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Jacksonville Insurance Law Blog

Signs of bad faith insurance

Having insurance should give you the peace of mind that you will receive financial security in case of property damage, disability or loss of a family member. However, you may find that when the time comes to file a claim, you will not receive the coverage you expected.

When insurers do not provide the benefits they promised, you are the recipient of bad faith insurance. As policies often can be complex, you may simply believe you are in the wrong and trust that the insurance company has a valid reason to deny your claim. However, watch out for these signs of bad faith insurance to prevent losing out on rightful compensation.

  • Denial: The company may outright deny your claim with or without an explanation. It may even change your policy without your knowledge and then say your plan does not cover your claim.
  • Accusation: You may face false accusations of fraud as an excuse for your insurer not to pay.
  • Partial payment: Your insurer may offer you less than you deserve and not put effort into a proper investigation of the circumstances surrounding your claim or may use illegal or intrusive methods.
  • Deception: Insurance reps may use vague language, misrepresent or withhold information, or deny you or your lawyer access to records. If you do receive payment, the company may not specify the policy coverage so you do not know if you are receiving enough.
  • Delay: By far the most common, providers often use multiple tactics to cause delays in accepting or paying your claim as a sneakier way to avoid obligation. They may demand unnecessary paperwork or action, ignore your efforts to contact, fail to notify you of a denial, make empty promises or refuse to cooperate in any way.

The basics of the insurance bad faith law

Insurance bad faith is a legal claim practiced in the United States, and describes a tort claim a person can have against an insurance company for bad or unfair acts. In Florida, this law allows an individual to recover damages from insurers for various reasons. Typically, this type of law helps settle a claim in good faith that the insurer should have initially carried out.

The Florida Senate clarifies the basics of the insurance bad faith law. According to its 2012 Interim Report, the state of Florida has had bad faith remedies in place through the common law and statute for many years, with a primary focus on helping insurance consumers with the protection needed in the case of insurers' unfair practices. The law has sparked controversy over the years concerning the level of ethics used in such bad faith cases, but officials consistently conduct research to better strategize the ways this practice is executed. The Florida Senate points out that the two major categories of insurance affiliated with bad faith are property insurance, in which a number of natural disasters can damage an individual's home and cause complications in insurance, and liability insurance, which can become complex in the case of determining the liability in vehicle collisions.  

Understanding insurers' long-term care claim denials

Many elderly people need assistance with daily tasks as they get older, and this is especially true if the individual in question suffers from memory loss or other health problems. Long-term care is the right solution for many families, but it can be prohibitively expensive. According to the U.S. Department of Health and Human Services, it can cost as much as $205 a day to stay in a nursing home.

Long-term care insurance policies offer a reasonable solution for aging people who predict that they may later reside in such a facility. Insureds can pay a monthly premium for coverage later, but when it comes time to file a claim, the insurance company might deny it. Here is what you need to know in such a situation.

Understanding national and local coverage determinations

While the care that you can expect to receive from any of the hospitals and clinics in Jacksonville is among the best in the world, it may come at a step price. That may be why receiving a denial notice from your health insurance company can be so disheartening. One of the more common reasons why medical claims are denied is because insurers deem that the procedures performed were not medically necessary. Here at Tyler & Hamilton, P.A., we’ve had several clients come to us wondering if such a decision can be appealed.

The answer to that question may depend on your health insurance carrier. If you are covered by a government plan (Medicare and Medicaid), then coverage for your care is subject to national and local coverage determinations. Insurance providers try to avoid overpaying on claims by only covering those services believed to be reasonable and necessary. According to the Journal of Oncology practice, NCDs and LCDs are established to inform providers when services are deemed to be warranted. NCDs apply on a national scale, while LCDs pertain to certain regions covered by contracted Medicare administrators. Commercial insurance carriers will often mirror their coverage determinations to government plans, as well.

Handling the denial of your homeowner's insurance claim

Each year, peoples' homes are destroyed for a wide variety of reasons. Sometimes, this destruction is a result of natural disasters, such as a tornado, hurricane, flood or lightning strike. In other cases, homes become damaged due to vandalism, arson or burglary. Regardless of the reason why your home becomes damaged, you should make sure that you gain access to any benefits you are entitled to if you have found yourself in this position. At Tyler & Hamilton, P.A., our law firm knows how difficult these problems can be for people who live in Jacksonville, and in other parts of Florida.

After your home becomes significantly damaged, you likely expect your insurance company to help you move forward. After all, you pay them for coverage that you count on when things go wrong. Unfortunately, homeowners' insurance claims are turned down for a myriad of reasons, which can make life far more challenging for those who are already trying to address severe damage to their home. In some cases, insurance companies may only pay a small portion of a claim, while in other instances they may reject the entire claim. Regardless of the nature of your denial, if your rights have been violated you should not be afraid to take action.

Denied payments and other bad faith insurance issues

From life insurance to homeowner's insurance, when people pay their insurance policy they expect to be covered. Unfortunately, insurance companies in Florida and across the country sometimes let their customers down. At Tyler & Hamilton, we know how frustrating it often is to be in this position, which sometimes leaves people feeling helpless. If your insurance company has denied payments that you were entitled to, or you are facing other problems such as delayed coverage, it is essential to stand up for your rights.

If you decide to take action against your insurance company, it is vital to be prepared. Sometimes, legal action becomes necessary and you should not be afraid to step forward and hold your insurance company responsible for any suffering they have caused as a result of bad faith. Depending on the details surrounding your case, you may be able to obtain compensation that can help you move forward and, hopefully, put these challenges behind you for good.

What constitutes a bad faith claim?

As a Florida homeowner, you should be able to rely on your insurance company to provide crucial coverage when your home sustains costly damage. Sometimes, however, insurance companies act in bad faith, denying or delaying settlement for valid claims. When this occurs, you may have grounds for a civil action. Here is an overview of some of the building blocks for an insurance bad faith claim.

According to Florida law, you are permitted to bring a civil action against your insurer if the agency acts in bad faith in any of the following ways:

  • Failing to settle claims that it might otherwise have settled were it acting honestly, in good faith and in your interests as the insured party
  • Delaying the settlement of claims made under one section of your insurance policy with the intention to alter settlements made under another section of your insurance policy
  • Failing to provide a statement specifying the relevant section of your insurance coverage when claims payments are made

The consequences of lying on an insurance application

Insurance applications can be tedious and tiresome. However, they are necessary — and unfortunately, many people lie on them.

Such lies can occur with many types of insurance. To give a simple example, drivers looking for auto insurance might fib about how many speeding tickets they have. Other times, what the insurance company sees as a lie or misrepresentation is actually an honest mistake, but these companies have little incentive to give consumers the benefit of the doubt. If you are about to fill out insurance forms, here are a few reasons to think twice about being less than forthcoming.

Florida insurer cancels thousands of policies

Florida residents who own homes and other property in the state should always be able to count on their insurance companies for help after a disaster like a hurricane, a flood or a fire. However, this can be a challenge at times when insurers and policy owners fail to agree on the causes, costs or other details of a claim. People who file fraudulent claims may also end up having a negative impact on honest homeowners.

This was reportedly one of the factors that led Heritage Property & Casualty insurance company to cancel or not renew several thousand policies between the end of 2015 and the end of 2016. In that time, the company, owned by Heritage Insurance Holdings, reduced the number of policies it held by more than 16 percent. The large drop in claims was a contributor to the company reducing the number of claims it processed during that timeframe. At the same time, some rates are said to have been increased for policies that were retained.

Common reasons for commercial property claim denials

One of the most important types of protection any business owner in Jacksonville can have is a comprehensive policy to cover their company. With the risk of property damage looming overhead, the right coverage can make it easier for them to sleep at night. As important as it is to have an active policy, it is equally important for business owners to be aware of the common issues they may encounter when they submit claims. 

Business owners who know the reasons that can potentially prevent their policies from paying out can make adjustments to their policies to ensure they have the right level of coverage from the start. 

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