Articles Posted in Insurance Coverage

Published on:

Since Florida requires that actions for breach of contract and bad faith insurance claims be bifurcated, insurance companies routinely oppose discovery and presentation of evidence pertaining to an insurance carrier’s conduct in processing the claim.  Our property damage claim attorneys understand that while an insured frequently will contend that evidence of an inadequate investigation should be relevant during discovery and admissible at trial for purposes of impeachment, insurance carriers routinely claim that such evidence has no bearing on the issue of whether a breach of the insurance contract has occurred.

It is not surprising that insurance companies would prefer to keep this type of evidence out of the breach of contract phase of an insurance policy claims dispute.  However, evidence of an investigation that fails to comply with industry standards can be relevant in a breach of contract case and expose the insurer to consequential damages that are caused by the breach of contract.  Florida insurance law imposes obligations on insurers to act in specific ways, such as those that require carriers to create and implement procedures and policies for proper investigation of claims brought by policyholders.  Florida insurance laws also prohibit insurance carriers from denying a policyholder’s claim without undertaking a reasonable investigation that includes all available facts and information. Continue reading →

Published on:

When homeowners experience a loss after faithfully fulfilling their obligation to make premium payments, they should be able to presume that their insurance carrier will cover a loss when disaster strikes.  Unfortunately, many claims are denied or underpaid when policyholders lack legal representation.  Sometimes policyholders notify their insurance company of a claim and presume it is being resolved only to discover that they have run afoul of some policy term or condition.  There are other times that an insured does not pursue a claim because it does not appear that the claim is covered.  An experienced Miami insurance claims attorney will carefully analyze the policy language and may be able to develop a persuasive argument for coverage.

The case of Rodrigo v. State Farm Florida Insurance provides a compelling example of how easy it is for an insured to make a mistake in pursuing a claim when unrepresented.  The insured made a claim for property damage to her condominium, the property within the condo, and related expenses.  While she never filed a sworn proof of loss, she did supply invoices and a list of specific damages.  An adjuster for the insurance company directed a contractor to inspect the policyholder’s condo.  The insurer tendered payment to the insured who rejected the payment because it did not cover the personal property damage.

Failure to Provide a Proof of Claim

Published on:

This blog has analyzed issues involving the denial of property damage claims based on a multitude of bad faith practices by insurance companies.  A bad faith claim against an insurance carrier involves seeking extra-contractual damages for the insurer’s failure to exercise good faith in executing its obligations under an insurance policy.  Common examples of acts of bad faith by an insurance company that our Miami property damage insurance attorneys have seen include denying a claim without investigating, refusing to provide a relevant policy provision to justify a denial, or intentionally low-balling the settlement of a claim.

A novel legal question that has been raised by insurance companies involves whether carriers have a reciprocal right to pursue an insurance bad faith claim against policyholders.  This would be a powerful weapon for insurance companies to discourage legitimate claims because insurers could intimidate policyholders with the threat of financial liability.  Although this is probably not a possibility contemplated by many policyholders, insurance companies in about a half dozen states have pursued bad faith claims against their insured.  These states have rejected such claims to this point, but policyholders can benefit from understanding the basis for such claims and the reasoning of courts that have declined to recognize bad faith lawsuits against policyholders. Continue reading →

Published on:

Our Miami property damage attorneys find that there are many procedural and evidentiary issues that make the process of pursuing a legal claim complicated when your insurance carrier denies your claim.  While the law provides remedies and legal venues to pursue your rights, the path to obtaining benefits under a homeowner’s policy can be convoluted and complicated.  One issue that homeowners will have to understand and navigate effectively if they pursue a lawsuit for breach of contract against their insurer is the nature of the shifting burden of proof in a lawsuit involving an insurance claims dispute.  A recent case decided by the 2nd District Court of Appeal of Florida provides an overview of this shifting burden under an “all-risk” homeowner’s policy.

In Citizens Property Insurance Corporation v. Salkey, policyholders filed a sinkhole claim with Citizens.  Under the insured’s all-risk policy, the property was covered for all perils unless they were expressly excluded.  While the policy specifically excluded sinkhole damage, it also contained an endorsement for “direct physical loss” resulting from sinkhole activity.  The policyholders filed a lawsuit for breach of contract after their sinkhole claim was denied.  The jury reached a verdict in favor of the policyholders in the amount of $542,883, and the insurance carrier appealed the judgment. Continue reading →

Published on:

Our Miami-Dade County homeowners coverage attorneys recognize that bad faith claims pose special challenges because the issues of liability and damages must be bifurcated in a separate legal proceeding from the first-party bad faith action.  Fortunately, this does not mean that an insured must obtain a breach of contract verdict or settlement before moving forward with the bad faith lawsuit.  Forms of alternative dispute resolution can constitute a sufficient determination of liability and damages to permit a bad faith action to move forward against recalcitrant homeowners insurers.

In the 2nd District Court of Appeal of Florida case, Hunt v. State Farm Florida Insurance Company, the court considered a bad faith claim brought by a homeowner based on the insurer’s failure to cover a claim related to sinkhole activity.  The trial court granted the insurance company’s motion for summary judgment based on the failure of the policyholder to satisfy a condition precedent before filing a bad faith action and a lack of adequate notice under the civil remedy notice (CRN) statute.  Continue reading →

Published on:

Our homeowners insurance claims lawyers understand that many policyholders rely on their insurance agent or an adjuster from the insurance company to determine their rights and potential benefits under their policy.  Although you should contact your insurance agent and promptly notify your insurance company of a claim, your insurer might not always act to protect your best interest.  A fair number of policyholders who suffer devastating financial losses when their homes are damaged by hurricanes, fires, or other perils receive less than they are entitled to under their policies because they do not seek legal advice.

Our insurance property damage lawyers offer the case of Clifton v. Shelter Mutual Insurance Co. as an example of the folly associated with expecting your insurance company or adjuster to aggressively protect your interest.  Although this case is from another state and involves uninsured motorist coverage, the facts related to the insurance company’s handling of the claim provide a cautionary tale for homeowners. Continue reading →

Published on:

Although Florida law can be tough on policyholders, our insurance coverage attorneys know that there are statutory provisions that provide important protections to consumers.  A valuable statutory protection under Florida insurance law is referred to as the Valued Policy Law (FVPL) [§627.702, Fla. Stat. (2008)].  The FVPL provides expedited procedures for homeowners (including owners of mobile homes) who experience a total loss.  The FVPL imposes a duty on an insurer to determine the insurable value of a building and specify the value in the policy.  In the event of a total loss (i.e. the cost of repair exceeds the value of the building), the insurer is to pay the value indicated upon which premiums are collected.  While this law does not prevent your homeowners insurer from raising defenses to coverage, the established value often prevents the need for costly and time-consuming litigation when an insured suffers a total loss.

Given the power of this provision, our Miami homeowners coverage lawyers know insurance carriers frequently search for ways to circumvent this protection provided to policyholders.  The 1st District Court of Appeal for Florida considered an insurer’s contention that the appraisal provision in a policy could trump the FVPL in Freeman v. Integrity Insurance Company of Florida.  In Freeman, the policyholders’ residence was badly damaged by vandalism during a burglary.  They notified their insurer of the loss and their assumption of total loss, which would trigger their FVPL rights.  Continue reading →

Published on:

When a burst pipe damages your living room or a defective water heater, time is of the essence in mitigating the damage.  Failure to properly remove the water can cause long-term structural damage, mold hazards, and other problems.  However, water damage remediation efforts can make the problem worse if qualified professionals do not perform these measures.

When a homeowner lacks the hundreds or thousands of dollars that might be needed to pay for a water remediation service, one available option is the assignment of insurance benefits to a water remediation company. This approach permits the insured to get the damage handled immediately without the need to pay the cost (or full cost) or to wait for the insurer to adjust and pay the claim.

This two-part blog series explains a policyholder’s right to assign their claim following a covered loss in the context of a decision by the Florida 4th District Court of Appeals.  In Part I of this blog, our Miami homeowners insurance claims lawyers review the factual background of the case and rulings by both the trial court and the 4th DCA.  Part II of this blog focuses on the court’s analysis of an insured’s right to assign a post-loss claim despite the presence of a non-assignment clause in the insurance policy. Continue reading →

Published on:

A range of remedies exists to resolve homeowners insurance disputes in Florida.  Since the availability of these remedies and venues depends on the facts and circumstances, homeowners should carefully review and analyze their entire policy.  If you are a Florida homeowner, our Florida Homeowners Insurance Attorneys find it is common for a homeowners policy to include a provision for appraisal.  Under Florida law, the extent of the loss is the proper subject of appraisal, but the question of coverage is solely within the purview of judges.  A decision from the Florida 2nd DCA provides insight into what constitutes the scope of issues that can be the subject of appraisal, as well as the types of conduct by the insured that constitutes a waiver.

In Florida Ins. Guaranty Assoc, v. Lustre, the policyholders pursued a sinkhole damage claim.  The insurer retained BCI, an engineering firm, to conduct an inspection and perform testing.  BCI produced a report that indicated the property damage was related to several causes with sinkhole activity among those factors.  The insurer notified the policyholders that the BCI report had been submitted to three contracting firms for bids to stabilize the residence.  The insurer also contacted another company for cosmetic repairs.  The insurer subsequently tendered payment to the policyholders for the actual cash value of the property damage based on an estimate by one of the contractors, Paul Davis Restoration. Continue reading →

Published on:

When your home is seriously damaged by a windstorm, fire, or other force of nature, you might end up being displaced from your residence.  Although the repairs associated with many insurance claims occur while homeowners remain in their homes, this may not be a safe or feasible option.  If your home is a total loss or the kitchen is unusable, the only viable option might be to relocate on a temporary basis.

Homeowners who must temporarily move out of their residence will be exposed to living expenses that would not have been incurred without the event that caused the loss.  These extra living expenses can impose a substantial financial burden because homeowners will be “doubling up” on certain expenses, such as housing in the form of both mortgage payments and motel/hotel bills.  These expenses also include such items as the increased cost of dining out if your normal practice is to prepare meals at home.  An insured’s homeowners policy might cover these increased living expenses.  This type of insurance company benefit, referred to as “additional living expenses” (ALE), are not automatic in every case where an insured suffers a loss caused by a covered peril.

Our Miami homeowners insurance lawyers understand the home must be rendered “uninhabitable” for ALE coverage to be triggered.  This term is not necessarily as straightforward as you might assume.  Even if an insured could elect to continue residing in his or her residence, this does not mean that the home is habitable under the terms of a homeowners policy.  While the basic definition of “uninhabitable” is “not fit to live in,” the standard for making this determination typically is based on state, county, or city code standards.  As a general rule, almost every locality requires that the occupants’ basic needs be met for a home to be considered habitable.  When such fundamental services as water, electricity, heat, or plumbing are unavailable, these deficiencies will usually constitute a basis for determining the residence is not habitable. Continue reading →

Contact Information