When insurance companies are selling their policies to consumers, their salespeople often focus on the supposedly full protection that a policy will offer for a person’s home, automobile, or other property. People all over Florida make their monthly payments under the belief that they’ll be protected should a catastrophe strike, but hoping such situations never truly arise.
Following an accident, disaster, or some unfortunate event, countless consumers are stunned to learn how difficult it can be to successfully file an insurance claim. Key exclusions or conditions in policies are cited as reasons for claims being denied, often leaving Floridians feeling powerless and misled about their investments.
Tampa Lawyer for Insurance Policy Exclusions
Did your insurance company deny your claim because of certain conditions, exclusions, or limitations that supposedly exist in your policy? Or is the insurance company taking an unreasonably long time to make payments you and your family desperately need right now?
Tampa personal injury attorney Michael B. Germain has more than a decade of experience representing individuals and businesses against their insurance companies. He has been repeatedly recognized as a Florida SuperLawyer in the field of insurance coverage litigation.
Germain Law Group represents clients all over Hillsborough County, Pinellas County, Brevard County, Pasco County, and Manatee County. You can receive a complete evaluation of your case during a free, no obligation consultation as soon as you call (813) 835-8888 today.
Florida Insurance Policy Limitations Information Center
- How do conditions apply to insurance claims?
- What exclusions are most commonly used by insurance companies?
- What limitations apply to cancellation or nonrenewal of policies?
- Where can I learn more about Florida insurance policies?
The conditions of an insurance policy are the part that states the obligations of both the person being insured as well as the obligations of the insurance company. This is an important section insurance companies will frequently list specific steps that a policyholder must take in order to recover his or her claim.
Failure to abide by any one of these conditions may lead to a claim being denied based on “strict compliance,” in which the insurance company has the power to deny a claim for a policyholder’s failure to honor any one requirement. To many people, these are rejections based on technicalities.
Consumers who have had their claims denied may be able to argue their claims should be honored based on “substantial compliance.” This means that policyholders who make good-faith efforts to comply with the conditions of their policies deserve to recover on their claims.
Florida courts have recognized substantial compliance arguments, but insurance companies frequently expect strict compliance with certain conditions. One of these is examination requests.
Two of the more commonly contentious such requests include the following:
- Compulsory Medical Examination (CME) — More commonly known as an Independent Medical Examination (IME), the procedure no longer goes by that name because it is not really independent. A CME is an examination conducted by a doctor who has been chosen and paid for by the insurance company. This doctor is not so much concerned with treating a victim’s injuries as getting information that will benefit the insurance company’s interests. For this reason, it is critical for a victim to have a lawyer so he or she can understand what questions he or she does not have to answer. Florida Rules of Civil Procedure 1.360 establishes when and how insurance companies may request CMEs as well as how examiner reports must be handled.
- Examination Under Oath (EUO) — While an EUO can feel like a deposition because a person provides sworn testimony in response to an attorney’s questions in the presence of a court reporter, an EUO is different because it is a contractual obligation while a deposition arises out of the rules of civil procedure. Insurance companies use EUOs to get key statements on record and investigate possible fraud. An EUO can last several hours, and the lawyer chosen by the insurance company may question a person about numerous items—even things that are seemingly unrelated. Like the CME, a person will want to make sure he or she consults an attorney as soon as possible before agreeing to an EUO.
Most insurance policies specifically state what aspects an insurance company will not cover. These are referred to as exclusions, and all consumers should be sure to review their own auto, home, and other insurance policies to make sure they know what exclusions apply.
Some of the most common exclusions that insurance companies use in denying claims include:
- Commercial Operations Exclusion — An automobile insurance policy may have this exclusion if a personal vehicle is used for business purposes.
- Defects Exclusion — If the builder of your home or office that you insured uses cheap materials or is negligent in the construction process, the insurance company may not cover the damage that results of defective items or maintenance.
- Personal Property Exclusion — When homeowners lose or have valuables in their home stolen, they can be shocked to learn that insurance companies will only reimburse them up to a specific amount. For example, a policy might have a limit of $1,500 on jewelry even if more than $10,000 worth was stolen. Homeowners should explore open peril and named perils coverage options to decide which policy best protects their valuables—and understand the exclusions with those coverages as well.
- Water Damage Exclusion — While most policies will cover sudden instances of water damage stemming from accidents within the home, insurance companies will frequently deny claims on the basis of the policyholder’s deferred maintenance. Similarly, flood insurance specifically needs to be purchased to cover rising water events.
It is not uncommon for insurance companies to attempt to cancel or nonrenew a consumer’s policy after he or she has filed a claim. This is especially common following catastrophic events such as sinkholes, hurricanes, or floods.
Some of the cancellation and nonrenewal limitations imposed under Florida law include:
- Act of God Claims — When a property insurance claim is the result of an “Act of God,” an insurance company cannot cancel or nonrenew the policy unless it demonstrates that the insured party failed to take action reasonably necessary to prevent recurrence of damage to the insured property.
- Hurricane Coverage — An insurance company is required to extend coverage until the end of the duration of a hurricane if cancellation or nonrenewal is scheduled to take place during the storm (although the insurance company can charge the current premium rate for the extended coverage).
- Sinkhole Claims — An insurance company cannot cancel any property policy on the basis of a claim for a partial loss caused by a sinkhole when the total of the claim payments does not exceed the current policy limit and the insured party has repaired the structure in accordance with the engineering recommendations.
- Water Damage Claims — A single claim on a property insurance policy which is the result of water damage cannot be used as the sole reason for cancellation unless the insurer demonstrates that the insured party failed to take action reasonably requested by the insurance company.
- Wind Coverage Elimination — An insurance company can offer a renewal policy with wind coverage excluded if a residential structure currently covered with a policy including wind coverage is eligible for wind-only coverage.
Florida Office of Insurance Regulation (FLOIR) — This office is part of the Florida Department of Financial Services. FLOIR is responsible for regulating insurance providers in the Sunshine State. This website is replete with industry data, including reports, eligible reinsurers, and financial data on companies removing citizens’ policies. FLOIR covers various types of insurance, including automobile, homeowners’, life, and flood insurance.
Homeowners’ Insurance | A Toolkit for Consumers — This Florida Department of Financial Services publication covers insuring your home, what your policy covers if a disaster strikes, and the property inventory and claim process. There is also a legal and financial document checklist. The document notes some important considerations when it comes to personal liability, how much insurance a person should buy, and policy terminations.
Find a Hillsborough County Lawyer for Insurance Policy Issues
If you have had your property damage claim denied based on language that your insurance company says was in your policy’s conditions or exclusions, do not assume that you are without options. Germain Law Group assists Florida residents with property insurance claims in Hillsborough County, St. Lucie County, Charlotte County, Indian River County, Sarasota County, and many other nearby areas.
Michael B. Germain is a Tampa insurance law attorney who fights to get his clients the recovery they deserve, and he is not afraid to take insurance companies to trial when a fair settlement cannot be reached. Call (813) 835-8888 right now to have him review your case during a free initial consultation.