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South Florida Homeowners Insurance Lawyers Examine When An Insurance Company Can Refuse To Pay A Claim

Insurance policies are binding contracts. Each party to the contract bears the responsibility of following all of the contract terms. The failure by you, the insured, to follow all of your obligations under the contract will allow the insurance company to avoid having to pay your claim. Insurance companies make money by taking your premium and then finding ways to avoid covering you. Do not let this happen to you.  The Miami homeowners insurance lawyers at Greenberg, Stone, & Urbano want to make sure their clients understand that they must follow the rules set out in the insurance policy and will work diligently with them to make sure they receive the coverage due.

Our homeowners insurance lawyers have seen cases where the insurance company tries to deny payment to their insured by arguing that the insured did not do what they agreed to do under the insurance policy.  Take, for instance, the case of Goldman v. State Farm. The Goldmans were insured by State Farm against theft from their home. Unfortunately, someone burglarized the Goldman’s home. The Goldmans filed a claim with their insurer for the amount stolen. They even submitted sworn affidavits setting out what property was taken and the value of it.

State Farm began investigating the claim as part of their due diligence. Part of their investigation involved taking the Goldmans’ examinations under oath and produce certain documents.  The Goldmans’ attorney asked to postpone the examinations, and they never refused to submit to them. On the other hand, the Goldmans sued State Farm for refusing to pay their claim. State Farm declined to pay their claim on the basis that they did not follow the appropriate procedures spelled out by the insurance policy before they sued State Farm. State Farm did not outright deny the claim either. They objected to payment because the Goldmans did not allow State Farm to complete its investigation.

Under Florida law, refusing to submit to an examination under oath is a violation of the terms of an insurance policy. The insurance company is justified in their decision to refuse to pay the claim if their insured does not submit to an examination under oath. Florida courts have said that refusing to submit to a request by your insurance company to take an examination under oath is a material breach of contract and a failure of a condition precedent to paying the claim.  The insured does not have to show prejudice, or that they were harmed in any way by the refusal if the policy required submitting to an examination under oath before the company will pay out a claim.

A cooperation clause, on the other hand, is different. Under Florida law, the insurance company bears the burden to prove that the insured failed or refused to cooperate with the insurance company’s investigation. A cooperation clause is a called a condition subsequent to the filing of a

lawsuit. In that scenario, the insurance company must claim that the refusal or failure on behalf of the insured to cooperate prejudiced the insurance company.

You should contact an experienced homeowner’s insurance attorney for consultation if you find yourself in this situation. You have the right to be represented by a lawyer at an examination under oath. You should talk with your attorney before attending the examination so you can prepare. It is similar to a deposition except that your insurance company is asking you questions instead of an opposing party. You will be sworn, to tell the truth, and failure to tell the truth as it relates to a material fact is perjury, which is a crime.

Consult With Miami’s Top Law firm According To The Miami Herald

Greenberg, Stone, & Urbano, with 130 years of combined legal experience and rated as a top law firm by the Miami Herald, understand insurance contracts. As such, let the lawyers given the AV rating by Martindale Hubbell review your case. They will work hard to interpret your insurance policy to find coverage for you. Call Greenberg, Stone, & Urbano today at (888) 499-9700 or (305) 595-2400.


Goldman v. State Farm Fire Gen. Ins. Co., 660 So. 2d 300 – Fla: Dist. Court of Appeals, 4th Dist. 

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