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Jacksonville Insurance Law Blog

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 The insurer cited an outdated capitation agreement that it had with a clinic only loosely affiliated with the hospital as the basis for the denials.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.

What to do if your insurance claim is denied

Florida homeowners, like other homeowners throughout the U.S., forego filing insurance claims for minor items, such as a broken window or damaged storm door, because they know their premiums might be raised. When they do file a claim, it is for something significant, and they expect it to be approved. When they receive a letter from the insurer denying the claim or fail to hear anything at all, they are understandably puzzled, to say the least.

For those who find themselves in this position, Fox Business suggests that first, homeowners do their homework, review their policy and make sure they understand their coverage. Common reasons for denial are lack of evidence or documentation, not taking adequate preventive measures or simply that the damage is not covered under the policy.

I just filed a homeowner’s claim, how fast can I expect results?

If you just filed a Florida homeowners claim with the carrier of your homeowner’s insurance policy, things will start to move relatively quickly. In fact, Florida law provides for a bill of rights for homeowner claims.

You should hear back from your insurance company within two weeks from the time it received your claim. There is a mandatory acknowledgment that the carrier must provide you.

Florida residents still hoping for help from FEMA after Irma

Jacksonville residents likely do not need to be told about the devastation that natural disasters can bring to communities. A major part of recovering from such events is the repairing or rebuilding of homes so that local residents can resume their normal lives. The cost of completing such repairs, however, can often be inordinate. People in these cases rely on their insurance providers (or in some cases, state or federal assistance programs) to help shoulder those costs. Yet as anyone who has had to file a homeowners or property insurance claim can attest to, such matters may rarely be resolved quickly. 

That had not been the case, however, with federal disaster relief programs until recently. Reports showed that people applying for home inspections through the Federal Emergency Management Agency following Hurricane Rita only had to wait an average of two weeks for those to be completed. The average wait time to speak to a FEMA representative to file a claim following Hurricane Katrina was only 10 minutes. Yet with Hurricanes Harvey, Irma and Maria having hit in such rapid succession recently (coupled with the widespread wildfires in California), people affected by these disasters are having to wait weeks for assistance. Florida residents in particular have reported having to wait on hold for hours just to talk with someone. While the massive backlog of claims FEMA is facing may be understandable due to its resources being stretched so thin, those who have submitted theirs are now facing the potential of having assistance denied. Of the 1.8 million submitted since Irma, 432,000 have been rejected after properties were determined to not have sustained storm damage significant enough to warrant assistance. 

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.

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