Insurance Issues

The Importance of Statutory Text and Policy Language in Florida Insurance Disputes

Published on: May 27, 2021 | by Friedman Rodman Frank & Estrada, P.A.

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.

Florida Car Accident Lawsuits Involving Complex Insurance Issues

Published on: April 13, 2021 | by Friedman Rodman Frank & Estrada, P.A.

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.

The Civil Remedy Notice Requirement in a Florida Insurance Bad Faith Lawsuit

Published on: March 22, 2021 | by Friedman Rodman Frank & Estrada, P.A.

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.

What Can You Do if a Florida Insurance Company Denies Your Claim?

Published on: March 15, 2021 | by Friedman Rodman Frank & Estrada, P.A.

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.

Florida on Track to Repeal No-Fault Insurance System

Published on: March 11, 2021 | by Friedman Rodman Frank & Estrada, P.A.

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.

Florida Insurance Companies Have an Obligation to Act in Good Faith

Published on: March 8, 2021 | by Friedman Rodman Frank & Estrada, P.A.

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.

The Consequences of Waiving Florida Uninsured Motorist Coverage

Published on: December 5, 2020 | by Friedman Rodman Frank & Estrada, P.A.

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.

Court Finds in Favor of Plaintiff in Florida Insurance Coverage Dispute

Published on: October 28, 2020 | by Friedman Rodman Frank & Estrada, P.A.

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.

Recovering Attorney’s Fees After a Florida Insurance Coverage Lawsuit

Published on: October 26, 2020 | by Friedman Rodman Frank & Estrada, P.A.

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.

The Effect of Willful Non-Compliance in a Florida Insurance Claim Proceeding

Published on: October 14, 2020 | by Friedman Rodman Frank & Estrada, P.A.

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.