The Insurance Company Paid My Claim, Now What?

Category: Miami Lawyer Blog
Published on 01 November 2017
Written by Patrick Russell Hits: 2176

Florida Insurance Claim Help

What to do after you have been paid?

So you have finally been paid for your insurance claim.  Is the process over?  Hardly.  In a world in which everyone acted in good faith and according to their contractual obligations, then perhaps.  But that is often not the case in the world of insurance claims. 

Let’s put this into perspective.  A Florida insurance company is like any other business out there, it operates to make a profit.  The insurance company answers to its officers, board of directors and shareholders.  Naturally, the primary concern is the bottom line and profits.  Precisely this mentality leads to the underpayment of insurance claims.  A penny saved is a penny earned.  If the insurance company can get away with paying a little less to you on your claim, those saved funds feed profits. 

Get a second opinion: Secure a Public Adjuster

A big mistake that homeowners make is to rely on the insurance company for the correct claim payment.  It is easy to cut corners and to pay less by either not paying for certain damages (scope) or not paying enough (amount).  For scope, an insurance company could ignore certain areas of the home and avoid paying for damages.  Likewise, as to the amount, an insurance company can improperly price the cost for materials or labor and shortchange you for the repairs.  Unless you are a construction expert, the only way to protect yourself is to get a second opinion from a licensed Florida public adjuster. A Florida public adjuster uses the same tools and software as the insurance company's adjuster to create an estimate. However, you will often find that the differences between the two estimates can be extreme. Have you been shortchanged? The only way to know if you are being paid the correct amount by the insurance company is to double check their work.

File a Supplemental Claim

If you discover you have been duped by your insurance company, your public adjuster can help you.  The public adjuster can protect your rights by filing a supplemental claim on your behalf to make sure you are paid everything that you are owed.  There is nothing wrong with filing a supplemental claim when you are owed more money from the insurance company.  This is your right and the reason you pay your insurance premiums. The insurance company will not accept your payment of 60% of the premiums, why should you accept their payment of 60% of what you are owed?


About the Author: Patrick Russell, Esq., has been a member of The Florida Bar since 1994 and is an experienced Florida insurance lawyer. Patrick started his insurance law practice more than twenty years ago when he represented homeowners and business owners for their Hurricane Andrew insurance claims. The purpose of this article is educational and not for the solicitation of legal services. The goal is to avoid the mistakes learned from the past, specifically those from previous windstorms. Knowledge is power. Information is free. Mistakes are costly. If you would like more tips on how to process your Florida insurance claim, Patrick can be reached at (305) 608-2977 or here.

 

 

Hurricane Irma Insurance Claim Help

Category: Miami Lawyer Blog
Published on 12 October 2017
Written by Patrick Russell Hits: 145

Delay Deny Defend - Insurance Claims

 

If you were frustrated by the slow disaster assistance after Hurricane Irma, you better buckle your seatbelts and get ready for the insurance claim process. Much like the stages of grieving, many of you after the storm went through shock and denial. Watch out, anger is next and your insurance company is most likely not going to help with that. 

Delay Deny Defend

The concept of Delay, Deny, and Defend is something that was established through the insurance industry's own business documents and practices as outlined in the similarly titled book Delay Deny Defend by Jay M. Feinman. This is an excellent book that exposes the insurance industry for coming up with a business model solely to maximize profits at the expense of wrongfully delaying, denying and then defending insurance claims. The long story made short is that insurance companies pooled their resources and hired a business consulting firm to streamline the claims process for the specific purpose of minimizing payments. After a lengthy research process, the consulting firm found that the longer the insurance company made the process, the more likely people would simply take whatever they were given or give up their claims completely. As a result, the insurance companies literally made the insurance claim process a war of attrition and exercise in restraint and patience. 

Delay

The first stage is delay. In this stage, insurance companies will take their sweet time in processing your claim. There will be no inherent rush or urgency to resolve your claim. Getting information or a commitment from the insurance company will be next to impossible. The first person you will normally meet will be an "independent" adjuster who ironically ONLY works for insurance companies. Most of the time, and more so in times of natural disasters like hurricanes, the "independent" adjuster will be inexperienced or newly trained. We are seeing "independent" adjusters in Florida that are being brought in from Texas, Alabama, and other neighboring states who have never adjusted claims in Florida before. More likely than not, this first adjuster is going to make mistakes, miss items, or deny coverage. The insurance company almost expects you to demand a better estimate or response, and that is why a second adjuster will routinely be sent to view the property. This begs the question why a better adjuster is just not sent right from the start. The second adjuster will routinely add more items to the repair estimate that were "missed" by his first colleague. If you as the property owner even get this far, this is normally where you stop since you believe this is the end of the claims process.

Deny

What you might not know is a desk adjuster is available to review claims for a third time if you ask. A desk adjuster is a more senior claims adjuster that normally works in the corporate offices of the insurance company. The desk adjuster has the ability to review all of the estimates, request more research, and adjust the estimate accordingly. Between the desk adjuster and a claims examiner, this is usually where the final decision is made to either deny a claim or what amount the insurance company will finally pay. Once they make a decision to either deny a claim or to pay only a certain amount, usually any other attempts to change that decision are denied. At this stage of the claims process, the insurance company exercises their leverage over you knowing that you are most likely not inclined to hire a lawyer to fight them. Even if their decision is wrong and they know it, they also know many people will simply give up at this point figuring they have no other options or simply do not want to hire a lawyer.

Defend

The final phase of the insurance claim gauntlet is to defend any lawsuits filed by property owners who feel they were wrongfully denied or underpaid for their insurance claims. Very few property owners ever get to this stage. Either they do not know that they have been wrongfully treated or they simply relied upon the insurance company as having dealt with them in good faith. Others simply have an aversion to hiring lawyers or feel that they cannot afford to fight the insurance company. In both cases, the insurance company wins and you lose. For those that proceed, the road can be long and frustrating, make no mistake about it. The insurance company has budgeted money from the premiums you have paid them to now fight you for your insurance claim. The lawyers the insurance company hires to defend them have no incentive to handle this cases quickly and so the legal case just like the insurance claim process drags on. Again, the goal is to make this process as long and as painful as possible so you simply give up. 

Do Not Give Up

No one said that processing your insurance claim and getting exactly what you are owed from the insurance company would be easy. Rarely is anything worth pursuing easy. That being said, you do have options that can help level the playing field against the insurance company. First, properly document your damages with the help of a Florida public adjuster so you know what you are in fact rightfully owed. Second, secure the help of a Florida insurance lawyer when your insurance claim has been either denied or underpaid.

Know that most reputable insurance lawyers will not charge you an hourly rate nor should they charge you a contingency fee based on the amount of the damages that they secure for you. Rather, a Florida insurance lawyer should charge you a contingency fee based on an hourly rate that he/she charges against the insurance company. In this way, the insurance lawyer is not taking any of your insurance claim monies but only securing a separate legal fee directly from the insurance company if he/she is successful in the lawsuit. This is possible because Florida has a fee-shifting statute for insurance companies that forces insurance companies to pay your legal fees if you should prevail in a lawsuit against them. Hopefully, you can use this playbook against the insurance company to level the playing field. If you have any questions, feel free to leave them below in the comments section or go ahead and contact me directly.


About the Author: Patrick Russell, Esq., has been a member of The Florida Bar since 1994 and is an experienced Florida insurance lawyer. Patrick started his insurance law practice more than twenty years ago when he represented homeowners and business owners for their Hurricane Andrew insurance claims. The purpose of this article is educational and not for the solicitation of legal services. The goal is to avoid the mistakes learned from the past, specifically those from previous windstorms. Knowledge is power. Information is free. Mistakes are costly. If you would like more tips on how to process your Florida insurance claim, Patrick can be reached at (305) 608-2977 or here.

 

 

Irma Insurance Claim Denials

Category: Miami Lawyer Blog
Published on 04 October 2017
Written by Patrick Russell Hits: 1287

Irma Insurance Claim Denial

 

History has a funny way of repeating itself. We have seen this story before twenty-five years ago during Hurricane Andrew. An overwhelmed insurance industry sending raw and poorly trained recruits to Florida to adjust insurance claims for the first time. As a result, many claims were poorly adjusted by the insurance company if not wrongly denied outright. I know, I spent nearly ten years trying to fix that mess on behalf of homeowners.

Wrongful Insurance Claim Denials

Let's face it, adjusters from Texas, Louisiana, or other neighboring states have limited knowledge as to the terms of your insurance policy or its coverage. They are also beholden to their master, the insurance company that pays them. Built into this system is an incentive to naturally minimize payments to you as the homeowner. Safe to say, the "independent" insurance adjuster, that is the guy that ONLY works for insurance companies, is not always looking out for your interests. Already in the early stages of Hurricane Irma, I have seen several instances of "independent" insurance adjusters telling homeowners that their claim is not covered when it is. This is amazing but true. As a result, you need to immediately consult with a Florida insurance lawyer for a review of any insurance claim denial.

Underpayment of Insurance Claim Damages

A second travesty from the "independent" insurance adjusters working on behalf of the insurance company is they are not familiar with local costs for materials or labor. Plugging in data to a computer to spit out a generic repair estimate that may work in St. Louis is not necessarily going to work in Florida. Likewise, due to the incentive to minimize payments, "independent" insurance adjusters are prone to get the scope of damages wrong by missing, intentionally or not, entire areas of damages. I cannot stress enough how important it is to secure a public adjuster to act as your advocate against the insurance company. The insurance company has their "independent" insurance adjuster, why would you not secure your own?

The Keys Are Just Different

As all Floridians know, the Florida Keys is just a different place and so are its people. The same can be said of the damages from Hurricane Irma. The Florida Keys, especially Marathon, Big Pine Key, and Little Torch Key took the brunt of Hurricane Irma. The devastation was catastrophic with homes suffering both flood and wind damages. A one-two punch with the storm surge taking out the ground level and the hurricane winds taking care of upstairs. If that was not bad enough, mold has and will complete the knockout as it runs rampant throughout these soggy homes unabated. Addressing these unique issues will take a special, creative, and resolute effort to absolutely maximize coverage. Do not accept "no" from your insurance company and accept nothing less than what you are owed. 


About the Author: Patrick Russell, Esq., has been a member of The Florida Bar since 1994 and is an experienced Florida insurance lawyer. Patrick started his insurance law practice more than twenty years ago when he represented homeowners and business owners for their Hurricane Andrew insurance claims. The purpose of this article is educational and not for the solicitation of legal services. The goal is to avoid the mistakes learned from the past, specifically those from previous windstorms. Knowledge is power. Information is free. Mistakes are costly. If you would like more tips on how to process your Florida insurance claim, Patrick can be reached at (305) 608-2977 or here.

 

Page 1 of 107

News / Updates

How to change the world from a Navy Seal. It is simple and courageous advice. Go do it! https://t.co/ew9KCbBq98
When science fiction and reality merge. First it was the communicator from Star Trek which is a modern day cell pho… https://t.co/MGkLcXoPgK
What a great way of looking at purpose. https://t.co/DAwP3i5yIP
What are the legal and ethical implications of artificial intelligence and robotics? By watching this, I am not sur… https://t.co/DtSCFsGPPa
What to do if your Irma Insurance claim has been denied #irmaclaims #hurricaneirma #irmalawyer #hurricanelawyer https://t.co/y4wAmzmC6J
Exercising my noodle and learning some new things at the Hurricanes Irma & Maria Conference in Miami Beach. Excelle… https://t.co/y0qKfo3ShD
Nice Chicago Tribune story covering the course that I co-taught this week on "War and Trauma" for an NEH grant. Tha… https://t.co/M0Vvpjbsas
In Honor of Veterans Day, take a moment to hear another cost of war, combat trauma. #oralhistory https://t.co/h5WKIm7S9a
What you should do after you receive a payment for your Hurricane Irma insurance claim #irmaclaims #hurricanelawyer https://t.co/2qhEDe5mi1
Finished the trip on behalf of the NEH grant with a small presentation at Lewis University on how to spot and identi…https://t.co/LcCoSeWmey