Articles Posted in Insurance Issues

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, 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.

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.

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.