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Issues With Insurance Contract Interpretation in Florida

Fri Apr 16th, 2021 on     Insurance Claims,    

Hire an Experienced Miami Insurance Claim Lawyer  

If you’ve submitted an insurance claim and been denied by your insurer or had your claim undervalued, then you may be able to challenge this adverse decision and secure a favorable outcome. Let a Miami insurance claim lawyer help.

Insurance companies generally write their contracts in such a way as to give themselves an advantage.  They may write provisions that help them circumvent having to provide coverage (except in highly specific, limited scenarios), or may otherwise write ambiguous provisions intended to confuse policyholders and to justify the denial of a legitimate claim.

Fortunately, Florida lawmakers are well aware of these tactics and have — to at least some extent — enshrined protections that enable policyholders to “fight back” and get put on an even playing field.

Given the complexities of insurance contract interpretation and the challenges of a related dispute, we encourage you to get in touch with an experienced Miami insurance claim lawyer here at Ver Ploeg & Marino, P.A.  We are standing by to help you identify the next steps.  Contact us today.

Let’s explore some of these basic issues, and how you (the policyholder) can secure a favorable outcome despite the manipulations of the insurance company.

Ambiguity and the Policyholder Advantage

Ambiguous provisions in insurance contracts seemingly give the insurance company an advantage — the insurer may attempt to justify their denial of your claim by pointing to ambiguous language in the insurance contract and by arguing that their interpretation of that provision is the correct one.

For example, a home insurer might argue that the “definition” of a covered event in the insurance contract does not include flooding, even though the covered event definition includes hurricane damage (which, ostensibly, would lead to flooding in many cases).  This ambiguity could be used as justification for denial.

Florida law is clear, however: ambiguous provisions in insurance contracts must be construed against the insurance company.

Whether a particular contract provision is ambiguous is a fact-based question.  Generally speaking, Florida courts acknowledge that a provision is ambiguous if its terms can be reasonably interpreted in more than one way.  That a provision is confusing to you is not necessarily proof that it is ambiguous.  It must be open to reasonable interpretation in a variety of ways.

In any case, if the provision is ambiguous, then your interpretation (as the policyholder) will win out.  The insurer is counting on you to “not” challenge their interpretation, as they are aware that an ambiguous provision will be interpreted in your favor.  For that reason, it’s critical that you consult with a qualified attorney for guidance on whether your insurance contract contains ambiguous language, and how best to proceed.

Other Considerations — Fraud/Misrepresentation

It’s worth noting that some contracts are simply unenforceable.  Consider fraud or misinterpretation.

Suppose that you enter into an insurance contract for home insurance.  In an attempt to get you to sign on, the insurance agent claims that the coverage is comprehensive and will cover flooding (even if the language does not allow for such coverage).  You trust the insurance agent, and on the basis of their representations, you decide to sign on.

If the insurance company denies your insurance claim for damages (due to flooding), you could ostensibly sue and recover damages due to fraud/misrepresentation, as you relied on the insurance agent’s representations — which were ultimately false.

Misrepresentation is rather common, though it can be difficult to prove.  Courts will need to see evidence that the insurer made certain promises during the sign-on process, and that you relied on those (false) promises to make your decision to enter into the insurance contract.  As this can be difficult to prove, it’s important that you keep good records of your interactions with the insurer, both before signing onto an insurance contract and afterward.

Though some policyholders shy away from litigation, it’s worth noting that litigation may be a sensible option in cases involving fraud or misrepresentation — this is especially true as the misconduct of the insurer can serve as a justification for punitive damages.  Punitive damages are essentially “bonus” damages that multiply the original damages amount by up to seven times.  For example, if you are attempting to sue your insurer to recover $100,000, a punitive damages award could be up to $700,000, for a total $800,000 recovery.

As punitive damages have such significant potential, they are almost always worth pursuing where possible.  Pushing for punitive damages early can also put the insurance company into a defensive posture, forcing them to consider an early settlement that favors you.  If they do not consider an early settlement, they could open themselves up to an extremely negative outcome in litigation.

Contact a Miami Insurance Claim Lawyer at VPM for Legal Assistance

Ver Ploeg & Marino, P.A. is a Miami-based insurance litigation firm, with a focus on providing efficient, client-oriented legal representation and achieving positive results.  Our team is more than capable of obtaining these results at every phase of litigation, whether in initial settlement negotiations or trial.

Over the years, our team has developed a trial-ready approach to navigating insurance disputes.  This approach has brought us significant success, as we are often able to leverage our understanding of the case at hand to pressure the insurer into settling the claim.

Unfortunately, insurers often take advantage of policyholders by writing ambiguous or otherwise problematic contracts.  This can surprise policyholders who may not have been aware (when they entered into the insurance contract) that they were being put at a disadvantage.

We’re here to help.

If you’d like to speak to a seasoned Miami insurance claim lawyer about your dispute, we encourage you to contact us to schedule a consultation at your earliest convenience.  We look forward to speaking with you.

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