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Jacksonville Insurance Law Blog

Understanding sinkholes

 If you are a resident of Florida, you are probably aware of the risk of sinkholes. According to the University of Florida, this phenomenon occurs when the material under the earth's surface disintegrates, often due to water damage. The surface then caves in, creating a chasm. A sinkhole on the road or in your neighborhood could be large enough to cause significant damage. We at Tyler & Hamilton, P.A. Attorneys at Law understand the devastating effects that a sinkhole could have on your property, and we fight to ensure that insurance companies honor their financial responsibility for the necessary repairs.

The corrosion of rocks under the surface on your property could result from a variety of factors. Elements of the weather, such as heavy rain, could saturate the rock. On the other hand, a period of intense drought could cause underground water tables to diminish, leaving the cave ceiling unsupported. As a result, the surface resting above it could collapse into the hole. The added weight of manmade machinery and building structures could also contribute to a sinkhole.

An insurance company's requirements for claim handling

Hurricane season has brought a slew of storms -- most notably Irma -- to Florida lately, wreaking havoc throughout the state. The large amount of loss and damage means insurance companies are receiving a massive number of claims as the aftermath is assessed.

The Florida Bar reminds potential claimants, however, that there are often specific timeline requirements given to the policyholders, so they must be prompt in filing that claim to ensure it is considered. Even with the large influx of claims, though, an insurer's legal obligation in handling them does not change and as long as the claimant meets deadlines, the insurance company must meet theirs.

  • Acknowledgement: An insurance company must respond to a claim within two weeks (14 calendar days) of it being received.
  • Investigation: An investigation into the homeowner's insurance claim must begin within the initial 10 business days after it is filed. If the client requests, a written confirmation must be given that the investigation has, indeed, begun.
  • Decision: A decision to either affirm or deny it must be made within three months (90 days) of the claim. Unless the result is a denied claim, the payout must be made within this time frame, as well.
  • Mediation: According to Florida's Division of Consumer Services, a policyholder has the right to mediation to try to work out claim disputes. The insurance company is responsible for the expenses and must send written notice of this right to the claimant.

Irma causes agency to take emergency action on insurance

For homeowners in Florida, dealing with damage from a hurricane is one of their biggest fears. Even those whose homes sustained only minor damage can still face major headaches. Having insurance is vital but going through the claims process can be difficult and frustrating.

In an effort to help alleviate some of the anticipated administrative difficulties that follow a major hurricane, the state of Florida recently issued an emergency order. The order aims to protect the interests of policyholders in a number of ways. For one, insurance companies are barred from not renewing or canceling homeowners' policies for 90 days. Notices of cancellation already issued after August 25 are withdrawn and shall be reissued after October 15.

Insurance claims after a hurricane

When a hurricane strikes Florida, the effects can be dire. Sometimes thousands of people must evacuate, and some lose their homes entirely. Those who have homeowner's insurance should be protected from complete ruin and able to rebuild, but unfortunately, that is not always the case. Since some insurance companies fail to honor their commitment, it is important for home owners to know the potential pitfalls they could face when filing a claim.

According to the National Storm Damage Center, one of the first steps after a claim is made is having an adjuster inspect the damaged property. This person's job is to assess the extent of the damage and determine the amount of money necessary to rebuild. However, since the adjuster is often employed by the insurance company, it may be wise to have a contractor present as well. The contractor may then keep the adjuster accountable, helping to ensure that the property is assessed thoroughly and accurately.

Claims for lightning strikes are on the rise

Florida's geographical location and climate mean that Jacksonville residents are subject to their fair share of weather-related catastrophes. Big storms, and not just hurricanes, often bring huge gusts of wind and occassionally, lightning. At Tyler & Hamilton, P.A., we understand that when a storm damages your home, filing an insurance claim for repairs is your top priority.

A lightning strike to your home can wreak all kinds of havoc. While structural damage is certainly possible, according to the Huffington Post, approximately half of the damage that most people experience is due to an electrical surge. This can cause damage to televisions, computers and appliances. In addition, some kinds of damage caused by lightning may not be readily apparent so if you suspect your house has been struck, you may want to undertake a careful inspection and inventory of your things. As with any kind of insurance claim, documenting any damage you may find is key.

The damages of assignment of benefits

Florida certainly delights countless vacationers each year with its gorgeous beaches and lofty city atmospheres. However, the state's residents face a less sunny situation: that of insurance issues. Due to hurricanes and other weather-related catastrophes in the past, insurances companies have struggled to cover the overwhelming costs of the insured. Various factors come into play regarding this situation, but it is impossible to predict the future of natural disasters and their potential destruction.

According to the Florida Office of Insurance Regulation, the assignment of benefits (also known as AOB) is a document signed by a policy holder that a allows a third party to stand in for the insured and request direct payment from an insurance company. A third party in this situation is usually a roofer or plumber. While AOBs have been a part of Florida's marketplace for over a century, loopholes in the way it is being used has caused a drastic increase in the cost of insurance for Florida homeowners. In 2016, the number of AOB lawsuits had reached a whopping 28,200. While this number is distressing, the issue is of top priority of the Office as they work to place less of the damage on innocent homeowners.

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.

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