling these nuanced coverage issues in the healthcare context.  We understand just how frustrating it can be to not have your insurer be an ally during such a vulnerable time — and we’re ready and willing to hold them to their promises.  Contact an experienced Miami insurance claim lawyer at our firm for […]

Common Boat Insurance Exclusions

Fri Jan 29th, 2021 on     Insurance Claims,    

Contact a Miami Insurance Claim Lawyer For Immediate Assistance Boat insurance coverage may seem comprehensive at first glance, but many policyholders find that despite the expense of their policy, the insurer denies their claims on the basis of an exclusion that may not have been obvious at the time of signing. For this reason, it’s critical that policyholders fully evaluate their insurance policy before moving forward.  By understanding your coverage in detail, you’ll be equipped to counter the insurer’s assertions about coverage exclusions, and potentially secure the compensation you’re looking for. If you’ve sustained damages to your boat and would like to submit a claim to your insurer, or have already submitted a claim and have had that claim denied, undervalued, or otherwise adversely affected, then we encourage you to contact a Miami insurance claim lawyer at Ver Ploeg & Marino, P.A. for legal assistance. Our team has decades of experience working with insurance policyholders, including those that are struggling to secure compensation on the basis of their boat insurance policy.  It is our belief that effective advocacy requires client-centered, thorough representation.  If you’d like to speak to a qualified Miami insurance claim lawyer about your case, contact our team directly to schedule a consultation. As a policyholder, it’s important to understand the basic issues that you are likely to encounter as you navigate the claim dispute.  Though every boat insurance policy will be somewhat different, there are certain commonalities that tend to crop-up — such as common exclusions that […]

Uninsured Boater Coverage

Fri Jan 15th, 2021 on     Insurance Claims,    

Get Help From an Experienced Miami Insurance Claim Lawyer Boating accidents are not uncommon, particularly in Florida, which is a boating paradise for both tourists and locals alike.  In fact, Florida leads the nation in boating accidents, deaths, and injuries — in 2018 alone, a U.S. Coast Guard survey revealed that there were 607 boating accidents resulting in 57 deaths, 297 injuries, and more than $7 million in property damage. As one can reasonably ascertain, protecting oneself against loss is critical given the relatively high likelihood of a boating accident in Florida.  However, doing so may require that you purchase uninsured boater insurance coverage.  Many boaters simply do not purchase liability insurance, and as such, when they cause collision accidents with other boaters, they may not be able to cover the losses.  This can put you in a vulnerable position if you’re involved in a boating accident with an uninsured boater — unless, of course, you purchase uninsured boater insurance coverage. If you’ve been injured in a boating accident, it’s important that you consult with a lawyer for guidance on how to submit a marine claim that will be accepted by the insurer — further, in the event of a claim denial, your attorney can help you challenge the decision and secure the payment you deserve. For now, let’s take a closer look at some issues commonly encountered with uninsured boater coverage.  After all, just because you’ve purchased uninsured boater insurance doesn’t necessarily mean that the insurer will cover the […]

Common Coverage Exclusions in Professional E&O Policies

Thu Dec 17th, 2020 on     Insurance Claims,    

Work With a Skilled Miami Insurance Claim Lawyer   Professional negligence is a serious and career-long concern for licensed professionals, in Florida and elsewhere.  In order to avoid the potentially catastrophic financial risks posed by a lawsuit, professionals typically purchase errors and omissions insurance coverage (E&O) to protect them in the event of a lawsuit. Unfortunately, it’s easy to assume that this protection will apply when you need it most — but insurance carriers often deny E&O claims, leaving the professional policyholder in a vulnerable position. If you’re a licensed professional who has been sued for malpractice, then you may be feeling overwhelmed, anxious, and unsure of how to proceed — even if you have comprehensive E&O coverage. We can help. Here at Ver Ploeg & Marino, P.A., our team has decades of experience working with professionals throughout the state of Florida, helping them to submit successful insurance claims under their E&O policies.  When a claim is denied, we advocate relentlessly for our clients, working with them to challenge the decision of their insurance carrier and secure the coverage they deserve. Ready to speak to an experienced Miami insurance claim lawyer at our firm?  Call us at 305-577-3996 or contact us online to schedule a consultation.  We look forward to speaking with you. Before you move forward, however, you may be wondering what justifications the insurance carrier might use to try and deny your claim.  Oftentimes, the insurance carrier will argue on the basis of an exclusion. These exclusions do […]

Florida Insurers and Their Duty to Defend

Wed Sep 30th, 2020 on     Insurance Claims,    

Work With Our Miami Insurance Coverage Lawyer Today In Florida, if a policyholder is potentially liable to a third-party (i.e., a liability claim has been brought against them and that claim is covered by the underlying insurance policy), then the insurer has a duty to defend the policyholder in the ensuing litigation.  As with most liability disputes, these disputes are likely to resolve through pre-litigation settlement — but the insurer must still adhere to their duties and take control of the defense. Unfortunately, many insurers will take steps to avoid having to invest the funds and resources towards defending a policyholder in litigation, even if they are required to do so.  The insurer may argue that the underlying issues do not involve claims that would be covered by the insurance policy, for example, and use this argument to avoid their “duty to defend.” This can pose significant challenges for a cash-strapped policyholder-defendant, as the policyholder would have to sustain additional costs by hiring an independent attorney to represent them in the liability dispute.  Quite obviously, this more costly path is not something the policyholder would have contemplated when purchasing insurance coverage — they no doubt purchased insurance with the assumption that it would lead to a reliable defense in the event of a lawsuit. If you are being sued by a third-party and believe that the lawsuit is covered by your insurance policy, it’s important that you get in touch with a qualified Miami insurance coverage lawyer for guidance on […]

Bad Faith Insurance Claims in Florida

Wed Sep 16th, 2020 on     Bad Faith Insurance,    

Let Our Miami Insurance Law Firm Work For You Insurers are fundamentally profit-motivated.  Though this is a truism that most policyholders accept and understand, it’s often forgotten when it comes time for the policyholder to make an insurance claim — after all, one would assume that the insurance provider would act with some semblance of “honor” and live up to their promises. The grim reality is that many insurers will do anything and everything — even violating basic good faith conduct — to avoid having to pay out damages in accordance with the coverage sought. Though insurers can naturally be expected to take a position that is in opposition to the policyholder (i.e., that they do not have to cover the claim due to interpreting the insurance policy differently), they also engage in potentially violative conduct: inadequately investigating the facts surrounding a claim, denying claims without a reasonable basis for doing so, delaying the processing of a claim unreasonably and undervaluing a claim to force an exhausted and vulnerable policyholder to simply resign themselves to the reduced payout. Florida law does provide some protection to policyholders and others who find themselves subject to this type of misconduct — specifically, this type of insurance misconduct may give rise to a bad faith claim. If you believe that an insurer has acted in bad faith, then it’s worth exploring your legal options.  Here at Ver Ploeg & Marino, P.A., we encourage you to contact our Miami insurance law firm to schedule a […]

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 […]

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