News & Resources

Miami Insurance Law Firm Liability insurance coverage is purchased to avoid the significant risks associated with a lawsuit, but insurance coverage does not always work out in a way that the policyholder might expect.  Insurers maximize their profits by minimizing their time investment and other costs.  It should therefore come as no surprise that liability insurers frequently deny coverage and skirt their plan-based responsibilities.  This can put the policyholder in an incredibly vulnerable position, particularly if they do not have the assets necessary to resolve their liabilities without coverage. Among the insurer’s responsibilities is the “duty to defend.”  Let’s take a closer look. Understanding the Duty to Defend Duty to Defend Requires Coverage Liability insurers are not required to step in and defend policyholders against third-party claims unless coverage would apply in the situation at-hand.  The legal duty only activates in situations where the insurer could be responsible for the damages. For example, suppose that you have purchased a marine liability insurance policy.  The policy precludes coverage in situations where you were intoxicated at the time of accident.  If your insurer is not “on the hook” for damages due to your intoxication, then they have no duty to defend you in litigation against the third-party claimant. Bad Faith Conduct In Florida, insurers may be held liable for their bad faith conduct in relation to the duty to defend.  Insurers may act in bad faith in a number of different ways, including the refusal to step in and defend their policyholder […]

Miami Insurance Law Firm If you’re being sued by a third-party due to them having suffered injuries in an accident that could implicate your commercial general liability (CGL) insurance coverage, then you may find yourself facing new and unexpected challenges. Insurers have a tendency to deny claims when they can just barely justify doing so, even if they are making bold and unsupported assumptions.  In the CGL insurance context, this often happens with regard to intentional misconduct.  If the insurer can paint your behavior as intentional misconduct, and not merely negligence or recklessness, then they can legitimately deny your claim and avoid having to payout. Intentional misconduct is typically not covered by CGL insurance.  As such, the key to recovering your benefits is in clearly establishing that the conduct at-issue does not demonstrate intent. Intent Can Be Difficult to Prove Unless the circumstances clearly indicate an intent to violate the law or otherwise cause harm, then the insurer may find that painting a picture of your conduct as intentional is quite difficult.  For example, suppose that the defendant slips and injures themselves in your retail store.  Your insurer is refusing to payout for the damages, however, because they believe that the injury was caused by your intentional misconduct — that you wanted to hurt the customer, so you spilled water on the floor to cause them to slip and fall.  In order for the insurer to prove that you intentionally caused the injuries, they’d have to find evidence of your […]

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 […]

If you have had your insurance benefits claim denied or otherwise mishandled by your insurance company, then you’re entitled to challenge the adverse determination made by your insurer under Florida (and federal) law.  It’s important to note, however, that the procedures and limitations applicable to your case will be somewhat different than the “standard” if your insurance benefits policy is ERISA-governed. The Employment Retirement Income Security Act (ERISA) is a federal regulatory scheme that establishes a unique set of standards, protections, and limitations that are applicable to qualified plans (e.g. all private insurance benefits plans that are provided or sponsored by one’s employer, so long as it is a non-religious organization). Among the unique requirements imposed by ERISA is that of “administrative remedy exhaustion.”  Those looking to claim benefits under an ERISA-governed plan are likely to encounter this limitation. Let’s take a look at some of the basics. ERISA Remedy Exhaustion Basics If your claim has been denied — or if you have been subject to some other serious and adverse determination (i.e., undervalued claim, award of partial benefits as opposed to full benefits, etc.) — then you may challenge the insurer’s decision, but ERISA requires that you go through an internal process known as the “administrative appeals” process. More specifically, ERISA requires that claimants first exhaust their administrative remedies available under their plan — the internal appeals process — before bringing a lawsuit in civil court.  In fact, claimants are not legally entitled to bring a lawsuit until they […]

Whether you’re a policyholder in a health, disability, or property insurance plan, it’s possible that you will encounter — or have already encountered — some blowback when it comes time to submit a claim for benefits.  Insurers are fundamentally incentivized to deny, undervalue, or otherwise mishandle claims so that they can minimize their own costs.  This is particularly true in situations where an important coverage-related provision of the contract is ambiguous and therefore open to interpretation. In many cases involving an adverse determination by the insurer, the policyholder-claimant is taken by surprise — after all, the policyholder may have interpreted an ambiguous provision quite differently than the insurer. Let’s take a look at how benefits disputes associated with such ambiguities are resolved. Interpreting Ambiguity in an Insurance Policy If you believe that your insurance policy contains an ambiguous provision that is being misinterpreted by the insurer in an effort to deny your rightful benefits, then it’s important that you don’t despair — it’s not necessary that you resign yourself to insurer’s decision.  Florida law imposes beneficial rules that protect you in circumstances where ambiguous insurance provisions are being misinterpreted or misused. Favoring the Claimant In Florida, ambiguous insurance provisions are strictly interpreted in favor of the insurance claimant — the courts must interpret any genuine ambiguities against the interests of the insurance provider. Suppose, for example, that you are a property insurance policyholder, and your plan contains an exclusion clause that is somewhat ambiguous.  Perhaps the clause prevents you from […]

If you have had your insurance benefits claim — disability, health, property, etc. — denied or otherwise subject to an adverse determination, then you are entitled by law to challenge the insurer’s determination.  Generally speaking, your plan will determine many of the protections and limitations relevant to your benefits claim (and any subsequent challenge). Policies that are ERISA-governed, for example, require that the claimant first exhaust their administrative remedies — by going through an internal appeals process — before bringing a civil action against the insurer for benefits and other damages. In situations where the policy is not ERISA-governed, by contrast, claimants are not bound to go through the internal appeals process.  They may choose whether to bring a civil action against the insurer, and in fact, many claimants choose to do just that instead of dealing with the additional hassle of the internal appeals process.  Pursuing a lawsuit puts immediate pressure on the insurer to reconsider their earlier decision and payout the benefits that you’re owed. Consider the following. Review Not Conducted by a Neutral Third-Party In many cases, those policyholders who have had their benefits claim denied (or otherwise been subject to adverse determination) choose to go through the internal appeals process with the intention of minimizing the time, cost, and complication they associated with litigation.  The policyholder may also not be comfortable with approaching an attorney for assistance until they have navigated the internal appeals process first. In truth, however, the internal appeals process can be something […]

Though Florida employers are well aware of the standard discrimination and retaliation prohibitions that restrict their ability to discharge and otherwise punish employees for their actions — such as reporting discrimination in the workplace — there continues to be something of a blind spot when it comes to the exercise of ERISA-related rights. Those who exercise their ERISA-related rights may therefore find themselves subject to unexpected retaliatory action, despite the fact that it is prohibited by law.  Fortunately, ERISA offers such employees the opportunity to bring an action against their employer for various damages, an injunction, and a reinstatement of benefits. Consider the basics. Employment Retaliation is Prohibited Under ERISA Section 510 of the Employee Retirement Income Security Act (ERISA) clearly prohibits retaliation against any ERISA plan participant (i.e., covered employees) who exercise their ERISA-related rights, such as pursuing the benefits to which they’re entitled under their applicable plan. Retaliation is rather common, particularly in situations where the exercise of ERISA-related rights could expose the employer to additional costs, or where it could reveal that the employer has acted in bad faith, perhaps by violating their fiduciary duties to plan participants.  For example, if you are injured and are making a significant disability benefits claim under your ERISA-governed plan, then your employer may attempt to terminate you from your position or otherwise “force you out” in an effort to prevent you from exercising your rights and receiving the benefits at-issue. What Qualifies as Retaliation? If you bring a claim against […]

Most businesses in Florida and elsewhere purchase some form of commercial general liability (CGL) insurance coverage so as to avoid the potentially disruptive effect of a personal injury lawsuit brought against the business. For example, a small retail business with few assets may only have enough funds to cover costs — if a customer slips-and-falls on the premises, and thus severely injures themselves, then the ensuing lawsuit could seriously disrupt (and even bankrupt) the business. CGL insurance coverage is fairly expansive, and covers all damages associated with the policyholder’s negligence (in a business context).  As a CGL policyholder, however, you may find that the insurer denies coverage due to an exclusion of which you were not fully aware. In fact, certain exclusions are rather common in the CGL insurance context, so it’s important to take them into consideration when submitting a claim (and ultimately, when challenging the adverse decision of your insurer). Consider the following. Intentional Acts Generally speaking, intentional acts are not covered by CGL insurance — only negligent acts are covered.  For example, if you have a negative relationship with a particular customer, and in a bout of anger, you shove the customer to the ground and cause them to suffer injuries, then your CGL insurer will likely avoid a payout due to the intentional nature of the act at issue. No Business Pursuit Involved CGL insurance policyholders are not entitled to submit a claim for benefits for liabilities sustained in a situation that is unrelated to their […]

As we’ve documented on this blog, the state’s infamous personal injury protection or no-fault requirement, which mandates that all Florida drivers must carry a minimum of $10,000 worth of medical coverage to cover injuries regardless of liability, has long been the subject of scorn, with detractors calling it an unnecessary system that facilitates fraud and results in higher auto insurance premiums.

As we’ve also discussed on our blog, the PIP requirement has nevertheless managed to hold on for nearly 40 years now despite a cavalcade of bills being introduced over the years calling for its elimination. Recent reports suggest, however, that the end of PIP is perhaps now closer to becoming a reality than ever before.

There are certain attractions here in Florida that hold universal appeal, meaning chances are good that you’ll go out of the way to pay them a visit regardless of whether you’re a resident, a tourist or even a snowbird. While this, of course, includes the major theme parks, spring training complexes and miles of sandy beaches, it also means historic sites, nature preserves and even animal sanctuaries.

Indeed, our state’s perpetually sunny skies and temperate conditions make it a prime location for animal sanctuaries hosting all manner of mammals, reptiles, fish, insects and birds.