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The Insurance Claims Process: A Few Things You Need to Know

Tue Aug 17th, 2021 on     Insurance Claims,    

When tragedy strikes, it helps for a policyholder to understand the process of filing a claim, including their obligations, the obligations of the insurance company, and what they can expect to happen. A Miami insurance claim lawyer can be a valuable resource throughout this confusing process as they are able to assist the insured in recovering the compensation they are owed.

Obligations of the Insured

Persons and entities are required to comply with certain obligations pursuant to the terms of their policy and governing law. First and foremost, the insured is required to pay a premium to the insurance company for their coverage. Other key obligations include:

  • Truthfully and completely answering all questions of the insurance provider prior to the issuance of the insurance policy
  • Prompt notification to the insurer of the incident that gives rise to the claim
  • Prompt notification to the insurer if they are sued or receive notification from another that a claim will be made
  • Mitigate loss whenever reasonably possible (e.g., If the claim is based on a leaky pipe, the home or business owner should take reasonable steps to stop the leak)
  • Cooperation with the insurance company as they conduct their investigation
  • Truthfully responding to the questions and inquiries made by the insurance company

Retaining a Miami insurance claim lawyer to assist with the obligation to respond to the insurance companies inquiries can be beneficial to the policyholder as it ensures the rights of the policyholder are protected throughout the process.

What is Expected of the Insurance Company?

Insurance companies in Florida have implied and statutory obligations that they owe to their insureds. These include the following:

  • Investigation: The insurance company must conduct an investigation when a claim is made.
  • Timeline Compliance: According to the type of claim made, there are certain timelines with which insurance companies are statutorily obligated to comply.
  • Prompt payment: When a claim has been approved or settled, the insurance company must pay promptly.
  • Explanation of Denial: If the insurance company denies a claim, they are required to provide the insured with a written explanation of why the claim has been denied.
  • Duty to Defend: When the insured is sued, the insurance company is required under the terms of the insurance policy to “step into the shoes” of the insured and provide them with a defense.
  • Duty to Indemnify: When the insured has been sued, and the matter has been settled or a judgment entered, the duty to indemnify requires the insurance company to pay the judgment or settlement on behalf of the insured.

Our Miami Insurance Claim Lawyer Explains How Long an Insurer Has to Pay a Claim 

The amount of time an insurance company has to pay a claim can vary according to the state of jurisdiction as well as the type of claim that is being made. Following are general timelines for insurance claims in Florida. However, it is important to note that there may be circumstances in a particular case that cause it to be delayed beyond the time limits listed below.

Auto Accidents

An insurer has 64 days to pay or settle a claim. This is broken down as: 

  • 14 days to acknowledge the claim and provide the necessary paperwork to the claimant;
  • 30 days after documentation is received to make a decision on the claim;
  • 20 days to pay if the claim was approved (or settled).

Homeowner’s Insurance Policy Claims

An insurance company has 90 days to decide whether or not to pay a claim made under the homeowner’s insurance policy, and if the decision is made to honor the claim, an additional 20 days is allowed to make the payment. 

Our Miami Insurance Claim Lawyer Discusses Your Options When Your Claim Is Denied

If you’re dealing with a weather event that has caused damage, you are undoubtedly turning to your insurance company to get the compensation you so desperately need to rebuild. However, all too often, claims are denied. When a claim is denied, the first step is to determine why. If this information is not provided voluntarily by the insurance company, ask that it be provided in writing. Denials can be due to any number of reasons, including:

  • Failure to properly notify the insurance company of the claim
  • The claim exceeds the maximum coverage allowed under the policy
  • The damage the claim is based upon is either fully or partially the fault of the claimant
  • Not enough evidence supporting the claim was provided to the insurance company

When a claim has been denied, and an explanation of the denial has been received, the next step is to review the policy to determine if the insurance company has been correct in its denial. If the claimant is unsure if the claim was correctly denied, or if the denial is in blatant violation of the policy terms, it is best to speak with a Miami insurance claim lawyer as an appeal will need to be filed. Even in situations where it appears the matter could be easily remedied, such as submitting a report to bolster the claim, it is important to remember that appeals are time-sensitive and must be handled in a way that is legally compliant. Promptly retaining a skilled attorney is the best option. 

Our Miami Insurance Claim Lawyer Is On Your Side

When the unexpected happens, it is common for a policyholder to have questions about their policy and what they can expect to happen. At Ver Ploeg & Marino, our attorneys have decades of experience helping policyholders recover from life’s unexpected moments. Contact our office to speak with a Miami insurance claim lawyer.

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