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Insurance Claim Denials in 2012

By Saunders Law Group on September 25, 2012


When it comes to insurance, the first thing that often comes to mind is “risk”. Insurance, after all, is protecting against risk, whether the “risk” involves auto, property, professional, life, or disability. When some unfortunate event happens, like someone gets injured on your property, or some hurricane or tropical storm comes across your area and causes damage to your home, or you get into an auto accident with an uninsured or underinsured driver, what is the first thing that comes to mind? Do you have enough insurance? Will the insurance cover this? When is the last time I saw my homeowners’ policy? Do I have the insurance I think I have?

But what happens if after an auto accident or after someone gets injured on your property – the insurance company denies your claim? You have paid insurance premiums regularly and expect the insurance company to pay because this is what you have insurance for, right?

This is why it is important to know what types and what amounts of insurance you carry. Many of our clients know what it feels like to receive a letter from an insurance company that says that they have evaluated the claim and are denying the claim. The letter in essence says: “You’re on your own.” Unfortunately, many insurance companies decide to put their profits over your rights under the insurance policy. Many insurance companies count on you giving up after you receive the rejection letter. Well, all too often it is the insurance company that is wrong.

In one instance, a gentleman bought and paid for insurance to cover damages if his vehicle was ever stolen. This was a part of his auto insurance policy. Well, one day, it happened. His vehicle was stolen from his driveway only to be recovered about five days later on the side of the road with a blown engine. The insurance company claimed that the damage was caused by a pre-existing radiator leak that was found to exist. But, the vehicle’s owner argued that as long as the radiator was kept filled, the engine worked just fine. The insurance company denied paying for the engine repairs, but paid for the cosmetic damages that were done by the thief in breaking into the vehicle. The money received by the gentleman was extremely deficient to pay for all of the repairs.

The fact of the matter was that the thief caused damage to the engine and caused it to blow because he or she drove the vehicle without any coolant after it had all leaked out. The bottom line is that had the vehicle not been stolen, the engine would not have been blown. The gentleman filed a lawsuit against the insurance company and ultimately, the insurance company paid the full amount of the repairs, plus interest and attorneys’ fees.

Unfortunately, in some instances, the insured person has to file a lawsuit against the insurance company to get the benefits to which they are entitled. Florida law has many laws that pertain to insurance companies and the claims handling process. If an insured is forced to sue the insurance company, and shows that there is in fact insurance coverage for the claim that was initially denied by the insurance company, the insured is entitled not only to the amount they are entitled and interest on that amount, but also attorneys’ fees. This assists us in taking cases against insurance companies on what is referred to as a “contingency” basis. That is, we will not get paid unless we recover for the client. If we do get the insurance company to pay, they will pay our fees also.

The law provides this remedy because the insurance company’s denial of the claim was flat wrong. Situations involving insurance claim denial can arise in many different contexts, and under many different contracts of insurance. We can handle claims that have been denied under property insurance policies, auto policies, liability policies, and many others. The law puts very powerful tools in the hands of insureds that can be used to enforce insureds’ rights. We can help you use those tools to their full potential and help you correct the wrongful denial of your insurance claim. Feel free to contact us regarding your insurance claim dispute, and we can arrange a time for a free consultation.

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