Articles Posted in Insurance Issues

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.

Under Florida Statute § 627.428, a party may be eligible to recover attorneys’ fees when a policyholder prevails and recovers actual insurance proceeds. However, not every insurance dispute or coverage lawsuit results in an award of attorneys’ fees. Typically, Florida courts authorize recovery of attorneys’ fees when the insurer has “wrongly withheld payment of the proceeds” of a policy. The law does not permit recovery of attorneys’ fees if the insured does not recover money or benefits, or if the court determines that the insurance company never wrongfully withheld payments.

Recently, the District Court of Appeal of the State of Florida issued an opinion addressing whether attorneys’ fees were appropriate. In this case, the plaintiff filed a negligence lawsuit against an at-fault driver. The defendant passed away during the proceedings, and the plaintiff substituted his estate as a party defendant. While awaiting the case’s status, the trial court ordered the plaintiff to set up the estate for the defendant and substitute the defendant’s estate for his name. During this time, an estate was created for the defendant in probate court. The court did not name a personal representative, and the plaintiff substituted “John Doe” for the defendant in his complaint. After that, the probate court appointed a representative, however, the plaintiff failed to amend his complaint to include this update.

The plaintiff proposed a settlement agreement, and the defendants moved to dismiss the claim, arguing that the complaint named “John Doe” as the personal representative. The trial court ordered the plaintiff to amend his complaint, and a jury found in favor of the plaintiff. The plaintiff argued that he was entitled to attorneys’ fees, because the defendants rejected his initial settlement offer.

Owning a home is a major milestone, but also comes with significant responsibilities and costs. Unlike renting, maintenance is no longer a call away to help fix things when they break or leak in your home. Home insurance, however, can often provide recourse in unexpected situations that are out of your control. These insurance policies often have specific rules and instructions on how to file a claim in the event of an issue that gives rise to a claim. As a homeowner, it is crucial that you read and understand these rules so that if an incident arises in your home, you can properly assert your rights for recovery.

In a recent Florida District Court of Appeal opinion, a homeowner filed a lawsuit against his home insurance company, arguing that they had breached their contract. The plaintiff’s home was insured by the defendant. The insurance policy provided that in the event of a loss giving rise to the claim, the homeowner must provide “prompt notice” to the defendant, give the defendant the requested records and documents, and submit to an examination under oath to recover for the loss.

Following a major plumbing leak incident in the homeowner’s house, the plaintiff provided notice and documentation of loss, but failed to show up for his examination under oath because he was out of the country and unaware that the examination under oath had been scheduled. The defendant subsequently denied the plaintiff’s claim, arguing that the plaintiff had breached the insurance policy’s requirements. The lower court ruled in favor of the defendant, and the plaintiff appealed.

An appeals court issued its opinion in a Florida insurance dispute between a homeowner and an insurance company. According to the opinion, a homeowner entered into a contract with an insurance company where they agreed that in exchange for a lower premium, the insurance company would have the option to repair any damage with its preferred contractor. The current claim arose after the homeowner’s home experienced water damage after Hurricane Irma. Immediately after the damage, the homeowner contacted a company to perform mitigation repairs. In addition, he contacted a public adjustor company to appraise the value of damage and assist in settling any claims with the insurance company. About a month after the damage, the homeowner contacted the insurance company.

The insurance company acknowledged receipt of the claim and sent its inspector to evaluate the premises. The company’s inspector valued the loss at around $13,000, and the company chose to repair the damage. Pursuant to their policy with the homeowner, the company notified him of their election, and required the homeowner to file a sworn proof of loss within 60 days. After the period lapsed, the company filed an action for declaratory judgment and a breach of loss. The homeowner moved to dismiss the case, and in the alternative, compel appraisal. At trial, the court dismissed the insurance company’s complaint. The insurance company argued that the homeowner’s failure to provide a sworn proof of loss amounts to a contract breach. As such, they argued that the court should find that the breach justified a loss of coverage.

Under Florida law, a party moving for a declaratory judgment must prove that there is a good faith dispute between the parties; there is a question regarding the existence of rights or status, there is a dispute regarding a party’s rights, and there is an actual need for the judgment. When a petition for declaratory relief meets these factors, the court should not dismiss the matter for failure to state a cause of action.

Recently, an appellate court issued its opinion in a bad faith claim homeowners filed against their home insurance company. According to the court’s opinion, the homeowners filed a claim with their insurance company after suffering losses from Hurricane Irma. The insurance company investigated the claim and determined that the homeowners’ loss was $3,013.20. In response, the homeowners provided the insurance company with their public adjustor’s estimate of their losses. According to the insurance agreement, the insurer began the appraisal process. The policy contained provisions that either party could demand an appraisal if the parties failed to agree to the amount of loss. Further, the policy included a provision that homeowners could not file a lawsuit unless the parties fully complied with the policy’s terms.

The homeowners filed a civil remedy notice of insurer’s violation (CRN), alleging that the insurance company breached its duty to settle the claims in good faith. They argued that the company was given notice of the severity of the homeowners’ losses, and the opportunity to inspect the property. The homeowners contended that, despite this opportunity, the insurer failed to identify the full extent of losses. As such, they filed a complaint based on Florida’s bad faith statute.

Under Florida Statutes, section 624.155, policyholders maintain a civil remedy for an insurance company’s bad faith. The claim applies in situations that an insurer failed to act reasonably, honestly, and in good faith to settle claims. Florida law requires plaintiffs to provide the Florida Department of Financial Services and the insurer with written notice of a violation. The CRN notice must include specific statutory violations, relevant facts and policy provisions, and a statement asserting the plaintiff’s right to pursue a civil claim. The statuary requirements to a Florida bad faith insurance claim require the claimant establish that the insurer was liable for coverage, the policy holder’s damages, and compliance with the notice requirements. The statute does not bar an insured from sending a CRN before a determination of liability or damages.

When a person is injured in a car accident and does not have insurance, they often encounter many issues while filing a claim. One such tool plaintiffs will use in this instance is a letter of protection. In Florida, a letter of protection is used by a person without insurance to obtain medical services in exchange for part of their insurance settlement claim. In a recent Florida appellate court case, the court was tasked with deciding whether a jury could have determined the credibility of a doctor who testified under a letter of protection after he made conflicting statements. Ultimately, the court decided that there was enough information presented during the trial for a jury to be able to assess the doctor’s credibility.

According to the court’s opinion, the plaintiff suffered various injuries, most prominently her right knee, in a car accident. The driver who caused the accident did not have car insurance. Because of this, the plaintiff filed a claim against her uninsured motorist insurance, to cover the costs of the accident. The payment dispute was regarding a prior knee injury; the plaintiff had previously hurt her knee, which was rendered permanently injured after the accident. However, the plaintiff’s doctor claimed that the plaintiff had stopped feeling pain in her knee prior to the accident, while the defendant, as well as evidence from the plaintiff’s own testimony, indicated this was not true.

In this case, the plaintiff was given treatment under a letter of protection. While many are unaware of it, a letter of protection can be extremely beneficial to those without insurance. A letter of protection is a document sent by an attorney on a client’s behalf to a health-care provider when the client needs medical treatment but does not have insurance. Generally, the letter explains that the client is involved in a court case, and in exchange for deferred payment of medical services, the health-care provider will receive part of the settlement or award.

In a recent opinion, an appellate court in Florida addressed the applicability of the set-off defense after a car accident victim filed a claim for damages with an insurance company. The plaintiff suffered injuries when an uninsured motorist crashed into his car, resulting in serious physical and property damage to the plaintiff. In response, the plaintiff filed a claim with his insurance company under the uninsured/underinsured (UIM) provision in his policy. The insurance company denied the claim, and the plaintiff filed a lawsuit for breach of contract.

A jury determined that the plaintiff was entitled to damages for his loss of earnings, medical expenses, and pain and suffering. Subsequently, the insurance company contended that the trial court erred in failing to set off duplicated benefits that the plaintiff obtained from other sources. The defendant asked the court to set off from the damages award, the amount of any settlements the victim received that duplicated any part of the verdict.

The court analyzed Florida’s set-off rules and concluded that the trial court should amend the verdict to reflect the duplication. After a car accident, injury victims may obtain benefits from more than one source for a single accident or claim. This often occurs when the negligent motorist or their insurance company settles or pays out damages for a portion of the victim’s losses. In most cases, the settlement amount specifies what exactly the payout covers. For example, the settlement amount may specify that the payments are for medical benefits or lost wages. Although, Florida’s laws allow double recovery, there are restrictions when there is a duplication of benefits.

Recently, the United States Court of Appeals for the Eleventh Circuit issued an opinion addressing issues that commonly occur in insurance coverage disputes between Florida homeowners and insurance companies. In this case, a couple in a neighboring state discovered that a home they recently purchased was infested with brown recluse spiders. After attempting to remedy the infestation, the couple bought a homeowners’ policy from an insurance company. The relevant provisions in the policy indicated that the company would provide coverage against the “direct loss to property,” in cases where there was a physical loss to the home. The policy enumerated exceptions to the coverage, including damages that were the result of “birds, vermin, rodents, or insects.” The insurance company cited that provision in their notice denying the homeowner’s claim.

In response to the denial, the homeowner’s filed a breach of contract lawsuit against the insurance company, alleging that the company was engaging in bad faith. They contended that the spiders presented a deadly risk and infested the entire home, rendering it unsafe for occupancy. They claimed that the insurance policy’s exclusionary provision did not apply because brown recluse spiders are not insects or vermin but rather arachnids.

Under Florida law, insurance companies must engage in good faith practices when reviewing a policyholder’s claim. Insurance companies must acknowledge the receipt of a claim, promptly investigate claims, respond to inquiries, not unnecessarily hinder progress, and offer valid and specific reasons for any denials or delays. In many instances, insurance companies cite specific provisions in the policy to support their decision. However, in some cases, this interpretation may be incorrect.

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