Articles Posted in Insurance Issues

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.

Currently, Florida follows the no-fault insurance system, requiring motorists to maintain personal injury protection (PIP) insurance coverage. However, Florida lawmakers proposed Senate Bill 54, which would eliminate the state’s no-fault insurance requirement. The current system allows a claimant’s insurance company to pay the insured’s bills, regardless of their fault. Critics of the no-fault system argue that the current framework evokes many fraudulent claims and the coverage limit is insufficient. On the other hand, critics of the change contend that the new system may leave injury victims in a precarious financial position, as insurance companies will not automatically pay out claims.

The new law would require motorists to carry bodily injury liability coverage, which would allow insurance companies to pay up to $25,000 for collision-related injuries or death or up to $50,000 for crashes involving two or more individuals. The new system would retain the current $10,000 financial responsibility requirement for property damage. However, it modifies the coverage limits for commercial motor vehicle coverage and garage liability. A critical change that may impact injury victims is that the repeal will eliminate the pain and suffering damage limitations.

In many cases, Florida accident victims need to seek compensation outside of the no-fault insurance system because their damages exceed policy limits. The change will have a more considerable impact on bad faith claims against Florida insurance companies. The new framework will include best practices standards for insurance companies to settle disputes. However, the bill also includes the condition precedents an insured must meet before asserting a claim.

Many people purchase insurance to protect against economic losses stemming from personal injury or property damage. In exchange for premiums, the insurance company must uphold its duties to the policyholder. The duties include providing coverage, paying valid claims, and adhering to the policy’s terms. Policyholders who believe their insurance company is violating their agreement may file a Florida bad faith claim against their insurer.

Insurance bad faith claims fall under first-party and third-party claims. Third-party bad faith insurance claims typically involve liability insurance. Bad faith claims occur when an insurer breached their duty to defend their policyholder and pay costs. Common examples of third-party insurance include, liability insurance, malpractice insurance, and commercial liability insurance. First-party insurance is a claim against a policyholder’s insurance company. Bad faith claims arise when a policyholder’s insurance company fails to pay a claim without an appropriate investigation or basis for a denial. This often includes claims against a health or homeowner’s insurance provider, but also in claims involving an accident with an uninsured or underinsured driver.

Under Florida law, a policyholder may file a first-party bad faith claim against their insurance provider. A lawsuit is appropriate if the insurer failed to engage in good faith by acting fairly and honestly towards its policyholder. For example, an appellate court recently issued an opinion in a homeowner’s appeal of a judgment in favor of their insurance company. In that case, a water supply line burst in the homeowners’ home. Following the burst, the homeowners’ filed a claim under their insurance policy. Their insurance company investigated the claim and tendered a payment the homeowners thought was insufficient. In response, the owners filed a civil remedy notice (CRN) alleging bad faith violations. They also asserted an amount that could cure the violations. The insurance company acknowledged the CRN, and the matter proceeded to appraisal. Following the appraisal, the company paid an amount less than the homeowners’ requested.

Under and Uninsured Motorist (UIM) coverage protects individuals if they are involved in an accident with someone who does not have adequate amounts of insurance coverage. In Florida, many insurance companies allow customers to purchase “full coverage” insurance. Despite the name, full coverage insurance does not typically cover UIM coverage; instead, it refers to Florida’s minimum requirements. Moreover, Florida law does not require drivers to purchase bodily injury insurance coverage, which leads to a significant number of motorists operating their vehicles with insufficient insurance. UIM coverage works to protect drivers from having to pay substantial out of pocket costs after an accident.

The law requires Florida insurance companies to provide a UIM coverage option to policyholders. Customers who wish to reject the coverage must provide a waiver in writing. However, in many cases, insurance brokers do not express the necessity of the coverage and are quick to allow a policyholder to proceed with a waiver. As such, many people end up opting out of the coverage without understanding the significant financial repercussions they may encounter.

For example, recently, an appellate court in Florida issued an opinion stemming from a class-action lawsuit against Geico General Insurance Company. The plaintiffs in the class were comprised of Geico policyholders who rejected UIM coverage. The policyholders argued that Geico violated Florida’s UIM rejection coverage process. In Florida, the rejection must be in writing and fully advise the policyholder of the ramifications of opting out of the coverage. Further, policyholders may reject stacked coverage by signing the appropriate form. Here, before 2013, Geico’s online signature process required policyholders to click through screens to get to the electronic signature page. From 2013-2016 the insurance company required customers to view the form two times before signing; however, the form did not comply with state requirements. Finally, in 2016, Geico began displaying the form but did not require policyholders to click any links. In this case, the policyholders all waived UIM coverage during different periods and manner. The court held that the parties did not meet a class-action lawsuit’s requirements because they failed to establish commonality and typicality.

Recently, a Florida appellate court issued an opinion in an insured’s appeal of a circuit court’s final order granting her insurance company’s motion to dismiss her claim for bad faith. According to the court’s opinion, the plaintiff filed a claim with her insurance company for damages to her home from a hurricane. The homeowner claims that, despite admitting the loss was covered, the insurance company “grossly undervalued the claim” and “refused to negotiate the damages.” An appraisal panel found that the damages the woman claimed were appropriate, further supporting the woman’s contentions against the company.

Abiding by the condition precedent to bringing a bad faith action, the woman filed a civil remedy notice (CRN) with the Department of Financial Services (DFS) and the insurer. Within sixty days of the DFS’s acceptance of the CRN, the company did not pay damages. Thus, the homeowner argued that the company committed bad faith in adjusting her claim. The insurance company argued that the notice was ineffective because the CRN misidentified the insurer. The homeowner appealed a circuit court’s ruling in favor of the insurance company, arguing that the company waived their argument by not raising it in its response to the CRN.

On appeal, the homeowner argued that the insurance company never claimed that the incorrect identification caused it any prejudice. Instead, the plaintiff claimed that the insurance company simply denied the claim and argued that the loss did not exceed the policy’s deductible, without attempting a cure. Second, the company had actual notice of the CRN within the cure period and responded to the notice. Next, the company waived any misnomer defects by timely responding without any objections. Finally, the company’s failure to note the misnomer in its CRN response, and failure to bring the defect to her attention, warrants the application of estoppel principles. The insurance company argued that the plaintiff’s claim failed to satisfy the condition precedents because it was filed against another company, the CRN was legally insufficient, and the company could not cure the defect.

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