Articles Posted in Insurance Issues

Florida residents and homeowners know very well that they and their properties exist comfortably at the whim of Mother Nature, whose destructive forces can cause problems on short notice. As the 2022 hurricane season comes to a close, many Florida residents are addressing maintenance and repair needs caused by the tropical weather. Floridians may purchase homeowner’s insurance, renter’s insurance, and federal flood insurance to protect themselves and their properties in the event of a weather-related disaster. The Florida Court of Appeal recently addressed a plaintiff’s water damage claim with their homeowner’s insurance company, which was previously rejected based on alleged fraud.

According to the facts discussed in the recently published opinion, the plaintiff purchased a homeowner’s insurance policy for her Orlando home from the defendant in May 2016. In April 2017, the plaintiff’s home was damaged in a storm, and she made a claim with the defendant to cover the damages. The plaintiff was offered a settlement of her claim that was not sufficient to cover her losses, and she pursued a breach of contract claim against the defendant to cover all of her losses. In investigating the plaintiff’s claim, the defendant discovered that a home inspection was completed in 2015, and the plaintiff did not disclose that the inspection found roof damage and water damage in the home before the plaintiff purchased the policy.

After discovering the inspection report, the defendant sought to deny the plaintiff’s claim and responded as such to the court. The trial court agreed that the plaintiff materially misrepresented the condition of the home when purchasing the policy, ruling that such misrepresentation invalidated the plaintiff’s claim of new water damage. The court threw out the plaintiff’s claim before a jury was even selected for trial. The plaintiff appealed the case resolution to the Florida Court of Appeal. The appellate court agreed with the plaintiff that for a homeowners insurance policy to be invalidated based on misrepresentation or fraud, the insured must intend to mislead the insurance company. Such intent is a fact judgment, that should be determined by the jury at trial. As a result of this finding, the court ruled that the trial court was not justified in disposing of the plaintiff’s claim. The trial court ruling was reversed, and the case will be remanded to proceed toward settlement or a trial on the plaintiff’s claims.

Accident victims in Florida who have worked with insurance companies probably understand how difficult it can be to get an insurance company to honor a claim. While insurance companies are notorious for making the claims process cumbersome and difficult, they still hold a duty to negotiate and attempt to settle a claim in good faith. A federal appellate court recently reversed a jury verdict that was in favor of an insurance company because the jury had not been properly instructed considering the good faith requirement.

According to the facts discussed in the appellate opinion, the plaintiff in the recently decided case is a man who was injured several years ago in a motorcycle accident. The plaintiff retained a personal injury attorney shortly after the accident, but communication was spotty between his counsel and the defendant. Months later, the plaintiff’s counsel sent a settlement offer to the defendant. The defendant did not communicate with their client about the settlement offer, and the plaintiff sued the driver and policyholder personally, obtaining over a $12 million verdict at trial.

After the initial trial, the plaintiff sued the insurance company directly, seeking to collect the $12 million judgment from them. The plaintiff argued that the defendant failed to act in good faith when considering the settlement offer, as required under Florida law. Specifically, the plaintiff alleged that the defendant’s failure to consult or advise their client of the settlement offer, or the consequences of a much larger trial verdict, constituted bad faith. After the parties presented their cases at trial, the plaintiff proposed a jury instruction explaining the requirements for a finding of bad faith, but the trial court rejected the instruction. The jury returned a verdict in favor of the defendant, and the plaintiff appealed the jury instruction issue to the U.S. Court of Appeals.

Dealing with the preventable death of a loved one is one of life’s most challenging burdens. Under Florida’s wrongful death statute, individuals or entities who acted negligently or recklessly in causing another’s death may be liable for the damages they caused. The state’s statute allows the deceased person’s survivors a mechanism to secure compensation for the death of their family members. However, these cases require a comprehensive understanding of the state’s complex evidentiary and procedural laws. An experienced Florida wrongful death attorney can represent family members in their wrongful death claims.

A recent Florida wrongful death appeal highlights the onerous burdens that many plaintiffs encounter when pursuing these cases. The Third District Court of Appeal issued an opinion addressing the dismissal of a wrongful death complaint involving an uninsured motorist. According to the record, the uninsured motorist collided with another motorist, rendering that motorist permanently disabled. After several years of litigation, the motorist died by suicide.

As the personal representative of the motorist’s estate, the motorist’s brother brought a wrongful death lawsuit against some of the motorist’s former attorneys. According to the complaint, the brother alleged that the attorneys’ negligence and legal malpractice were the proximate cause of his brother’s death. Specifically, the plaintiff argued that the attorneys’ failure to render reasonable care and professional skill prevented him from having the ability to pay for treatment and medication and caused him to experience pain and suffering that ultimately led to his suicide.

Following a major car accident, it may be obvious who was at fault and who caused the accident. Sometimes, however, car accidents are not as clear cut. In accidents with complex timelines, multiple parties, and conflicting testimony from witnesses and those involved, it can often become messy very quickly to handle the details of who was at fault, for how much fault, and other important elements of the accident timeline.

According to a recent local news report, a major accident left nine individuals injured and one killed. Local authorities reported that a van carrying three adults and four children with special needs was traveling through an intersection when it crashed into the side of another vehicle going in another direction through the intersection. The initial accident caused three other vehicles nearby to be impacted also. Local fire rescue authorities reported nine people, including six children—four of which have special needs—injured. These injured individuals were transported to the hospital, with some of the adults being issued trauma alerts. A 36-year-old woman who was also a passenger in the van was pronounced dead on the scene. The accident remains under investigation by troopers.

Florida, like some other states around the country, is called a “no fault” state. This means that Florida has a law requiring that all drivers have a specific type of car insurance coverage that pays regardless of who was at fault for the accident.

The District Court of Appeal in Florida issued an opinion in an appeal stemming from an insurance dispute between an insurance company and the insured. The insurance company appealed a final judgment against them after a lower court found that the insured’s material breach of the contract was immaterial.

According to the record, storm damage prompted the homeowner to file a claim with the insurance company. The insurance company argued that the policy bars the homeowner from filing suit because he failed to comply with the three post-loss conditions in the insurance contract. Specifically, the violations include the homeowners’:

  1. Failure to provide the insurance company with prompt notice of the loss.

An appellate court recently issued an opinion in a bad faith insurance lawsuit stemming from an accident between an 18-year-old driver and a motorcyclist. The accident occurred when the 18-year-old turned into a median in front of the biker. The biker slammed into the driver’s car with such force that the vehicle spun 180 degrees. The biker suffered serious injuries from the collision and was airlifted to a hospital.

The 18-year-old was driving his mother’s car at the time of the accident, and when he called the insurance company, he reported property damage but neglected to report any physical injuries. The insurance company interviewed the driver, who disclosed that the biker suffered injuries, and he indicated that the biker might have been speeding. The preliminary insurance investigation revealed that the accident occurred in a low-speed limit area, the motorcycle left long skid marks, and the driver did not receive a citation. With these facts, the insurance company concluded that the biker was likely contributorily negligent.

About ten days after the accident, the insurance company decided to tender the bodily injury limits to the biker; however, they asked the biker’s attorney if they could inspect the motorcycle. The next day the insurance company delivered a “tender package” to the biker’s attorney. The package included a cover sheet and described the content of the delivery, which included a $50,000 check and a form that released the company of “all claims.” The letter invited the biker’s attorney to edit the release or suggest changes to a release. The biker’s attorney did not address the release but rejected the offer stating the insurance company was trying to take advantage of the biker and his family by including an overbroad release.

An appeals court recently issued an opinion stemming from a Florida car accident between an insured and an uninsured motorist. The insured purchased non-stacking uninsured motorist coverage from their insurance company. After suffering injuries in an accident with an uninsured motorist, the insured sought to receive benefits of a stacking coverage policy. The woman filed a lawsuit against the insurance company after the company refused to cover the woman under the more comprehensive policy.

The record indicates that the woman’s boyfriend purchased an insurance policy that provided bodily injury and uninsured motorist coverage up to $25,000 per person. During the renewal period, the boyfriend rejected the non-stacking coverage, and the Office of Insurance Regulation approved the form. The policy states that there is no coverage for an insured who sustains bodily injury while occupying a vehicle owned by the policyholder or any resident relative if it is not in the policyholder’s car—the policy applied to the woman and her boyfriend and their Ford pickup truck. The two suffered injuries while operating a motorcycle that the insurance company did not insure.

On appeal, the court reviewed the insurance policy by looking at its plain language. Generally, exclusion provisions are more strictly construed than coverage provisions and tend to be interpreted in favor of the policyholder. However, courts cannot rewrite contracts or add intentions or meaning that are not present. Ambiguities exist when a provision is open to more than one reasonable interpretation. A court cannot deem a contract ambiguous just because it is complex or requires an in-depth analysis.

Insurance coverage is a critical resource to motorists and provides many financial protections to those who suffer injuries in a Florida car accident. While insurance companies tout the benefits of their plans to consumers, they simultaneously operate to protect their own financial interests. These for-profit companies have a vested interest in maintaining their financial standing, and they often do so by wrongfully denying personal injury claims. Florida accident victims may face an uphill battle with their dealings with insurance companies. Attorneys play a crucial role in ensuring that injury victims overcome these hurdles and recover the damages they deserve.

There are many ways that insurance companies avoid paying out rightfully due payments to consumers. Although Florida is a no-fault state and injury victims submit claims to their own insurance company, the payments rarely cover the extent of a policyholder’s losses. Typically, claimants only receive around 80% of the total cost of their medical expenses, and the coverage does not include pain and suffering damages. Further, insurance companies may focus on a victim’s pre-existing medical condition to show that the accident is not responsible for the claimant’s injuries. Insurance companies contesting coverage will go as far as to question the claimant’s credibility and elicit evidence to show that the victim is not suffering as much as they say they are.

Although all of these tactics pose issues to clients, the most complex issues arise when insurance companies establish procedural mistakes that may reduce or eliminate a claimant’s damages. Florida Rules of Civil Procedure are a complicated set of procedural and substantive rules that require a thorough understanding of the law. Insurance companies may deny liability by pointing to the statute of limitations, jurisdiction and venue issues, and insufficient notice and pleadings. Courts may dismiss all or part of a victim’s claims because of a single error with any of these requirements.

After a Florida insurance claim, policyholders may file a first-party claim with their insurance company seeking benefits under the terms of the policy. First-party bad-faith claims occur when a policyholder sues their own insurance provider for unlawful and improper denial or settlement of a claim. Third-party bad faith actions have long been recognized; however, the Legislature enacted Florida Statute §624.155, to address first-party causes of action. Courts will evaluate the totality of the circumstances to determine whether an insurance provider has acted in good faith. Some of the common factors they evaluate are whether the insurance company investigated the facts, gave fair consideration to the circumstances, and settled the claim where possible. In cases where the insurance company did not engage in these steps, they may be held liable for their statutory breach.

A claimant may only recover against an insurance company if they meet the statute’s condition precedent. One of the condition precedents is filing a Civil Remedy Notice (CRN) with the Department of Financial Services (DFS). The failure to do meet this requirement may lead to a dismissal of a claimant’s case. For example, recently, an appellate court issued an opinion in a Florida homeowner’s claim against his insurance company. In that case, the insurance company disputed a property owner’s claim regarding water damage to his home. After filing a CRN, the property owner moved forward with a bad faith claim against the insurer. The court dismissed the complaint, reasoning that the plaintiff did not meet the requirements of the CRN.

The CRN statute outlines the specific information that a claimant must include in their notice. In sum, the notice must essentially specifically state the facts and circumstances surrounding the case, and the specific relevant policy language that the insurer is alleged to have breached. In this case, the court found that the plaintiff cited every provision in the insurance claim to meet the specificity requirement. The court found that citing every provision does not meet the specificity standard. The plaintiff argued that the insurance company’s failure to allow him to correct the defect meant that the CRN was sufficient. However, the court ruled that the insurer’s option to return a defective notice is discretionary. Therefore, because he did not meet the specificity standard, the court affirmed the trial court’s dismissal with prejudice.

To many people, even the thought of dealing with your insurance company is a headache. Unfortunately, insurance coverage is an important part of our lives, especially in areas such as home ownership, renter’s coverage, and auto insurance. When an insurance company in Florida acts in bad faith or causes damage to a policyholder because of their conduct, holding them accountable can be challenging without proper representation.

In a recent Florida District Court of Appeal case, the court considered whether a homeowner’s insurance claim was filed properly. According to the court’s opinion, the homeowner initially filed a claim with his homeowner’s insurance company for damages to his home that was caused by a fire.

The insurance company’s investigation revealed that the homeowner previously filed two plumbing claims and another claim for fire damage with a different insurance company. In addition, the insurance company discovered that after the homeowner received the insurance payout from one of the previous claims, he did not repair the damage. The company believed that earlier damage overlapped with damage from the current claim.

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