Determining Business Interruption Losses

Fri Apr 27th, 2018 on     Insurance Claims,    

If you are covered by business interruption insurance, then you may find yourself in a particularly vulnerable situation when some event occurs that interrupts the normal flow of business and thus leads to unexpected losses.  A significant enough interruption to business can cause irreparable damage to one’s brand and reputation.  Depending on the nature and extent of the damage, submitting an insurance claim and successfully obtaining benefits may be fundamental to the continuance of the […]

Policyholders: Be Careful Not to Misrepresent Yourself on Your Insurance Application

Fri Apr 13th, 2018 on     Insurance Claims,    

In some cases, your insurer may deny your claim due to a specific misrepresentation in your insurance application — even if the misrepresentation at issue was not intentional and was merely a mistake borne of a simple misunderstanding. Material Misrepresentation as a Defense Insurers can use a material misrepresentation defense to avoid having to pay out for your legitimate insurance claims.  Oftentimes, an insurer will discover some mistake in your application and will anchor their […]

Common Justifications for the Denial of a Health Insurance Claim

Wed Feb 7th, 2018 on     Health Insurance,    

Insurers — whether in the health insurance context, or some other context — will look for any possible justification to support their denial of a policyholder’s substantial claims, however legitimate those claims may be.  Recent scandals plaguing health insurers have shaken the industry to its core and revealed that many health insurers do not enforce their guidelines or properly supervise their assessors, which can lead to systemic wrongdoing. If you have a legitimate health insurance […]

Insurers Must Process Claims Within a Reasonable Timeframe

Fri Jan 12th, 2018 on     Insurance Claims,    

Florida insurers owe a duty of good faith to their policyholders.  Essentially, Florida law (as is the case in various other jurisdictions throughout the country) requires that insurers avoid acting purely out of self-interest in handling the claims filed by their policyholders.  In processing the claims filed by their policyholders, insurers must act with a degree of care and diligence akin to that a reasonably prudent person who is managing the affairs of their own […]

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 — […]

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 […]

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 […]

Six Things to Know About Making Storm-Related Insurance Claims

Mon Sep 25th, 2017 on     Insurance Claims,    

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 […]

Florida-based insurance class action lawsuit settles for $39M

Mon May 1st, 2017 on     Insurance Claims,    

Anyone who has ever been involved in what proves to be a relatively minor car accident knows that one of the biggest headaches from the entire ordeal comes from the damage to their vehicle.

Indeed, the headache rapidly reaches migraine proportions if their vehicle, which was otherwise in good working order, was totaled, such that they’re left looking for a new means of suitable transportation.

Insurance concerns from Hurricanes Hermine, Matthew linger

Mon Dec 12th, 2016 on     Insurance Claims,    

At this time of the year, most people are focused on preparations, gatherings and all things holiday-related. Indeed, it’s probably safe to say that the last thing on the minds of many Floridians are the two major hurricanes that hit the state this past fall — Hurricane Hermine in September and Hurricane Matthew in October.

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