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Category: Insurance Claims

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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 […]

How to Maximize Your Recovery for Hurricane Damage

Fri May 17th, 2019 on     Insurance Claims,    

Most homes have homeowners policies covering wind damage, but insurers have been steadily increasing hurricane wind coverage deductibles and imposing other sometimes draconian policy limitations.  In addition, homeowners’ policies do not cover flood, earthquake, tree removal (unless the tree damages the house) or food spoilage from power failures.  As a Miami insurance recovery attorney can tell you, in the wake of a storm, homeowners must be vigilant with their insurance companies throughout the claims process to ensure that they receive a full and fair settlement.  Your claim is unique and should be treated as such by your insurance company.  Here are some important tips and considerations as you go through the claims process.    Tips for Filing Flood and Wind Claims First, If you have a legitimate claim, do not hesitate to file it.  Insurers should not raise your rate for filing a claim or fail to renew your policy as a result.  Second, once your claim is reported, be sure to make a note of your claim number.  Third, maintain receipts for any expenditures related to immediate repairs you had to make to secure your home or any living expenses (hotel, meals) if you could not return to your home following the storm.  These may be reimbursable under the “Additional Living Expense” portion of your homeowners’ policy.  Forth, many insurance companies have repair programs in which they offer to send out one of their approved contractors to estimate your property damage.  While you may wish to obtain an estimate […]

New Jersey High Court Rejects Junk Science in Product Liability Cases

Fri May 10th, 2019 on     Insurance Claims,    

New Jersey has joined the majority of states by supporting the federal “Daubert standard” for assessing the reliability of expert testimony.  In a recent decision, the New Jersey Supreme Court upheld the “gatekeeper” role of judges, allowing them to prevent juries from hearing scientific evidence the courts deem unreliable.  As a Miami insurance law firm, we stay up-to-date on legal developments that impact our practice.  Expert witnesses are the lynch pin of a product liability case, so the Court’s decision clarifying the standard for admissibility of expert testimony will have a huge impact on product liability litigation in the state.  In re Accutane Litigation Decision  The plaintiffs alleged a causal condition between the acne medicine Accutane and Crohn’s Disease, a gastrointestinal illness, despite the fact that all of the epidemiological studies concluded that there is no causal relationship.  At trial, plaintiffs intended to call experts to dispute the conclusions of the studies and to assert the contrary view, “relying on other facts and forms of data.”  Defendants challenged the methodology as unreliable and sought the exclusion of the expert’s testimony.  The trial court agreed, but the Appellate Division reversed the decision, concluding that the experts employed a “sound methodology” and simply interpreted the data differently than defendants’ experts.        In a unanimous decision, the Supreme Court upheld the trial court’s exclusion of plaintiffs’ expert testimony and clarified its standard for assessing the reliability of expert witnesses.  The Court expects trial courts “to assess both the methodology used by the expert […]

Guide to Bad Faith Insurance Claims in Florida

Fri Mar 22nd, 2019 on     Bad Faith Insurance,    

If your insurance company has denied your claim or resolved it unsatisfactorily, you may be able to bring a bad faith claim against them in court.  Of course, not every denial constitutes bad faith. As Miami insurance claim lawyers, we are experienced in determining whether an insurer has handled a claim appropriately and in recognizing bad faith insurance practices.  For a policyholder, the first step is to educate yourself as to what your insurance company is obligated to do.  The law requires insurers to act in good faith and to engage in fair deals.  Specifically, they are obligated to: Recognize your claim; Investigate in a prompt manner; Respond quickly to your communications; Not slow down the progression with unnecessary forms; and Offer actual reasons for denial of your claim or delays in the process. There are Two Types of Bad Faith Claims A “first-party” bad faith claim arises when an insurance company unreasonably refuses to pay a claim or to properly investigate a claim.  A “third-party” bad faith claim is when an insurance company unreasonably fails to defend, indemnify or settle a claim within policy limits or to investigate a claim for a different-party, such as when the insured (the first party, you) buys insurance from the insurance company to protect against claims from another (the third party).  Florida Law on Bad Faith Claims The good news for bad faith claimants in Florida is that the law is quite clear.  The statute provides that “any person may bring a civil […]

Federal Court Decision Clarifies Timing for Bringing Bad Faith Claims

Thu Feb 7th, 2019 on     Insurance Claims,    

The Eleventh Circuit Court of Appeals, which includes Florida, Georgia, and Alabama, has made clear that a five-year statute of limitations applies to bad faith claims in Florida. The case involved a policyholder’s bad faith claim against his automobile liability insurance provider for failing to settle a personal injury lawsuit. The insured had timely notified his carrier of a personal injury lawsuit brought against him involving an incident in which a passenger in his car suffered serious injuries after being ejected from the car. The insurer failed to settle the dispute and a jury returned a verdict well in excess of the insured’s coverage.  Insured Brings Bad Faith Claim Approximately four years and seven months after the $2.6 million judgment was entered against him, the insured filed a federal court claim against his insurer for failing to negotiate and settle the case in good faith. He also argued that the insurance company failed to advise him of settlement opportunities, warn him of the possibility of an excess judgment, adopt and implement standards for the proper investigation and handling of claims, and properly train its adjusters and claims personnel. Trial Court Dismisses Action as Time Barred The Florida trial court dismissed the case as time barred by the four-year statute of limitations for intentional torts (a category that includes assault, false imprisonment, slander). The court characterized the action as one for the breach of fiduciary duties, which is considered a tort. The insured appealed.     Bad Faith Claim Against Insurance Company […]

Intentional Conduct May Be Excluded from CGL Insurance Coverage

Fri Dec 14th, 2018 on     Insurance Claims,    

Businesses purchase expensive CGL coverage in order to prevent — or at the very least, to minimize — the damaging impact of a lawsuit on their continued commercial operations. For example, a grocery store might purchase CGL insurance so that they are covered if a shelf falls on a customer or if a customer slips-and-falls and injures themselves.  In the event of a lawsuit for such injuries, the store would be defended by their insurer (and the damages would be paid out by the insurer). In reality, however, CGL insurers are always looking for ways to back out of coverage and avoid the hassle and expense required by the insurance policy.  There are a number of circumstances under which a CGL insurer need not extend coverage, including situations that involve intentional misconduct. Disputes surrounding commercial general liability (CGL) insurance coverage can be rather complex, and may confuse first-time claimants.  Let’s take a look at the basics of the intentional misconduct exclusion. Exclusion for Intentional Misconduct CGL insurance coverage typically excludes the intentional misconduct of the insured, and in fact, it is quite rare for such policies to payout for intentional misconduct.  The critical issue in many CGL insurance disputes, then, is whether the conduct of the policyholder qualifies as excluded “intentional misconduct” pursuant to the language of the underlying policy. Generally speaking, whether conduct is deemed “intentional” for the purposes of a CGL insurance claim depends on whether the damaging event was: 1) expected, or 2) intended by the policyholder. […]

Fundamental Unfairness in an Insurance Contract

Fri Dec 7th, 2018 on     Insurance Claims,    

Let a Miami Insurance Litigation Lawyer Help All too often, insurance policyholders find themselves beholden to policies that are fundamentally unfair.  Perhaps the insurance contract includes a mandatory arbitration provision that is not explained properly.  In the alternative, perhaps the insurance contract includes a rather odd and unexpected provision such as indemnity for costs in the event of a challenge. If you’ve had a legitimate claim for insurance benefits denied on the basis of a fundamentally unfair provision in the underlying insurance contract, then you may be entitled — under pervading Florida common law — to bring an action against your insurer and have the provision at issue modified or ignored. In Florida, unconscionable contract provisions cannot be enforced, but it can be quite difficult to show that a provision of your insurance contract is unconscionable.  Let’s take a closer look at the concept. What Qualifies as an Unconscionable Contract Provision Under Florida Law? A contract provision will be deemed unconscionable if it is both procedurally and substantively unconscionable.  Florida applies a sliding scale when determining unconscionability — stated simply, a contract provision may be deemed unconscionable if it is “mostly” procedurally unconscionable or “mostly” substantively unconscionable.  It is not necessary that both procedural and substantive unconscionability be at the same level. So, what are the two forms of unconscionability? Procedural unconscionability involves unfairness relating to the manner in which the contract was entered.  Factors influencing procedural unconscionability include: the lack of a meaningful choice at the time the contract […]

Insurance Agents Do Not Have a Duty to Advise Policyholder With Regard to Coverage

Fri Nov 30th, 2018 on     Insurance Claims,    

If you’re experiencing issues with regard to making an insurance claim, then you might be wondering about the liability of the insurance agent who marketed and brokered the contract in the first place.  In the event that you were misled or otherwise misinformed by your insurance agent, Florida law may entitle you to bring an action against them for damages as compensation for your losses.  Under certain (limited) circumstances, a failure to advise you as to what would be “ideal” or “sufficient” coverage may also give rise to a cause of action for damages. Let’s take a closer look. No General Duty to Advise Insurance agents do not have a general duty to advise prospective policyholders on what coverage they should procure.  Simply put, an insurance agent’s failure to advise you on what sort of policy you should ideally acquire is not actionable — the insurance agent need only explain the details of coverage and exercise care when selecting such coverage (at the direction of the client). Exceptions exist, however. Special Relationship May Be Created Under Limited Circumstances In Florida, if the insurance agent created a special relationship with the prospective policyholder above and beyond that of a normal insurance agent — for example, if they offered insurance advisory services to the policyholder — then there may be a duty to properly advise the prospective policyholder on coverage.  Failure to exercise reasonable care in this regard could expose the insurance agent to significant liability. Confused?  Consider the following. Suppose that […]

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