Insurance Issues

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.

Florida Court Addresses Declaratory Judgment in Insurance Dispute

Published on: September 30, 2020 | by Friedman Rodman Frank & Estrada, P.A.

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.

Florida Homeowner Successful in Bad Faith Claim Against Insurance Company

Published on: September 17, 2020 | by Friedman Rodman Frank & Estrada, P.A.

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.

What Is a Letter of Protection in a Florida an Uninsured Motorist Claim?

Published on: August 30, 2020 | by Friedman Rodman Frank & Estrada, P.A.

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.

The Applicability of the Set-Off Defense in Florida Car Accident Claims

Published on: July 29, 2020 | by Friedman Rodman Frank & Estrada, P.A.

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.

Florida Bad Faith Insurance Disputes Regarding Homeowner’s Claims

Published on: May 25, 2020 | by Friedman Rodman Frank & Estrada, P.A.

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.

What Is “Stacking” Under Florida Insurance Law?

Published on: May 20, 2020 | by Friedman Rodman Frank & Estrada, P.A.

Florida has one of the highest rates of car accidents involving uninsured or underinsured (UIM) drivers in the country. Car accidents with drivers without appropriate insurance can have long-term medical and financial consequences on a car accident victim, and Florida drivers must protect themselves.

Florida requires that motorists maintain two types of auto insurance, personal injury protection (PIP), and property damage liability (PD). Florida’s designation as a “no-fault” state means that a motorist’s PIP coverage will cover covert medical expenses up to $10,000, without consideration of fault. However, Florida does not require motorists to carry bodily injury coverage; this coverage pays expenses the other party incurs because of an accident. The only time this does not apply is if the responsible driver has been convicted of DUI.

In response to these potentially devastating situations, Florida insurance law requires insurance companies to offer motorists the option to purchase UIM coverage. Thus, although UIM coverage is not mandatory, insurance companies must offer coverage to policyholders. The insurance protects the insured if they are involved in an accident with another motorist who does not have any or enough bodily injury insurance. However, policyholders must understand that UIM coverage is only an option if they carry bodily injury coverage in an amount higher than the UIM coverage. Florida’s minimum bodily injury coverage is $10,000 per person and $20,000 per occurrence.

Implications of COVID-19 on Florida Car Insurance

Published on: May 18, 2020 | by Friedman Rodman Frank & Estrada, P.A.

The COVID-19 pandemic has uprooted the lives of most Americans in Florida and across the United States. Employers, educational institutions, retailers, and almost every other industry has made changes to the way they operate. As a result, Florida drivers are typically only venturing out for mandatory travel or essential supplies. This has led to insurance companies experiencing a decrease in Florida car accident claims and higher profits.

According to an industry news source, in response to the COVID-19 pandemic, the Consumer Federation of America and the Center for Economic Justice, issued a statement advising automobile insurance companies to provide their policyholders with premium relief. The agencies issued this advisory to help individuals who are facing financial difficulties because of an income reduction during this time. Insurance companies are using their discretion to determine whether they will take steps to issue refunds of policyholder’s premiums or provide them with another benefit. The Insurance Information Institute has stated that insurance companies will be returning nearly $10 billion to customers across the United States. However, because this is not a mandatory call to action, insurance companies have the choice as to whether they will reduce insurance rates or return premiums.

There are several different ways that Florida insurance companies are responding to this advisory. The most common actions that insurance companies are taking are reducing premiums, waiving late fees, and issuing discounts. These reductions include, multi-vehicle discounts, multi-vehicle discounts, safe driver discounts, occupation-related discounts, and professional association membership discounts.

Florida Court Discusses Liability When a Vehicle Owner Lets Another Use Their Car

Published on: April 9, 2020 | by Friedman Rodman Frank & Estrada, P.A.

Those who have experience dealing with a Florida insurance company, know the process can be a difficult one. Earlier this month, a state appellate court issued a written opinion in an insurance dispute case arising from a fatal Florida car accident. The case illustrates the difficulties that many accident victims face when attempting to recover for their injuries through either a Florida personal injury or a wrongful death lawsuit.

According to the court’s opinion, a driver caused a fatal accident while using his step-father’s vehicle. At the time of the accident, the driver had his step-father’s permission to use the vehicle. There were several insurance policies in effect at the time of the accident. Specifically, the driver had three policies with three different insurance companies, one of which was with Geico. In addition, the driver’s step-father had a policy with Allstate.

Allstate paid out $250,000 to the plaintiffs, which was the policy maximum. Pursuant to that agreement, the $250,000 was not an agreement to release the driver of all liability, but would offset any other recovery obtained by the plaintiffs.

Insurance Disputes in the Aftermath of a Florida Accident

Published on: April 6, 2020 | by Friedman Rodman Frank & Estrada, P.A.

Many individuals in Florida have purchased some sort of insurance policy, whether it be car insurance, homeowner’s insurance, or another form of insurance. Insurance can protect an individual when accidents occur, but, unfortunately, sometimes insurance companies can be difficult to work with, or may refuse to cover a claim even when they are supposed to. Insurance disputes are common because insurance companies pour significant resources into legal teams to limit their liability. One form of insurance dispute occurs when the parties disagree on the amount of loss suffered by the insured. Depending on the policy, there are different ways to solve this type of dispute; one common way is through an appraisal.

For example, take a recent Florida appellate case. According to the court’s written opinion, the plaintiff had a homeowner’s insurance policy from State Farm, the defendant. The policy stated that when the two parties could not agree on the amount of loss suffered by the plaintiff, both parties would choose a qualified, disinterested appraiser who would then set the amount. In September of 2017, the plaintiff submitted a claim under the policy, and State Farm issued her a payment for her loss. However, the plaintiff disputed the amount of the loss, and notified State Farm that she was going to use a public adjuster as her appraiser. State Farm objected to this, because the plaintiff and the adjuster had an agreement that the adjuster would assist her and then receive a ten percent contingency fee. Because the adjuster received a portion of the final amount, State Farm argued that he could not be truly disinterested as the terms of the policy stated he must be.

The court ultimately agreed with State Farm. Under Florida law, when interpreting the terms of a contract, courts interpret plain and unambiguous language in accordance with its plain meaning. If a term has an ordinary meaning that it is usually assigned, then the court will give it that meaning in a contract, unless the parties specifically define it otherwise. The court found that the term disinterested could not apply to an adjuster who had a direct financial interest in the outcome; the higher the appraised value, the higher his commission. As such, the plaintiff was unable to retain the adjuster as her appraiser, and instead had to find an independent, disinterested appraiser who did not have a financial stake in the final outcome.