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Jacksonville Insurance Law Blog

Why are health insurance claims usually denied?

You expect your insurance company to cover the medical care you need to stay healthy. However, claims are often denied, and it can be stressful trying to get to the bottom of a rejected claim when you’re not entirely sure what went wrong. Knowing why denials happen is useful in this case and Nerdwallet.com offers a few reasons why your health insurance claim may not be approved.

The Medical Provider Was Not In-Network

Differences Between Property Insurance & Liability Insurance

Securing the right insurance policy is crucial for Florida property owners to protect what matters most. That’s why it’s so important to understand the difference between insurance products, such as property and liability policies. Insureon.com explains these differences, so you can make sure your current policy offers the protections you need (which will prevent denied claims when the time comes).

Protections Offered by Property Insurance

Why are mold remediation claims typically denied?

The door of your home in Jacksonville may be open for all to enter. That is, of course, excluding those people (and things) that you do not want to be there. Mold is likely right at the top of that lise, yet somehow it can find its way in, anyway. You might think that the reason you have homeowners (or property) insurance is to handle these exact situations. However, if you do end up submitting a claim, you make quickly discover (just as others have) that insurers rarely cover mold remediation. Why is that? 

The common school of thought is that indoor mold is a health hazard. While research findings compiled by the Institute of Medicine (and shared by the Centers for Disease Control and Prevention) showed a limited connection between mold and the development of respiratory issues in those with asthma, people with compromised immune systems and even otherwise healthy adults and children, more research is needed to determine exactly how big a health concern mold truly is (the same study also points out that many are not affected by mold at all). This lack of information confirming the health risks posed by mold may account for the unwillingness of insurance companies to help deal with it. 

What should you do if your insurance claim has been denied?

You are still recovering from a violent motor vehicle accident in Florida. Fortunately, you survived and are making progress in your healing. However, you are also still dealing with the lingering consequences of your crash including a damaged vehicle and mounting medical bills. To worsen matters, you recently discovered that your insurance claim has been denied. What are you supposed to do now? Understanding your options may allow you to come up with an alternative plan as you continue to recover from your accident. 

According to the National Association of Insurance Commissioners, from the time you acquire your insurance policy, it is imperative that you take the time to read your policy in full. Understanding your coverage and its limitations can help you to be better prepared in the event you have to rely on your insurance for assistance. Your insurance company can explain different clauses to clarify confusion and give you a clear picture of how your coverage will function. 

What Can I Do If My Insurance Claim Is Denied?

When making a home insurance claim in Jacksonville, you expect the insurance company to work with you, so you can get the help you need to repair your home. However, claims are often denied, and it can be difficult for a homeowner to work out the next steps when faced with a rejection. FoxBusiness.com offers the following advice in the event you’re faced with a denial and aren’t sure what to do next.

Read Over Your Policy

I have hurricane damage and need to file a claim. Now what?

Once you have gotten to the other side of a Florida hurricane, you can breathe a sigh of relief and take inventory of your property and home. Unfortunately, coming across damage can bring the tension right back as you prepare for the next storm: dealing with a hurricane insurance claim.

Your first instinct may be to begin cleaning up the mess around your home. However, according to the Florida Office of Insurance Regulation, it is important to document immediately. Take plenty of photographs and videos to show the extent of the damage. This includes damage to the structure, to equipment or furnishings and any water damage. If you must make an emergency repair, first take photos and record the damage that was done. Keep all receipts relating to the project and snap additional photographs after you make the repair. Keep any damaged materials, if it is at all possible, for the adjuster.

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. 

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