Florida Insurance Claim Lawyer Blog - Page 6 of 19 - Insurance claims for property damage in Miami, Florida.

May 19 2014

Third District Court of Appeal Tackles Appraisal Agreements

Appraisal provisions in insurance policies have been getting some much needed attention in the courts over the last few years. An “appraisal,” as defined in a homeowner’s insurance clause, is different from the common connotation given to the term appraisal in everyday language. It is not the same as a real estate appraisal used for valuing a home, nor is it equivalent to an estimated value for an item, such as a car or antique.

Appraisal, as used in a homeowner’s policy, is a tool used for determining the value of a home repair dispute that arises from a covered insurance loss.
Indeed, most first-party property insurance policies contain an “appraisal” clause whereby each party, insured, and insurer, appoint a “disinterested” or “impartial” appraiser who, in turn, selects an umpire to resolve issues of the amount of loss.

The appraisal process is an alternative dispute resolution intended to resolve disputes without the need for litigation. Indeed, Florida courts have concluded that appraisal clauses are preferred, as they provide a mechanism for prompt resolution of claims and discourage the filing of needless lawsuits.

Recently, however, insurance companies have become much more sophisticated regarding appraisal agreements. Insurance companies often send out elaborate agreements detailing the scope of the appraisal before the appraisal process even begins. Those appraisal agreements are quickly becoming the source of many disputes.

One such case was recently decided by the Third DCA. In Citizens v. Casar, 2012 WL 6741083 (3d 2013), the third DCA held that the insurance company was not required to participate in appraisal given that there was an ongoing dispute over the scope of the appraisal agreement.

In that case, the insured sustained a significant water loss. Citizens denied a portion of the claim, but agreed to open coverage for another portion of the claim. The insureds submitted a written appraisal demand for the entire claim. Citizens, however, only agreed to participate in appraisal for the portion of the claim that they deemed afforded coverage, but not the whole claim. The insured refused to sign Citizen’s proposed appraisal agreement. As a result, the insured filed suit against Citizens seeking to have the entire claim, as opposed to just a portion of the claim, appraised.

The trial court ordered the parties to appraisal, but the third DCA reversed the trial court. In so doing, the third DCA concluded that Citizens had complied with the terms and conditions found in the insurance policy when it agreed to appraise a portion of the claim, but not the whole claim. The third DCA reasoned that appraisal may be required only as to those disputes concerning which the parties have expressly agreed. And in this instance, there was still very much a live dispute as to the scope of damages that could be included in the appraisal.

Appraisal agreements are often tricky. Insurance companies are becoming more sophisticated and aggressive with their insistence on having an insured sign a detailed appraisal agreement. However, if the scope of that agreement does not fully and completely encompass the scope of loss, then the insured may be forever barred from asserting a claim for those additional damages that fall outside the scope of the agreement.

So before one agrees to sign an appraisal agreement, please make sure that the agreement accurately conveys the scope of damages. If not, then litigation may be required to determine the proper scope of the claim for appraisal.
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EXTENDED BODY:
Consequently, a Miami insurance claims lawyer should always be called to handle significant damage claims and to address any concerns you may have regarding an appraisal agreement.

May 19 2014

Insurance Company Discrimination Leads to Lowball Settlement Offer and a Lawsuit

Posted by Hugo V. Alvarez |

It should come as no surprise that adjusters for insurance companies are often scrutinized and criticized for a variety of reasons. Most of this scrutiny and criticism stems from their decisions to deny claims outright or low ball settlement offers. Yet they are seldom disciplined for their poor claims handling.

In some instances, these low-ball offers or denials could be as simple as the software insurance adjusters use to evaluate the claims. These programs incorporate a large number of statistical data to evaluate claims and do not take into account the unusual circumstances of the policy holder, which leaves them with little to no money to make repairs.

On other, rarer occasions, adjusters engage in discriminatory practices when coming up with a figure to settle first-party insurance claims. News 4 in Jacksonville Florida recently reported allegations that an insurance adjuster for Florida Peninsula lowballed a couple’s claim based on their sexual orientation.

You should contact us today if you feel as though your insurance company is giving you the run around regarding your insurance claim.

According to the News 4 report, the life partners sustained water damage to their Florida home as a result of Tropical Storm Beryl and Debbie. After first reporting their claim, the insurance company hired Belfor Property to make temporary repairs to mitigate the damages.

An employee for Belfor at the time, Andy Boswell, experienced firsthand the discriminatory views of the adjuster Florida Peninsula hired to oversee the claim. “‘From the very beginning of it, he [Mark Jager] said ‘I am not going to bother with these people. I am going to deny their claim,'” Boswell said of Jager’s attitude. Boswell then said the conversation got worse. He said the adjuster told them he did not want to be here, “that these people disgust me.'”

Fortunately for the homeowners, they did not hear the hurtful and degrading comments Jager made. It was only made aware to them when Boswell called to apologize and reveal the true nature of Peninsula’s troubled adjuster.

After demanding a new adjuster based on the revelation above, the couple filed suit against Florida Peninsula, Jager, and the group he works for, Crawford and Company.

Florida Peninsula refused to provide specific information about the claim but released a statement that said, among other things, that “the alleged conduct had no impact on Florida Peninsula’s claim decision.”

The couple disagrees and will soon have their day in court.

May 19 2014

Time to Reform the Homeowners Insurance Market to Make Purchasing Insurance More Transparent and Encourage More Insurance Companies to Enter the Market

Posted by Hugo V. Alvarez |

With the 2013 Florida legislative session about to begin, it is time to start talking about potential reforms to help consumers understand what home insurance products they are in fact purchasing. Florida continues to be plagued by scandal to Citizens insurance, coupled with sky rocketing insurance rates. Not only that, but too often Florida homeowners are not properly advised of the scope of insurance coverages that they are in fact purchasing.

As we head into the next legislative session, here are some thoughts on how we can help make the insurance market more transparent for both insurance companies and homeowners alike:

(1) Push for a single policy that serves as a minimum baseline of coverage. Too often we see insurance companies writing different coverages and different exclusions. Here is a NY Times article discussing this very issue in great detail. Promulgate a single policy that everyone must use and adopt, and this will make it much easier for everyone to understand exactly what is being purchased.

(2) For a consumer to understand what they are buying they really need to rely on their insurance agent. The insurance agent needs to understand the difference between say an HO3 policy v. a HO6 policy. And if they do understand the difference, the actual coverage purchased may be watered down by certain exclusion or cap on damages (see no. 1 above). To correct this issue, Florida should adopt some type of graph that makes it easy for the consumer to grasp what they are in fact purchasing. A “nutritional label” or pyramid scheme of coverages would help the unsuspecting consumer understand what they are purchasing. So we should not only make the policies consistent, but we should make it easier for the consumer to understand what they are purchasing too by providing some form of graph or pyramid so they could actually see the scope of coverages being provided.

(3) Everyone likes disclosure. And with insurance, the old adage is important – you don’t need it until you need it. But too often there are some insurance companies that are simply too quick to deny a claim. But those are often the insurance companies that offer the best rates. So consumers should understand what they are purchasing, and from whom. The consumer should be provided with the variables regarding that insurance company. In other words, the consumer should not only be provided with information regarding the financial strength of the company in the event of a catastrophic loss, but the consumer should also be provided information regarding information pertaining to (a) the percentage of claims denied, (b) the average time within which claims are paid, and (c) the frequency of non-renewal or cancellation within a year of a claim being submitted.

(4) In an effort to promote more competition in the market, and encourage more insurers to enter the market, there should be goals that are established that would permit the complete abandonment (or loosening) of price regulation designed to suppress insurance rates so long as a certain number of companies are in the state of Florida providing insurance coverage. By the same token, extreme pressure should be put on those companies that want to offer insurance for all of our cars (and boats) to make sure that they also offer homeowners policies too. Possibly providing some form of financial incentives to enter the market may also be useful to get the insurance companies to do this too.

(5) Insurance agents should receive the same amount of compensation regardless of the carrier with which they place consumers. Too often insurance agents may attempt to steer a consumer to insurance company A because the financial incentives may be better than if insurance company B were selected by the consumer. But that also assumes that there is/was a choice for the homeowner/consumer – something many of us don’t have given how restrictive the market is currently.

May 19 2014

The Insurance Company’s Right to Repair in the Event of a Loss Creates a New Repair Contract with New Rights Imposed on both the Insured and Insurance Company

Posted by Hugo V. Alvarez |

The insurance company often has a right to repair the damaged property in the event of a loss. This right is found in many insurance policies. Moreover, when the insurance company elects to repair the damaged property, that election is binding on the insured.

But the insurance company’s election to repair the damaged property creates a new contract with its insured. If the insurance company breaches that new contract to repair then the insurance company becomes liable for the damages proximately caused by this breach despite the policy limits. Thus, for instance, if an insurance company elects to repair property and then fails to do so, the insured may recover damages for loss of use.

Today, more and more insurance companies are invoking the right to repair. When they do so, they are creating a new repair contract with no limit of liability. Please contact our office today if you are in doubt regarding your rights under the insurance policy.

However, what many field adjusters working for insurance companies are doing is often “pushing” an insured into selecting a contractor of the insurance company’s choosing without so much as giving the insured an option to select a different contractor. That contractor “selection” often times becomes a source of dispute in litigation, especially when the insured is never given a choice to select a different contractor.

For instance, in Drew v. Mobile USA Ins. Co., 920 So.2d 832 (Fla. 4th DCA 2006), the appellate court concluded that a jury must decide whether the insured had in fact selected the contractor that performed repairs to the damaged property, or if the contractor was selected by the insured. In so ruling, that court concluded as follows:

where the insurer elected to repair, the insured could recover damages for loss of use proximately caused by the failure to repair it within a reasonable time, even though there was no coverage in the policy for loss of use. when the insurer makes its election to repair, that election is binding upon the insured and creates a new contract under which the insurer is bound to restore the property within a reasonable time. Where the insurer breaches this new contract to repair, it becomes liable for the damages proximately caused by this breach. Thus, this court allowed the insureds to recover damages outside of the scope of the policy in their breach of contract claim, even though the insurer was not alleged to have acted in bad faith. See also State Farm Mut. Auto. Ins. Co. v. Dodd, 276 Ala. 410, 162 So.2d 621, 626 (1964) (“It is the general rule that where a policy gives the insurer an election to repair or pay, the exercise of the option to repair converts the original contract into a contract to repair, subject of course to various refinements and exceptions.”).

If the insurance company selects the contractor to repair the property, and if the repairs are done poorly, then the insured could be able to recover damages in excess of the policy limits including damages for loss of use.

May 19 2014

Florida Courts Further Clarifies The Burden of Proof All Parties Must Satisfy when Litigating Late Notice Insurance Claims

Posted by Hugo V. Alvarez |

Late notice claims have become a very litigious issue for property owners and insurance companies recently. This is particularly true since the Fourth District Court of Appeal receded from its ruling in Kroener v. FIGA, 63 So.3d 914 (Fla. 4th DCA 2011).

Since that ruling, our appellate courts have clarified what an insurance company must demonstrate in order to have an insured’s claim dismissed as a result of the insured’s failure to provide prompt notice of the loss.

The first thing that is learned from these line of cases is that all insureds should position their claim in the best possible light with the insurance company. The best way to do that is to immediately notify the insurance company of the loss upon its occurrence. Contact our office today if you are in doubt of your options with respect to your claim.

The second thing that is learned with respect to these claims, and how the law is evolving, is that the courts must take a case by case approach. Each case will present a different set of facts. And depending on the facts presented will dictate the outcome. This is a far from cry from the erroneous ruling rendered in Kroener v. FIGA which suggested that claims not reported within 2 years were barred as a matter of law regardless of the underlying facts leading up to the loss.

The latest pronouncements on this issue came from the Fourth District Court of Appeal as well as the United State District Court for the Southern District of Florida.

In Slominsk v. Citzens, 2012 WL 4511322, (Fla. 4th DCA 2012), the appellate court affirmed the granting of the summary judgment in favor of the insurance company, Citizens. It did so because the appellate court reviewed the affidavits and testimony on file and ultimately concluded that the record evidence did not rebut the presumption of prejudice to Citizens given the late notice reporting. In Slominsk, as contracted with the Stark case that we recently discussed, the issue ultimately turned on an evidentiary basis. Affidavits filed were contradicted by deposition testimony which permitted the insurance company, Citizens, to carry their burden. But the bigger significance of the Slominsk is not the actual result rendered, but rather the analysis as the analysis is consistent with Stark and further erodes the court’s earlier ruling in Kroner.

However, in Aspen Specialty Insurance Co. v. River Oaks of Palm Beach Homeowner’s Ass’n, 2012 WL 3260398 (S.D. Fla. August 8, 2012), United States District Court for the Southern District of Florida, recently concluded that if the insured cooperates to some degree or provides an explanation for its delayed notice in reporting the claim then a fact question is presented for resolution by a jury. In that case, the court concluded that it was undisputed that the insured did not totally fail to comply with the Post-Loss Provision, and, as such, it would be improper to enter judgment as a matter of law in the insurance company’s favor. In so concluding, the court reasoned that a genuine issue of material fact exists with respect to whether the insured violated its duty to (1) provide prompt and sufficient notice, (2) provide inventories of the damaged and undamaged property, (3) permit the insurance company to inspect the Property to determine the amount of loss or damage, and (4) cooperate during the claim investigation process.

May 19 2014

Are Your Valuables Properly Protected and Insured? Do You Have a Plan to Protect Your Artwork, Exotic Cars, Jewelry, Precious Metals in the Event of a Significant Weather Event?

Posted by Hugo V. Alvarez |

When was the last time you checked your insurance policy to determine how much coverage you have for your artwork, jewelry, precious metals, and other items of value? If you have a standard homeowners policy then odds are that expensive diamond wedding ring, or Rolex given to you by your father likely exceed the amount of available coverage available in your policy.

Such a result could be terrible given that you likely spend thousands of dollars every year on insurance coverage thinking that your valuables are in fact covered. So you could come home one day to find that your house has been burglarized only to be further insulted to learn that you don’t have enough insurance coverage to help you replace your stolen valuables. So to repeat, it is of paramount importance to understand your scope of available insurance coverage in the event of a loss.

Moreover, it is also of paramount importance to take extra precautions to protect expensive artwork, jewelry, exotic cars and other valuables in the event of a hurricane in south Florida.

The need has even led to something of a growth industry: Just as the need for extra space led to the boom of the self-storage industry in the 1960s, so has the need to protect exotic valuables from storm damage led to businesses like Museo Vault, a business aimed at protecting high-priced assets like artwork or cars.

Our Miami insurance dispute attorneys encourage you to determine the coverage needs for expensive items in your home and take steps to make sure that you are properly covered in the event of a hurricane. If your jewelry is stolen during a home invasion, and you have not taken steps to ensure that all of your jewelry is insured, then odds are you will likely not recover the full value of your valuables. Conversely, if you are dealing with an insurance company that refuses to pay a legitimate claim to which you are entitled, then contact our office today to discuss your rights.

Moreover, Miami’s booming art reputation has led to a cottage industry of art galleries and other businesses that specialize in handling, shipping and storing art. The idea for Museo Vault came after the busy 2005 hurricane season.” The topic of conversation was how to keep artwork safe in this environment where we have five or six months of terrible hurricane storms that come through,” said owner David Lombardi.

Art collectors also know that a solid hurricane protection plan can be required by insurance companies. But they should also ensure that they have secured enough insurance coverage for all other causes of losses in the event of a loss.
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EXTENDED BODY:
If you are facing a dispute over an insurance claim in Florida, contact Alvarez & Barbara, LLP toll free at 866-518-2913 for a free and confidential consultation to discuss your rights.

May 19 2014

Florida’s Insurance PIP Laws are Reformed

Posted by Hugo V. Alvarez |

In 1971, Florida became the second state in the country to adopt a no fault automobile insurance plan which took effect on January 1, 1972. From a policy perspective, the no fault plan was offered as a viable replacement for the tort reparations system as a means to quickly and efficiently compensate injured parties in auto accidents regardless of fault.

In other words, a trade off was implemented. On the one hand, those that were injured in accidents were assured of payment of medical, disability (wage loss) and death benefits, regardless of fault. On the other hand, those that were injured in accidents were restricted on their ability to sue for non-economic damages (pain and suffering.).

Simply put, PIP was implemented to ensure that anyone injured in a Florida car accident would have access to medical care and treatment as well as recover lost wages regardless of who actually caused the accident.

As a result, all Florida car and truck owners are required to have PIP insurance. PIP is designed to pay 80 percent of an injured person’s medical bills and 60 percent of lost wages up to $10,000 regardless of who or what caused the car accident and where and when they received medical care and treatment.

However, a law passed this past legislative session that will alter Florida’s PIP system for all Floridians. Sparked in large part due to the perceived increase in fraud in the filing of PIP claims, Florida’s governor signed into law some sweeping changes to Florida’s PIP laws.

Florida’s new PIP law will require anyone injured in a car accident who wishes to have their medical bills paid by their PIP insurance, to seek medical care and treatment within 14 days of the accident. And those injured are not free to seek care from just any health care provider for just any ache or pain. Now only medical doctors, osteopathic physicians, dentists, physician’s assistants or advanced registered nurse practitioners are approved to for PIP reimbursement, provided that they also find that the injured victim has an “emergency medical condition.” The law specifically excludes treatment given by either a chiropractor or acupuncturist.

The new law also has teeth, giving the insurance companies the right to question you under oath about the care and treatment you received and why. These interrogations are referred to as EUOs but they are conducted by insurance fraud adjusters. If the EUO is not enough, insurance companies are not legally permitted to force the injured insured to submit to a physical examination by a doctor of the insurance companies choosing and these examinations are called “Independent Medical Examinations.” Failure to attend an IME can result in having the PIP benefits denied.

This new legal scheme that was enacted may be well intended, but it misses the mark. The average person injured in a car accident will likely not receive the care and benefits they paid for as part of their PIP coverage in their policy. Thus, this will ensure that the insurance companies pay less in claims while keeping more of your insurance premiums since they have just made it more complex and difficult to submit a claim all in the name of saving a dollar to the detriment of all hard working Floridians.

May 19 2014

What are the Insurance Companies Doing with your Money – State Farm is Under Criminal Investigation While Citizens Spends Lavishly on Themselves Even as They Pleaded Poverty and Raised Rates for Florida Homeowners

Posted by Hugo V. Alvarez |

We often hear how about all the problems facing insurance companies despite the fact that Florida went a record 6 straight years without getting hit by a hurricane.

Yet despite that amazing streak of good fortune for all of Florida, insurance companies are still raking in huge profits while increasing the premiums we Floridians have to pay on insurance.

What are the insurance companies doing with those premiums? According to the Miami Herald, high ranking officials at Citizens enjoyed lavish dinners and outings at our expense.

How lavish? Citizens executives spent nearly $9,200, including two nights in a boutique hotel and a $234.91 dinner for three at an award-winning French restaurant. Other instances of financial abuse included traveling executives often staying in luxury hotels costing as much as $600 a night even when less expensive accommodations were available nearby. Many Citizens executives dined at fancy restaurants and repeatedly spent more than $50 per person on such fare as rack of venison, sea bass and dungeness crab.

If those financial abuses were not enough, State Farm is under even greater scrutiny. State Farm Insurance, the nation’s largest home insurer, is currently addressing an ongoing criminal investigation related to how it handled potentially tens of thousands of hurricane claims.

State Farm’s internal documents reveal a clear corporate policy of intentionally denying consumer claims for roof damage originating from wind storms. The systematic denial of those types of claims may have quietly saved State Farm close to $1 billion.

State Farm documents reveal an attempt by State Farm managers to hide the company’s policy of non-payment from state insurance regulators.

Our storm damage attorneys are not surprised at the insurance companies conduct. If you have sustained property damage then contact us today to discuss your rights.

May 19 2014

Insurance Companies are Seeing a Spike in Claims being filed as a result of the damage caused by Tropical Storm Isaac in South Florida

Posted by Hugo V. Alvarez |

Tropical Storm Isaac left its imprint all over South Florida. Tropical Storm Isaac produced flash flooding, down power lines, and overall extensive property damage throughout South Florida.

The next step for all South Florida homeowners who sustained property damage as a direct result of Tropical Storm Isaac is to assess the extent of the damages and determine what needs to be done to repair the damage.

It should be emphasized that all damage should be photographed, and any repairs made should be properly documented. If you purchased supplies at the local hardware store, make sure to keep the receipt. If you hired the contractor to perform certain remedial measures, make sure you keep the invoices documenting the nature, cost and scope of work.

After you have assessed your damages, and performed any remedial repairs to prevent the damage from getting worse, it may be time to contact your insurance company. Our storm damage attorneys are prepared to assist you with the claims handling process as well in the evaluation process.

Filing an insurance claim is often times not an easy process. But it is best to be prepared prior to filing the claim in order to help ensure a smooth claims process. And the best preparation is to fully understand the nature of the loss, and have it properly documented.

With that said, insurance companies in South Florida are expecting a rise in claims. Citizens expects approximately 5,000 to 6,000 claims to be filed over the next few weeks.

As you prepare for your claim, please understand that time could be a significant factor working against you. In order to properly file a claim with your insurance company the claim needs to be timely filed. If you fail to timely file a claim, then your claim is forever barred.

Some claims require that they be filed “immediately” with the insurance company. And failure to file an “immediate” claim may jeopardize the claim. Flood claims in particular have special rules that need to be properly handled. Please contact our office today if you are in doubt regarding the claims process, or if you simply have questions regarding the potential claim.

May 19 2014

The Aftermath of Tropical Storm Isaac in South Florida – What Do You Do If Your Property Was Damaged or Flooded? What About Your Business?

Posted by Hugo V. Alvarez |

Tens of thousands of homes and businesses remained without power Monday across South Florida as the remnants of Tropical Storm Isaac continue to wreak havoc for South Florida residents and businesses alike.

Heavy rains, and hail, have caused wide spread flooding and property damage. Strong wind gusts has caused trees to fall which has resulted in extensive property damage throughout South Florida.

Our storm damage attorneys stand prepared to assist you during this time of heavy rain and chaos. But now is also the time to ensure that you remain pro-active to protect yourself, your property and your business.

This significant weather event may have caused damage to your home, your property, or even your business. It is of critical importance that your damage be properly documented.

Start by taking photographs of the damages and properly inventorying your damage. Damage to your personal contents is of particular importance since it could be both time consuming and emotional to document.

Also, please take the necessary efforts to stop any further damage with your property as a result of the wind and rain coming from Tropical Storm Isaac. Keep all receipts and paperwork associated with such efforts and any emergency repairs you may need to take.

It will also be critical to determine whether or not your claim is a result of flooding, or wind. This distinction is critical to understand and in assessing your rights and applicable coverage available to you as a result of the damage sustained thanks to Tropical Storm Isaac.

What about your business? Well, if you have a business interruption policy then you may have coverage available to you as a result of Miami-Dade County Mayor’s decision to issue an evacuation order for people living in mobile home parks, unsafe structures, and areas prone to flooding. He also closed the Port of Miami.

As a result of this Order, businesses have been ordered to close until further notice. Such an order is commonplace when a natural disaster threatens, like Tropical Storm Isaac.

If your business purchased standard business income coverage then it is likely that your policy provides coverage for any loss of income caused by the Mayor’s decision to issue an evacuation order and close the Port of Miami.

Our firm stands ready to assist with your property damage needs and to battle with your insurance company to ensure proper compensation for your insurance claim. Whether you are a resident with damaged property, or a business owner who has sustained an interruption to your business as a result of Tropical Storm Isaac, call us today for a free consultation.

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Third District Court of Appeal Tackles Appraisal Agreements

Insurance Company Discrimination Leads to Lowball Settlement Offer and a Lawsuit

Time to Reform the Homeowners Insurance Market to Make Purchasing Insurance More Transparent and Encourage More Insurance Companies to Enter the Market

The Insurance Company’s Right to Repair in the Event of a Loss Creates a New Repair Contract with New Rights Imposed on both the Insured and Insurance Company

Florida Courts Further Clarifies The Burden of Proof All Parties Must Satisfy when Litigating Late Notice Insurance Claims

Are Your Valuables Properly Protected and Insured? Do You Have a Plan to Protect Your Artwork, Exotic Cars, Jewelry, Precious Metals in the Event of a Significant Weather Event?

Florida’s Insurance PIP Laws are Reformed

What are the Insurance Companies Doing with your Money – State Farm is Under Criminal Investigation While Citizens Spends Lavishly on Themselves Even as They Pleaded Poverty and Raised Rates for Florida Homeowners

Insurance Companies are Seeing a Spike in Claims being filed as a result of the damage caused by Tropical Storm Isaac in South Florida

The Aftermath of Tropical Storm Isaac in South Florida – What Do You Do If Your Property Was Damaged or Flooded? What About Your Business?

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