Articles Posted in Bad Faith

As Florida life insurance lawyers we understand that losing a loved one can be overbearingly stressful. Dealing with the loss of a loved one can often times become even more stressful if he or she had life insurance and the claim is being delayed or denied payment. There are many reasons as to why an insurance provider may deny and or delay the payment of such a claim. It is important to know that after a policy has been in effect for 2 years, your insurance company cannot contest to the validity of the policy for any reason other than the failure to pay premiums. If a policy has not been in effect for two years then the insurance company may and will most likely attain medical records to confirm the validity of the application as it was completed and answered by the deceased. It is when the insurance company finds any errors in the initial application that they may in fact deny or delay payment as a result of misrepresentation.

If you have been denied or delayed payment on a life insurance claim, the first step is to review the initial application and remove any possible defense for misrepresentation, if it was in fact that the application was completed without error and or concealment. In the event that the deceased person listed the incorrect age or incorrect gender on his or her application, the insurance carrier is typically allowed to recalculate benefits and/ or premiums based upon the applicant’s true age or gender. A life insurance claims attorney can at this time properly asses, review and determine the value of your claim and the money that you are entitled to, should there be an error that was discovered in the initial application. Acquiring this representation is beneficial and at time crucial if the insurance company is wrongfully listing the cause of death as a suicide. Most insurance policies state that if the insured dies as a result of suicide or self-inflicted injury during the first 2 years of the contract, the death benefit is to be limited to the total premiums paid by the insured. However, the insurance company must prove that the death was caused by suicide or self-inflicted injury, and not by other causes.

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Aside from living in South Florida and dealing with tropical storms, hurricanes, sinkholes, and the occasional tornado, property investors seem to be more concerned about their tenants and possible liabilities and claims that can be brought against them more so than the previously mentioned catastrophes. Even with the threats that loom over property owners some dissuade the threats and protection against potential liabilities and still choose to not insure their property. In some cases the property owner has every intent to be protected against such catastrophes but unbeknown to them are being underinsured. It is important that not only property owners investing in rental properties, but all property owners for that matter are educated in the types of policies and coverage that will best fit their needs in order to avoid being under insured, avoid having a claim denied and or have a claim short paid. As South Florida property insurance attorneys we stress the importance of knowledge in this field to not only our clients but the general public in hopes of avoiding situations that can prove to be much more costly to the property owner in the long run.

Some property owners are under the impression that a basic HO3 Homeowners insurance policy will be sufficient if they suddenly decide to rent out their home. Not only is this a violation and exclusion under many homeowners insurance policies, but this leaves the property owner at risk of not being insured, should an event call for such protection. Having a separate land lord policy tailored specifically towards rental properties is essential. Yes, your homeowners insurance covers your property if it burns down, your possessions if there is a theft, and medical and legal bills should someone get injured on your property, but the problem is, that homeowner’s insurance might not offer protection if you decide to rent out your home; Landlord insurance does.

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As homeowners recuperate after a 19 percent statewide insurance rate increase that was implemented in mid 2011, Insurance premiums are expected to once again hike up across Florida as several carriers request a rate hike. For some Insurance carrier’s specifically private insurance companies, this will be the sixth rate hike in 2.5 years. Many homeowners find themselves troubled by this news and many are left with questions as to what may constitute continued increases in their premiums. What makes this situation especially troubling for some is that many homeowners have bundled policies that would make switching to another homeowner’s insurance provider a much greater burden, but what in fact is the cause of these increases and are these increases justifiable? As Miami insurance loss attorneys we understand the difficulties of raised premiums.

As experienced South Florida homeowner insurance attorneys we can list several contributing factors that lead to an increase in rates, one of them being the sudden recent increase of policies issued to the private market by and through State held and ran Insurance providers. With no recent Hurricanes, companies still wish to build cash reserves to prepare for a large claim event and this is primarily done through reinsurance. Reinsurance can prove to be extremely costly for consumers when compared to other ways of hedging in preparation for a large claim event. The fact of the matter is that after the devastating 2004-2005 hurricane season that hit Florida the cost of reinsurance dramatically increased. The cost of reinsurance is not the only contributing factor to increases in premiums, the rise of insurance fraud specifically in South Florida has caused many insurance companies to increase their premiums in order to cover such losses.

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As Miami homeowner’s insurance claims attorneys we often encounter issues with the endorsement of insurance proceeds by a bank. This often occurs when there is a foreclosure occurring or the homeowner is in arrears/late with mortgage payments. Most insurance proceeds checks related to homeowners claims have multiple parties on them. This is usually an issue, unless the property that is insured is owned free and clear. Most bank drafts will include your mortgage company or companies. Things can get really complicated when there is a second mortgage. This will require multiple endorsements, which can become quite a headache.

Many mortgage companies require you to begin work and once these start, then they will send parts of the proceeds piecemeal fashion, until the repairs are completed. Matters can be more difficult if you have a public adjuster involved. This would mean that there is another interested party involved. Therefore, the insurance company has a duty to name the adjuster or adjusting company on the insurance draft as well. Some insurance checks/drafts may have as many as four or five interested parties.

So what happens if you are in foreclosure or in arrears and you are having a problem getting endorsements and thus have no access to proceeds. In many cases, since interested parties cannot agree as to disbursement, then the proceeds remain in the control of the insurance company. Note, the insurance company has no interest in dealing with endorsement and disbursement issues. This is not their arena or role.

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Accidents can occur anywhere. As south Florida trip and fall attorneys we are aware of these dangers. A trip and fall accident can occur when there is a change of a surface level in a certain location and there are no markings to denote it. If there is a change in level there should be reflective tape or another mechanism that will make it easy for the eye to detect. Failure to take preventive measure may amount to negligence or lack of care on the part of the premises owners.

Slip and falls usually occur on a slippery surface. The surface can be slippery due to a liquid on the floor or perhaps recent polishing. If an area is slippery it should be clearly marked so that patrons know to avoid the area. Failure to warn or to contain the area can be tantamount to negligence or lack of care. Certain steps should be taken after a trip/slip and fall:

1) It is important to stay in the area where the fall occurred and wait until trained medical professionals can attend to your injuries.
2) It is important to make a record of the trip or fall on the scene of the accident. This can be accomplished by having an employee of the premises make a report. If EMS comes out, then they will produce a report of the incident as well. Generally, it is not wise to leave the scene of an accident without production of a report by an employee of premises or EMS.
3) If possible, have someone a friend or relative take pictures of the scene. This may help document the circumstances of the fall.

These all may seem like common sense. However, in a state of emergency these things are often forgotten. As Miami-Dade slip and fall attorneys we are well aware of this. Taking measured steps in such situations is uncommon. Nonetheless, keep in mind that a nearby friend of relative can assist as well.
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There are plethora of types of insurance coverage. For example, car insurance, motorcycle insurance, boat insurance, life insurance, homeowner’ s insurance, business interruption insurance, disability insurance, health insurance, among many other types of coverage. Occasionally, disputes arise as to coverage of a loss. This dispute can take various forms. A common dispute is whether a certain loss is covered under the policy. Insurance policies tend to have a number of exclusions. South Florida Insurance attorneys can help review you policy and determine your rights.

It is important to study and understand what a certain policy entails. You may want to ask your insurance agent and also hire an attorney to make sure your interests are covered as per your requirements. It is also paramount to understand what your duties are under a certain policy. Disputes often arise as to whether a policy holder complied with post loss requirements. This means that an insurance company may be arguing that a policy holder did not cooperate with an investigation or provided all the information required.

An insurance company may stipulate that a loss is covered, but that certain elements of the loss are not covered. Further, an insurance company may argue that a loss is covered, but that their evaluation of the loss is different. This is not to say that insurance companies always act unfairly. However, presenting a claim to an insurance company may not be easy for someone with little experience. Many claims need experts to be able to evaluate and present a loss to an insurance company. As Miami insurance dispute attorney’s we can help present these claims.

A Florida Insurance dispute lawyer can assist you make a compelling claim to your insurance company. We can make sure that your loss is properly evaluated, documented, and that you comply with all requirements under the policy. This process does not have to be adversarial in nature. Often both parties can come to agreement without the need of Court intervention. However, if not agreement can be reached, then Court intervention is always an option.
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There are about 114,716,356 households in the United States. These households pay about $70 billion in premiums on a yearly basis. About 7% of these homeowners make claims in any given year and these claims usually average to about a value of $8,311. About 2.3% of all claims result from wind and hail damage and 1.52 % results from water damage. As South Florida homeowner’s insurance attorneys we find water damage to be the most common cause of loss. There are probably about 70,000 to 80,000 Florida homeowner insurance claims per year. This would mean that on a regular year insurance companies have a risk amounting to $582,000,000. Of course, this number is multiplied tremendously if a wind event like a Hurricane occurs.

It is estimated that Citizens Insurance Company bears a burden of risk amounting to $500 billion. Of course, this would require the absolute destruction of almost every home in Florida. We would hope this is a very unlikely circumstance. For the most, catastrophic hurricane seasons cause damages amounting between $20 and $30 billion. It is estimated that Citizens has a reserve of amounting to some $11.3 billion. This reserve has been growing (thankfully) due to the lack of any major events. Citizens probably takes in about $1,513,200,000 in yearly homeowner’s insurance premiums. Indeed, much of these premiums are used toward a hefty infrastructure. Thus, there may be basis for the argument that Citizens may not be able to deal with a truly catastrophic event without depleting reserves.

Unfortunately, these circumstances lead to high premiums and constant struggle with homeowner’s insurers. As Miami Homeowner’s insurance lawyers we understand this too well. The tendency of insurance companies is to deny, delay, or undervalue claims. These strategies may indeed be the result of some form of overexposure. Is there a solution to this problem? That is, can there be healthy insurance structures that can respond rapidly and efficiently to insurer needs and yet remain highly profitable. We think there may be hybrid mechanisms that could be used to minimize risk to an insurer and maximize benefits to a policy holder.

One example would policies that act as a sort of emergency savings fund. For example, what is part of the premium went toward a saving account and the other toward administrative fees and the premium. The average premium in Florida is about $1,164 per year. Thus, $500 could go toward a saving account and the remainder toward fees and premium. Let’s assume a homeowner suffers a water loss amounting to $5,000. This homeowner has not suffered any losses in the last 10 years. He may elect to withdraw the $5,000 and waive the claims process. Thus, the homeowner can repair his home quickly and without hassle. If there is an excess, then the insurer would have to go through the regular claims process. However, given that the average claim amounts to $8,000 this may be unlikely.
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If you are worried about a life insurance issue, then it means you are going through a difficult time. The last thing in a reasonable persons mind would be worrying about life insurance benefits in times of crisis. However, if you are or think you are the beneficiary of a life insurance policy in Florida it is important to be on top of such issues. As South Florida life insurance attorneys we have encountered many cases where it is not clear who the beneficiary is. If this is your case, then it is paramount that you contact an attorney as soon as you can. This is the sort of case where it is necessary to move quickly both on your part and that of the attorney.

The insurance company needs to know who is making a claim for the benefits. If the insurance company is unaware that there is a possible claim, then it may inappropriately disburse the funds or benefits. Matters become much more complicated once the funds are disbursed. If there is debate as to who the beneficiary of policy is or who is entitled to the funds, then it is very important to retain or consult with an attorney immediately. It is understandable that individuals in such a situation are concerned with attorney’s fees. However, this is a matter that should not be handled alone. As South Florida life insurance beneficiary lawyers we know how to handle such situations and get the best results for our clients. If an insurance company is stating that it is taking time to review your claim, then it is time to hire an attorney. Here an attorney can curb an insurance company from funds being disbursed in erroneous manner. If an insurance company is not responding to you, then it is time to hire an attorney. An attorney will find a way to make your claim known to the insurance company and will make sure that they respond accordingly.

There are ways to avoid these situations. Primarily, if you are a beneficiary of a life insurance policy, then it wise to make sure that it is clear who the primary beneficiary of a policy is. If the beneficiary of an insurance policy is changed, it is wise to make sure that the change of beneficiary form is prepared with care and submitted per the terms of the policy. Thus, before submitting a change of beneficiary form it is wise to read the policy carefully. It is probably best to do this with an attorney’s assistance to avoid any unnecessary errors or mistakes. Many times change of beneficiary forms are submitted during times of despair and lapse of judgment, and thus are not submitted in an appropriate manner.
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We have written previously about House Bill 909 and how it will limit the ability of Florida Homeowner’s to mitigate damages and assign contractual rights. There has been little if no media coverage on this matter and we felt compelled to shed some more light on the subject. We would like to encourage media outlets to look into this subject more closely. This is an issue that profoundly affects Florida homeowner’s insurance claims. Florida homeowner’s insurance is a complex and delicate issue in Florida due to the frequency of damage causing events in this State.

More worrisome is the fact that HB 909 passed the Insurance & Banking Subcommittee thirteen (13) votes to zero (0). You can see the votes below:
Y Broxson Y Hager Y Lee Y Rader Y Taylor Y Caldwell Y Ingram Y Moraitis Y Santiago Y Tobia Y Goodson Y Jones, S. Y Nelson

Total Yeas: 13
Total Nays: 0
Total Missed: 0
Total Votes: 13

It only took two (2) hours for this bill to get through the Insurance & Banking Subcommittee. Also, it should be noted that all members were present and voted in favor of the bill. Furthermore, Subcommittee offered a substitute version of the bill that is deeply worrisome to both Florida homeowners and public adjusters. The new language seeks to cap public adjuster’s fees at 15% for non-emergency claims. HB 909 also includes a plethora of language that seems to be designed to circumvent public adjusters, for example;

1) The public adjuster must ensure that PROMPT notice is given to the insurer, the public adjuster’s contract is provided to the insurer, the property is available for inspection of the loss or damage by the insurer, and the insurer is given the opportunity to interview the insured directly about the loss of the claim. The insurer must be allowed to obtain necessary information to investigate and respond to the claim.
2) The insurer may not exclude the public adjuster from its in-person meeting with the insured. The insurer shall meet or communicate with the public adjuster in an effort to reach agreement as to the scope of the covered loss under the insurance policy.
3) A public adjuster may not restrict or prevent an insurer, company employee adjuster, independent adjuster, attorney, investigator, or other person acting on behalf of the insurer from having reasonable access at reasonable times to any insured or claimant or to the insured property that is the subject of the claim.
4) The public adjuster representing the insureds may be present for the insurer’s inspection, but if the unavailability of the public adjuster otherwise delays the insurer’s timely inspection of the property, the public adjuster or the insureds must allow the insurer to have access to the property without the participation or presence of the pubic adjuster or insureds in order to facilitate the insurer’s prompt inspection of the loss or damage.

As South Florida insurance attorneys we are well aware of the dangers the above language holds. It should be noted that these lawmakers are proposing that these provisions take effect on July 1, 2013. It is amazing how efficiently the legislature can move when they put their minds to it. In effect, the above language will almost render an Adjuster’s services useless. The adjuster is there to protect insurer and present a claim to insurer. The adjuster cannot present a proper claim to insurer if he is to be disregarded and circumvented as the above language proposes. The insurer already has access to the insured through a recorded statement and also an Examination Under Oath (EUO). Any more access to the insured seems unnecessary and clearly excessive.

This bill also intends to prohibit post loss assignment of benefits under the policy. As mentioned in a previous blog this will force Homeowner’s to pay repair bills out of pocket first and then be reimbursed later by the insurer. The problem here is that many homeowners buy insurance so they don’t have to incur out of pocket expenses. Further, many of these repairs may be expensive and out of reach for common policyholders. This may have a counterproductive effect by producing more damage than necessary. Many homeowners will not have the financial capacity to properly contain a loss from getting worse.

HB 909 deserves much more attention and analysis. Links provided here can help others analyze and comment on HB 909. It should be noted that the legislature intends to pass this bill quickly given the time frame in which they want it to take effect (July 1, 2013). This gives opposing voices, homeowners, adjusters, and other interested parties little chance to comment and allow for dialogue on the matter.
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As South Florida homeowner’s insurance attorneys we understand the importance of keeping a close watch over actions taken by our State legislature. It is goes without saying that a particular emphasis should be had when dealing with bills pertaining to matters regulating the insurance industry. Although, in Florida it would be seem that many of the bills proposed by the legislature grant wider latitude to the insurance companies and regulate the insured instead. A pointed example of this policy is House Bill 909 (“HB 909”) which states in part;

Any Homeowner’s insurance policy may prohibit the assignment of rights or benefits under the policy, and a third-party beneficiary may not accept and assignment or recover against any policy that prohibits assignment. Any assignment of rights or benefits under a homeowner’s insurance policy that prohibits assignment renders the coverage void.

The language here cannot be any plainer. This will basically allow an insurance company to absolutely prohibit an assignment of rights under the policy. Therefore, if you suffered a tremendous loss to your house and are unable to pay a restoration company to perform repairs and contain the loss, then you are out of luck. Insurance companies will argue that these monies can be recovered once a claim is resolved. However, the purpose of insurance is to provide monies to deal with such emergencies. The above cited proposed bill will only complicate matters for the insured. Ironically, most (if not all) Florida homeowner’s and commercial insurance policies require that an insured contain a loss. This is called the duty to mitigate. The idea is that an insured should keep a loss or damage from getting worse. A typical Florida policy contains language similar to the following;

Duty After Loss.

You must see that the following are done in the event of loss or damage to covered property:

Protect the property from further damage. If repairs to the property are required, you must:
(1) Make reasonable and necessary temporary repairs to protect the property; and (2) Keep an accurate record of repair expenses.

Well, the entire purpose of a remediation/restoration company is to protect a property from further damage. The insurance industry is obviously aware that this takes a substantial amount of monies. After all, they do state that you “must keep an accurate record of repair expenses.” It would seem counterintuitive to require “repairs to protect a property” and yet not allow for an assignment of benefits to a restoration/remediation company. HB 909 would hinder Floridians in their ability to protect their property from further harm. It may also backfire on the insurance companies because many Floridians will be unable to stop damage from getting worse. Ultimately, this will lead to insurance companies paying out more and perhaps premiums going up. As Miami homeowner’s insurance claims attorneys we are of the belief that an insured should be able to mitigate his loss and assign benefits to any contractor who can perform the work.
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