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Jacksonville Insurance Law Blog

What is the best way to avoid an insurance claim denial?

Getting a large hospital bill that you were not expecting can be a financial nightmare. If your health insurance in Florida, denies your claim, it can take a long time to iron things out and get the bill paid. The better option is to avoid a denial in the first place. Consumer Reports explains there are several things you can do to prevent a claim denial from your health insurance company before you ever get treatment.

Above all, you should understand your coverage. Know what doctors you can use and what procedures the policy covers. Be aware of anything that requires preauthorization. These days, preauthorization may even be needed for certain pain medications. Knowing this ahead of time is important to avoid having to pay the bill yourself. Also, understand what to do if you need care due to a work or auto accident. Often your insurer will not cover those claims initially since they may be covered under worker's compensation or an auto insurance policy.

Water vs. flood damage

Florida homeowners know all too well the damage water can inflict on their property. Such damage often results in a claim made to the homeowner’s insurance company, from which compensation is provided to repair and replace damaged fixtures. While water damage can be covered by standard property insurance, flooding and other types of water damage require separate coverage.

To know the difference between flood and water damage, you must first understand the definition of a flood. According to the Federal Emergency Management Agency (FEMA), flooding is defined as typically dry land being partially or totally besieged by seas, inland bodies of water, runoff surface waters, and mudslides. Floods usually fall into three categories, which includes shallow, river line, and coastal flooding.

What it means if you live in a wind pool area

Having a house on the Florida shore is a dream come true for many residents. Properties at or near the beach can command top dollar. If you are like most homeowners, you want to protect your investment by purchasing the right insurance. At Tyler & Hamilton, P.A., our team has experience representing policyholders when they are denied insurance claims.

The United States hurricane season begins June 1 and continues through the end of November. According to Insurance Market Source, most coastal states affected by high winds have a wind pool. This is government-subsidized coverage against hail and windstorm damage. However, it does not cover everything. If you have a high-value home in a wind pool area, you may want Excess Wind insurance for coverage gaps. A wind migration inspection can determine if your property qualifies for premium credits towards the policy cost.

Negative emotions over a denied insurance claim

When it comes to denied insurance claims, some people may focus on the financial effects of this issue, which can certainly have a major impact on a person's life. However, it is crucial to keep in mind that there are other reasons why denied insurance claims can be incredibly difficult, especially when an insurance company is in the wrong. For example, the emotional toll of these challenges can be overwhelming. Some people in Jacksonville and all over Florida who have had their insurance claims wrongfully denied may experience a great deal of stress over legal matters, while others may face different emotional difficulties.

Aside from legal stress, which can be especially hard for some people, some may become angry because they feel as if their insurance company has failed to live up to its promises and respect their rights. Others may become depressed and feel hopeless over the entire situation. While all of these negative emotions are understandable and can be very tough, it is crucial for you to work through them properly. For example, if you believe that your insurance claim has been wrongfully denied, you should not hesitate to take action and hold your insurance company accountable in the courtroom, if necessary.

Does my insurance protect against hurricanes?

Hurricane Florence is on the minds of many people living in Florida and surrounding areas. Along with concerns about getting you and your family to safety, you may also be wondering whether your property is protected under your current insurance policy. Allstate explains how coverage is determined when a home or other property is damaged by a hurricane.

Wind damage

Is water damage covered by home insurance?

If your Florida home sustains water damage, you want to rest assured that your insurance company will help cover the cost. However, conventional home insurance policies do have some limitations, and it’s important that consumers are aware of what is and is not covered when making a claim. Esurance.com explains how water damage is typically addressed by insurance companies so you can determine whether you’re being treated fairly.

The difference between water damage & flooding

How can I choose a good insurance company?

If you’re shopping around for insurance in Jacksonville, you probably have numerous options in front of you. Choosing the right insurance company is important for many reasons, but it can also prevent issues with denied insurance claims down the line. Esurance.com offers the following tips on how you can find a reliable company to do business with.

Look at a few different companies

Typical insurance issues that follow natural disasters

If your Florida business sustained damage as a result of a natural disaster, you may assume that your insurance coverage will kick in. However, in some cases your insurance policy may fail to offer coverage based on the details on how the damage occurred. Because these issues can be complex even if you have a good understand of your insurance policy, Marsh.com offers the following information.

Understanding Deductibles

The importance of having someone in your corner

You should not assume that any insurance companies in Florida are in the business of handing out money, even if they are ethical organizations that care deeply about the losses of their policyholders. However, if your insurer were to make a decision that you believe was based on something other than a responsible assessment of your situation and a dutiful interpretation of the terms of your policy, then you might choose to enter into negotiations. At Tyler & Hamilton, P.A., we are proud to advocate for our clients' rights, even if our opponents happen to be large insurance providers with accomplished legal teams.

Our clients often come to us in a state of approximate panic; they are often depending on support concerning a recent loss from the insurance companies to which they have paid premiums for the duration of their policies. Our job at this initial stage is to gather enough information to determine whether or not the insurer could be acting in bad faith in regards to their contract with our client.

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

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