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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 […]

6 Ways Insurers Act in Bad Faith

Fri Feb 12th, 2021 on     Bad Faith Insurance,    

Hire an Experienced Miami Bad Faith Insurance Attorney   If you’ve submitted a claim for insurance benefits and have had those benefits denied, undervalued, or delayed (or have perhaps had the insurer refuse to step in and defend you against third-party litigation), then you may be entitled to challenge the insurer’s decision under Florida law. In some cases, the insurer has violated its obligations to you — the policyholder — to such an extent that it qualifies as bad faith misconduct.  Bad faith claims can give rise to independent compensation, and even bonus punitive damages.  If you believe that your insurer has acted in bad faith, it’s worth exploring your legal options. Here at Ver Ploeg & Marino, P.A., we encourage you to contact an experienced Miami bad faith insurance attorney at our firm to schedule a consultation. For now, let’s explore some ways in which insurers act in bad faith. Insurer Had No Reasonable Basis for Their Denial Insurers may not be held liable for bad faith if they simply made a mistake.  As such, the mere fact that they “denied” your claim is not justification for a bad faith lawsuit.  Instead, you will have to show that they had no reasonable basis for denying your claim. This can be a bit of a challenge. For example, an insurer who denies your claim on the basis that you did not submit sufficient evidence may have reasonably denied it, even if your claim is legitimate — once you provide the […]

Common Boat Insurance Exclusions

Fri Jan 29th, 2021 on     Insurance Claims,    

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 could impact your ability to secure compensation. Consider the […]

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 […]

Prompt Notice Issues in Property Insurance Claims

Thu Dec 31st, 2020 on     Property Insurance,    

Let our Experienced Miami Insurance Claim Lawyer Help Today In many cases, property insurance claims are denied because the insurance carrier argues that the policyholder failed to provide “timely notice of the loss” — even in extreme situations involving hurricane damage.  Lack of prompt notice is a common excuse justifying claim denial, but it can be somewhat confusing and stressful for policyholders — after all, at what point does a delay go from reasonable-to-unreasonable? Given the complexity of prompt notice issues, we encourage you to contact an experienced Miami insurance claim lawyer here at Ver Ploeg & Marino, P.A. for guidance.  We are committed to thorough, client-focused advocacy.  Our team will help you navigate the dispute and secure the benefits you deserve. It’s worth noting that Florida law is relatively policyholder-friendly.  Though you should always seek to provide notice without delay, minor (and sometimes even major) delays do not necessarily justify a claim denial.  There are a number of persuasive arguments you can make to overcome the insurance carrier’s excuses. Let’s take a closer look at prompt notice as a concept under Florida law. Prompt Notice Requirements Under Florida Law In Florida, property insurance policies require prompt notice of the claim to the insurance carrier.  Failure to provide prompt notice will result in a forfeiture of benefits that might otherwise have been available. There are two aspects to a violation of the prompt notice requirement: Lack of timely notice of the claim to the insurance carrier, and The insurance carrier […]

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 […]

A Florida Insurer’s Duty to Defend — Frequently Asked Questions

Mon Nov 30th, 2020 on     FAQs,    

Let Our Miami Insurance Coverage Lawyer Help If you are a Commercial General Liability (CGL) policyholder, then you may be feeling a bit lost if your insurer has refused to defend you in the underlying litigation.  After all, you purchased insurance coverage in the hopes that — should a third-party sue — you would have a reliable ally to defend you and cover your losses. In Florida, CGL insurers have a duty to defend their policyholders when the underlying litigation involves covered claims.  Despite this broad duty to defend, insurers often take the position that they are not required to step in to defend the policyholder — they are likely to argue that the claims are not covered by the policy. This can put the policyholder in a vulnerable position.  They may not have the financial resources necessary to pay for legal assistance out-of-pocket, and may therefore be resigned to an unfavorable settlement with the plaintiff.  Worse still, paying for CGL insurance coverage would have been a waste. Fortunately, an insurer’s refusal to defend you in the underlying litigation can be challenged with the help of an experienced Miami insurance coverage lawyer. Here at Ver Ploeg & Marino, our team has decades of experience working with policyholders to secure their rights — including their right to have their insurer step in and defend them in the underlying litigation.  We are committed to client-focused representation and work closely with our clients at every step of litigation to meet their needs and […]

Common Issues in Fidelity Bond Coverage

Mon Nov 16th, 2020 on     Insurance Law,    

Seek Guidance From a Skilled Miami Insurance Coverage Lawyer   Fidelity bonds are a form of insurance coverage that pays out for losses caused by crimes perpetrated by employees (and other related individuals/entities) against your business.  For example, fidelity bond insurance coverage would pay out for losses caused by an accountant who commits fraud while working at your company. Fidelity bonds are an important tool, not only to protect your business from employees and others who could undermine the business but also to avoid the serious interruption to business operations that might occur if you’re forced to pursue recovery directly from the problematic employee. Unfortunately, despite the fact that fidelity bond coverage is intended to “kick in” at a time when the business owner may be financially vulnerable and feeling betrayed by their employees, insurers may deny or undervalue claims.  You need not resign yourself to this underwhelming or adverse result, however — with assistance, you can challenge the decision and obtain the benefits to which you’re entitled. If you would like to get in touch with a qualified Miami insurance coverage lawyer, we encourage you to contact the team here at Ver Ploeg & Marino to schedule a consultation at your earliest convenience.  Coverage disputes are common, and can put immense financial and psychological pressure on the policyholder — after all, you no doubt purchased insurance coverage under the impression that you could “rest easy” and rely on it to cover the losses you sustained. Here at VPM Law, […]

E&O Insurance Coverage FAQs

Fri Oct 30th, 2020 on     FAQs,    

Work with Skilled Miami Insurance Law Attorneys   Errors and omissions (E&O) insurance is a necessity for many professionals who engage in high stakes work that could lead to third-party misconduct claims.  For example, a real estate broker may find it necessary to purchase E&O insurance, as they could be on the hook for damages if they sell a house and fail to disclose certain construction defects that would be relevant to the new homeowner. Mistakes happen.  Though you may be a high-performing professional who does very well relative to the competition, flawless performance is not realistic.  E&O insurance coverage is meant to cover those “gaps” in performance that could lead to a professional misconduct claim for damages. The problem is that E&O insurers often refuse to “step up to the plate” when a claim is brought.  The insurer may deny the claim and argue that they have no duty to defend you in the underlying litigation.  This can be quite a shock — after all, you were relying on the insurance company to take steps to protect you from harm. Professional misconduct accusations can be frightening, overwhelming, and disruptive to one’s life and reputation.  Here at Ver Ploeg & Marino, P.A., we understand just how frustrating it can be to navigate these complex emotional and professional issues while the insurer you were supposed to be able to rely on is refusing to provide the support you need. It is important to us that we resolve your claim efficiently and […]

Common Homeowner’s Insurance Concerns

Fri Oct 16th, 2020 on     Homeowners Insurance,    

Experienced Miami Insurance Litigation Lawyer   Homeowner’s insurance coverage pays out for property loss — generally caused by natural events, such as a flood or a hurricane, or a fire.  Various other property losses may also be covered, depending on how comprehensive the coverage is. However, homeowners often feel confused as to what they can or should do after they have suffered a loss.  This is perfectly natural.  There are many strategic complexities to homeowner’s insurance coverage, and the correct approach to pursuing a claim is not always clear — especially for those who have minimal experience in navigating negotiations and disputes in this context. As such, it is important to consult an experienced Miami insurance litigation lawyer for guidance on how to proceed. Here at Ver Ploeg & Marino, P.A., our team of attorneys have represented insurance policyholders for decades, helping them to secure the benefits to which they’re entitled (and recover damages through litigation, when necessary).  We encourage you to contact us as soon as possible to schedule a consultation. For now, let us briefly explore some common homeowner’s insurance issues that you may encounter in the wake of a property-related loss. Rising Premiums Many homeowners — even if they feel they have a legitimate claim to submit for property loss under their policy — are worried about submitting a claim and in doing so, raising their premiums. This is a common problem faced by homeowners, and reasonably so, as there may be confusion as to 1) the amount […]

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