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Jacksonville Insurance Law Blog

Identifying unreasonable delays

When it comes to dealing with insurance companies, what people in Jacksonville may tend to dread most is the waiting game. They have to wait to learn if their expenses have been covered or denied, and then wait to hear about the results of any follow-up action that is required. The main reason behind their worry is they know that every day that passes without a resolution to their claim, the filing deadlines that their insurers pose creep closer. What they may not know is that insurers actually use this as a tactic to facilitate claim denials

Insurance companies do not stay afloat by paying out on every claim, yet they cannot deny claims without a valid reason either. Having a filing deadline pass gives them that reason. They can blame subscribers or service providers for not acting promptly, when in reality, the delays may have been intentionally caused on their end. 

Are There Different Types of Commercial Property Insurance?

As a commercial property owner in Florida, you know having the right insurance in place is vital to protect your investment. However, did you know that there are actually a few different types of property insurance available? The Balance offers the following information on the differences between property coverage, which can help you find the best policy for your needs.

Direct Damage Insurance

What are some reasons a water damage claim may be denied?

Water damage is one of the most confusing aspects of homeowner's insurance for many people in Florida. Some types of damage are easily approved claims, but others are often denied. It is important for you to understand what claims your insurance will cover, so you can make sure you are properly insured for all possible events. 

Insure.com explains there are certain water damage claims that will almost always be approved and then there are claims that depend largely on the situation. However, even with claims that are usually approved, there are still conditions. Insurance is rarely ever easy, but water damage claims can be the trickiest because of all the exceptions and the requirement that damage is accidental and sudden.

Understanding insurance settlement guidelines

One of the more common forms of insurance bad faith dealings is discounting. This occurs when your insurer tries to pressure you into accepting a settlement amount that is perceived to be far less than what you are actually owed (or what you understand you should be paid per the details of your policy). The most common complaint that we here at Tyler & Hamilton, P.A. hear from clients when it comes to dealing with insurance companies is that their lack of knowledge makes the vulnerable to abuse. Thus, understanding how insurance adjustors arrive at a settlement amount may help you determine if you are being taken advantage of. 

Your settlement offer should be based off of the type of coverage you have. The terms of your policy should include details such as whether your coverage entitles you the replacement cost of covered property, or the actual cash value. Per the Insurance Information Institute, the difference between the two reimbursement models is depreciation. A replacement cost policy pays you what is needed to replace a property without deducting an amount to account for its depreciation, while an actual cash value policy does consider depreciation. Thus, a replacement policy should offer you enough to replace the property entirely. 

How can I protect myself from property insurance issues?

For Florida residents, hurricanes and property insurance issues often go hand in hand. While you may not have any control over what the weather brings, you can take preventive measures when it comes to minimizing property damage and ensuring solid insurance coverage.

According to Florida's Division of Emergency Management, it is important to protect any part of your home that can be affected or entered by the brutal winds of a storm. Begin by performing a pre-emptive assessment of your home. Take inventory of your roof to ensure it does not have any weak points that may catch or compromise the structure. Not only does this reduce the chances of roof damage but helps keep the elements from entering your home from above. Check out windows, exterior entry doors and garage doors to make sure they are properly maintained and safeguarded. Secure and clean out gutters and downspouts and keep trees trimmed to help avoid limbs breaking and landing on your home or vehicles.

How much time do insurers have to approve a claim?

When disaster strikes, Florida homeowners may feel a great sense of relief just getting an insurance claim filed. The hard part’s over, right? Maybe not. Waiting is hard too, especially when you are waiting for a claim approval so you can get your life back to normal. As the days pass, you may experience growing frustration and begin to wonder if you are ever going to see a check in the mail.

Florida lawmakers have enacted what is known as the Homeowner Claims Bill of Rights. This law establishes a timeframe in which homeowners can expect to hear from their insurance company after filing a claim. The law does not establish grounds for a civil lawsuit, however, nor does it affect the insurance policy itself and its conditions. It also allows for exceptions to the timelines due to situations that are beyond the control of the insurer.

What is bad faith?

There's a term that you may hear thrown around in professional circles in Jacksonville: "bad faith." Typically, it is meant to describe the disingenuous actions of a party in reference to a deal or negotiation, yet its application can be different depending upon the context that it refers to. For example, insurance bad faith is a problem sometimes encountered by policyholders when trying to get claims resolved. Yet to recognize when it might be happening in your particular case, you first need to understand what it is. 

It may seem easy for insurers to deny that they have acted in bad faith because the definition of the term seems so broad. Fortunately, state law defines exactly how it applies when dealing with an insurer. Section 624.155(1)(b)(1-3) of the Florida state statutes lists the following as being examples of insurance bad faith: 

  • Your insurer not attempting to settle a claim when, had it acted fairly and honestly towards you, it should have done so
  • Your insurer offering claim payments without accompanying statements detailing the coverage the payments are meant to settle
  • Your insurer failing to settle a claim under a certain portion of your policy in order to influence a settlement due under another portion

Judge sides with hospital in dispute with insurer

While most in Jacksonville likely value the assistance their insurers offer, they also may understand that insurance companies are businesses, and that businesses typically do not remain in operation by giving away money. Thus, the idea that insurers may constantly be on the lookout for loopholes that allow them to deny or reduce coverage may be more of a fact than a notion. Yet it should be remembered that despite their efforts to save money, insurers are obligated to provide coverage and reimbursement according to the promises made in the contracts they have with their clients. 

A recent ruling in a reimbursement dispute in Texas reaffirms this fact. A local area hospital had sued one of its contracted insurance partners for denying more than $10 million in patient claims. The insurer cited an outdated capitation agreement that it had with a clinic only loosely affiliated with the hospital as the basis for the denials. This reason was given despite the hospital having a current contract with the company that contained different reimbursement provisions (which included payment at 100 percent of the Medicare allowed amount on claims). The judge hearing the case agreed with the hospital's argument, and went even further in saying that insurers shorting providers their payments could potentially put patients at risk. 

What steps should I take for a denied claim?

Living in the Sunshine State means the threat of intense weather is a way of life for most Florida residents, making the proper homeowner's insurance an imperative part of planning. However, what do you do when a catastrophe strikes and the insurance company denies a claim that you were certain was covered? According to the National Association of Insurance Commissioners, you have options to explore before blindly accepting the decision.

The first step is to take a deep breath and read over the fine print of your policy to make sure you know what is covered and verify that you made your claim in the time allotted. If the written explanation sent by the company does not clear up confusion, call the provider's billing office directly and have a representative explain exactly why you were denied. This helps eliminate the possibility of a simple human error or glitch that was overlooked. Be sure to have your policy close by and mark any sections that pertain directly to your claim.

Handling a commercial property insurance dispute

When it comes to commercial property, a wide range of stressful problems can arise. For example, you might encounter challenges while trying to buy commercial property or during your attempt to sell or rent real estate. However, insurance disputes can be especially stressful for those who own commercial property and it is vital for you to have a solid understanding of your different options if you have found yourself in this situation. From gaining access to the compensation you need and should receive to understanding your rights and being prepared for any hurdles that might lie ahead, there are numerous reasons why it is important to approach property insurance issues appropriately.

An insurance dispute over commercial property insurance could arise for various reasons. For example, a policyholder may believe that an insufficient investigation was carried out, resulting in the delay or even denial of a claim. Moreover, someone may believe that the compensation they received was inadequate. Unfortunately, some people refuse to take action during these circumstances, whether they are stressed out due to unfamiliarity with the law or have little hope that they will be able to secure a better outcome. However, this can be a costly decision that results in a policyholder being denied compensation that they should have been entitled to.

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