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Recent Court Decisions Could Impact the Insurance Industry

Fri Mar 29th, 2019 on     Insurance Law,    

In two recent decisions, Florida’s highest court has issued significant rulings relating to insurance law.  In both cases, the Supreme Court reversed the decisions of the lower appellate court and upheld the decisions of the trial court, which were favorable to the policyholders.  As Miami insurance law attorneys, it is our job to stay up-to-date on important legal and regulatory developments in the industry, particularly those that may impact our insurance law practice. Court Supports Jury’s Finding of Bad Faith Against Insurer Harvey v. GEICO involved the application of the law of bad faith, which imposes a fiduciary obligation on an insurer to protect its insured from a judgment that exceeds the limits of the insured’s policy.  The case arose from a fatal car accident in which the insured driver had limited coverage ($100,000) under his liability policy.  GEICO resolved the liability issue against the insured and tendered the policy within days of the accident but failed to promptly cooperate with the request of the victim’s attorney for a statement from the driver concerning the extent of his assets.  The estate of the victim returned GEICO’s check and sued the driver for wrongful death, resulting in an $8 million verdict against the driver.  Mr. Harvey then brought a bad faith action against GEICO. During the bad faith trial, the lawyer for the estate testified that had he known that the driver’s only other asset was a business account worth approximately $85,000, he would not have filed suit and would have […]

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 […]

What You Should Know About Sinkhole Coverage

Fri Mar 15th, 2019 on     Property Insurance,    

Florida has more sinkholes than any other state; thousands of sinkhole insurance claims are reported here every year.  Unfortunately, not all homeowners’ insurance policies provide coverage for damage to your home resulting from sinkholes.  Florida law, which defines a “sinkhole” as “a land form created by subsidence of soil, sediment or rock as underlying strata are dissolved by groundwater,” only requires insurance companies to cover “catastrophic ground cover collapse.”  What’s the difference between coverage for sinkholes and coverage for “catastrophic ground cover collapse?”  As Miami Property Insurance Lawyers, we have experience with both.  As for sinkhole coverage, while all insurance companies licensed in Florida must offer it, the coverage is usually an endorsement to an existing policy and costs an additional premium.  Moreover, insurance companies may require a property inspection before extending coverage, and if sinkhole activity is present on the property, or even within a certain distance of the property, the insurer may refuse to provide sinkhole coverage. If you do not purchase sinkhole coverage, or it is declined, the only coverage you have is for “catastrophic ground coverage collapse.”  Importantly, four conditions have to be met before this coverage kicks in.  They are: Abrupt collapse of the ground cover A depression in the ground cover clearly visible to the naked eye Structural damage to the building including the foundation; and The insured structure is being condemned and ordered to be vacated by the applicable government agency. All four of these criteria are necessary for coverage.  If, for example, […]

How To Communicate With Your Insurance Company

Fri Mar 8th, 2019 on     Insurance Law,    

Communicating with your insurance company can be challenging, particularly if you are in the middle of a crisis and need to report a claim.  Your emotions may be running high and you may not remember everything that is said in your initial conversation with the adjuster. What is more, you may say things about your claim in the heat of the moment that may be inaccurate or uninformed, as you may not have received any damage estimates.  Keep in mind that your calls with your insurance company are most likely recorded, so you want to avoid coming across as too emotional or too eager to settle under the insurer’s terms.  As Miami insurance law attorneys, we know how insurance companies work.  From documenting all your communications, to having the right attitude, how you communicate with your insurance company can impact how your claim is resolved.  Document Your Communications The most important thing to remember is to document every communication with your insurance company in a notebook or folder so you can easily keep track of the status of your claim.  Start collecting receipts and damage estimates as well and keep all of your notes and documents together in one place.  You should also create a paper trial by confirming what your insurance company has said by sending them a quick follow-up e-mail or letter.  This helps to avoid any misunderstandings about representations or promises made, whether about timing of the claims process or more substantive discussions about damage estimates and […]

Homeowner Claims: Know Your Basic Rights

Thu Feb 28th, 2019 on     Insurance Law,    

You may not know it, but if you have a Florida homeowner insurance policy, you have certain rights, as defined by the Florida Office of Insurance Regulation.  The FLOIR Bill of Rights sets forth a timeline for the claims process, as well as certain services you are entitled to.  The Bill of Rights also contains useful advice for claimants.  As a Miami Insurance law firm dedicated to representing the interests of policyholders, we are familiar with the Bill of Rights and the protections it outlines.  When to Expect a Response From Your Insurance Company When you report a claim to your insurance company, you have a right to receive an acknowledgment of the claim within 14 days.  Within 30 days after you submit a complete proof-of-loss statement to your insurance company, you have a right, upon written request, to receive confirmation that your claim is covered in full, partially covered, or denied, or receive a written statement that your claim is being investigated. Within 90 days, you have a right to receive full settlement payment for your claim or payment of the undisputed portion of your claim, or your insurance company’s denial of your claim. The Bill of Rights does state that there are exceptions to the timelines when conditions are “beyond your insurance company’s control.” What Services are Available to Assist You With Your Claim? Under most circumstances and subject to certain restrictions, you are entitled to free mediation of your disputed claim by the Florida Department of Financial […]

What Types of Insurance Should My Small Business Have?

Thu Feb 21st, 2019 on     Insurance Law,    

There are many different types of insurance coverage available to small business owners.  Knowing what you need will depend on many factors, including the type of services or goods you provide, where your business is located, its corporate structure, and the applicable state laws.  As Miami Insurance Coverage Lawyers, we can help you navigate the many options, as well as evaluate whether your current coverage is adequate.  First, here’s a summary of the most common types of insurance for business owners.  General Liability Every business needs to have a liability insurance policy.  This policy, often referred to as The Commercial General Liability Policy (or “CGL”), provides coverage to a business for personal injury and property damage caused by the company’s operations or products, or personal injuries to third parties that occur on the company’s premises.  Many insurers use what is known as the standard Insurance Services Office CGL form.  Property If you own your office building or have business personal property, such as office equipment or computers, you should consider having a policy that will protect you in the event of fire or theft.  You may also want to consider including business interruption insurance to protect your earnings if the business is unable to operate because of property damage. Professional Liability This policy, also known as Errors and Omissions Insurance, provides defense and damages for failure to or improperly providing professional services.  This is different than your general liability policy.  Professional liability insurance applies to any professional firm, including lawyers, […]

Demystifying the Commercial General Liability Insurance Policy

Thu Feb 14th, 2019 on     Insurance Law,    

A Commercial General Liability (CGL) policy protects your business from financial loss stemming from injuries or property damage caused by your operations (or products) or personal injuries to third parties that occur on the company’s premises. It covers non-professional negligent acts, while professional negligent acts (such as malpractice) are covered under a Professional Liability policy. In addition, injuries to employees on company property are covered by workers’ compensation, not the CGL policy. When issuing general liability policies, many insurers use standard forms published by the Insurance Services Office (“ISO”). In addition to the convenience of using standard forms, insurers are able to reduce their risk because much of the language contained in the forms has already been interpreted by the courts. Indeed, how a court interprets an insurance policy will be based in large part on the policy wording itself. CGL policies must therefore be read carefully, paying close attention to the specific language used.  Unfortunately, what the policy actually says is not always so straight-forward and clear, and there are certain aspects of CGL coverage that are often misunderstood. This post seeks to demystifies those areas. Duty to Defend First, the wording of the ISO CGL will not allow an insurer to simply tender its policy limit and not defend an insured. This may come into play when a catastrophic event occurs involving multiple injuries or losses.  The insurer cannot simply pay the policy limit and refuse to defend the claim. The insured’s duty to defend does not end […]

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 […]

Liability Insurers Have a Duty to Defend

Thu Jan 31st, 2019 on     Insurance Law,    

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 […]

Medical Devices and Health Insurance Denial

Thu Jan 24th, 2019 on     Health Insurance,    

Miami Health Insurance Lawyer Though healthcare insurance denials are common, many policyholders are shocked when they are denied benefits for having received a medical device at the behest of their treating physician.  In truth, healthcare insurers are built to deny as many claims as they can reasonably justify.  They profit and thrive on the expectation that you will not challenge their decision and that they will “get away” with not having to pay out the benefits that you might be owed. We can help. If you’ve had your healthcare insurance claim denied on the basis that your medical device is not covered by your policy, or for any other reason, then you may be entitled to challenge their initial decision and secure benefits.  Contact Ver Ploeg & Marino, P.A. for further assistance with your dispute. Let’s take a brief look at the basis for such denials. Medical Necessity Generally speaking, health insurers deny benefits for medical devices on the basis of medical necessity, which is a rather broad concept.  Every insurance policy is different, of course, and the definition of “medical necessity” can vary considerably from plan-to-plan.  Most share certain commonalities, however. Determining whether a device is medically necessary requires a comprehensive evaluation of factors: whether the use of such device is clinically appropriate, whether it has been provided in accordance with generally accepted standards of practice, and whether it is no more costly than competing devices or therapies that could produce an equivalent result. For example, suppose that you […]

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