Florida Insurance Law Blog : Florida Insurance Lawyer & Attorney : Mark Nation Law Firm : Orlando, Longwood, Gainesville

My client, a local lawyer, sustained substantial wind damage to his tile roof as a result of the severe unnamed storm that hit our area on March 30, 2011.  He submitted the claim to his homeowners insurance company.  The insurance company had his roof inspected by an engineering firm that found that his tile roof - which had been in place for about 15 years without any problems - had been improperly installed. 

Based on the engineering report, the homeowners insurer denied the claim.  The insurer and the engineering firm it hired ignored the facts that: 1) prior to March 30, 2011 the roof was working perfectly; and 2) during the storm, many of his roof tiles were blown off and others shifted. 

Yesterday, I filed a lawsuit against the insurance company for breach of contract. I suspect that once the insurance company hires a lawyer he will tell the insurer to settle this case. 

The important lesson for homeowners in this case is that you still have options even if your insurance company hires a professional engineer who writes a report against you.  My promise is simple: I will review any insurance denial for free.  Never evaluate an insurance company denial on your own.  What may seem like a bullet-proof denial to you, may really be simple to overcome. 

As with most of my roof cases, if I win, the insurance company will be required to pay my fees and costs, and if I lose, I'll work for free. 

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In US Airways, Inc. v. McCutchen, 2011 WL 5557411 (3rd Cir. Nov. 16, 2011), an ERISA plan sought reimbursement of 100% of what it had paid for medical bills for a car crash victim even though the victim had not been fully reimbursed because of limited liability coverage. The lawyers for the car crash victim claimed that the ERISA plan should reduce its claim pro rata for attorneys fees and costs. The ERISA plan administrators refused, and demanded reimbursement of 100% of what it had spent.

The ERISA plan eventually filed a lawsuit against the plan beneficiary seeking 100% reimbursement. The language of the plan states that the ERISA plan was entitled to reimbursement “for amounts paid for claims out of any monies recovered from a third party….”

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After back-to-back trials which ended last week, I've been quite busy meeting with new clients.  In this case, my client's homeowners insurance company confirmed that his house was suffering from damage from sinkhole activity.  The insurance company hired an engineering firm to prepare a sinkhole remediation plan.  On its face, the remediation plan appeared deficient. 

I sent the insurance company's remediation plan to a geotechnical engineer for review.  The review confirmed that the insurance company's remediation plan was indeed deficient.  It failed to include sufficient grouting and failed to utilize underpinning. 

Today, I filed a lawsuit against my client's homeowners insurance company in order to force the insurance company to pay for an appropriate remediation plan. 

As with most of my insurance cases, if I win, the insurance company will be required to pay for my hourly fees and costs, and if I lose, I'll work for free. 

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My client owns a business which operates out of a wooden building which was built in 1956.  Recently, upon arriving at the business, my client noticed that ceiling was sagging.  Upon further inspection, it was determined that one of the wood trusses had cracked.  The one cracked truss, has now led to another cracked truss.  Because of the problem, the building is uninhabitable.

My client reported the claim to his property insurer.  The property insurer summarily rejected the claim, alleging that the cracked truss was due to old age, and poor construction. 

Today, I filed a lawsuit against the property insurer under the collapse coverage.  The collapse coverage contained in most policies is quite broad and allows recovery if there is a sudden falling down or caving in or a building or any part of a building.  The cracking of the truss was sudden, and certainly constitutes a "part of a building." 

As with most of my insurance cases, if I win, the insurance company will be responsible for my fees and costs, and if I lose, I'll work for free. 

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My client took out a short term disability policy in December of 2010. He then suffered a stroke in May of this year. His short term disability carrier denied the claim, asserting that the stroke was a preexisting condition. 

You won’t be surprised to hear that I filed a lawsuit against the STD carrier for breach of contract. I can’t wait to see how they prove that a stroke that occurred in May 2011, preexisted an insurance policy taken out in December 2010. 

As with most of my insurance cases, if I am successful, the insurance company will be required to pay my hourly fees and costs, and if I lose, I’ll work for free. 

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My client’s homeowners insurance company has confirmed that a sinkhole is damaging his home. Additionally, several of his surrounding neighbors have sustained significant sinkhole damage. The insurance company retained an engineering firm to come up with a sinkhole remediation plan. The plan suggested by the insurer’s engineering firm is inadequate in two very significant respects. 

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My clients sustained lightning damage to electrical items in their home. A few weeks later, someone stole their truck from their driveway and torched it.  The truck contained a significant amount of Ham Radio equipment as well as other items. They filed claims with Allstate, their homeowners insurance company, for the lightning damage, and also for the stolen/burned items from the truck.  (Yes, most homeowners policies cover items stolen from your car).  

Because of the amount of electronics and radio equipment involved, as well as what Allstate claimed were other irregularities, Allstate put its Special Investigations Unit on the claims. Prior to us becoming involved, Allstate took 3 recorded statements from our client, and received photographs and documents that supported the claim. Then Allstate set my clients for an Examination Under Oath. At that time we were retained.

Allstate claimed that it had requested our clients to fill out a Sworn Statement in Proof of Loss prior to them retaining us. After we were hired, we requested blank POL forms to fill out, as well as a copy of the policy. Neither was provided to us.

Our clients sat for their EUO’s. The day after the EUO’s were completed, we wrote a letter to Allstate asking if they needed anything else in order to evaluate the claim. They did not respond to that letter. So, we waited, and waited, and waited. Ninety-two days after their EUO’s with no word from the insurer we filed suit.

Allstate defended by claiming that the insureds had failed to timely file a sworn statement in proof of loss, and that the insureds had committed fraud in the presentation of the claim.

The case went to a jury trial in October. We won.

Just prior to the case going to the jury, the judge dismissed Allstate’s claims of fraud. The jury then determined that while the insureds did not file the POL forms, Allstate was not prejudiced by that failure.  In other words, Allstate had all the information it needed to evaluate the claim.

I want to thank our fantastic clients who would not back down.

Because we were successful, Allstate will be required to pay all of our fees and costs incurred in prosecuting the case.
 

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One of the most common types of homeowners claims is for water damage.  And, one of the most common types of claim denials or underpayments I see is for water losses. 

In many cases, the insurance company will deny the claim and assert that it is not covered, or will low ball the damage.  Typical illegal denials include where the insurance company says that the water loss is due to wear and tear, or improper maintenance, or that the leak was caused by a plumber.  These are covered losses under your policy, although the insurance company may tell you otherwise. 

Yesterday, I was retained by a homeowner who had a water leak.  The estimate for repairs was around $32,000.  The insurer agreed that the loss was covered, but then low balled the damage at $13,000.  The adjuster told my client that was all he was going to pay "no matter what."  Upon hearing this, most people go away.  I'm sure that is what the adjuster was hoping. 

Instead, I filed a a breach of contract lawsuit against the insurance company.  If I win, the insurance company will be required to pay my fees and costs, and if I lose, I'll work for free. 

Please know that I promise to look at any insurance denial for free.  Even if you think there is no way to overturn the denial; even if the insurance company has an engineering report against you; even if you think the insurance company is right...let me look at that denial for free. 

Fighting the good fight. 

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My client's slate roof was damaged by wind in a severe March 30, 2011 unnamed storm.  I have many, many roof cases arising from this severe wind event.  Several tiles were blown off during the storm.  Thankfully, there is no leaking yet.  Nor, does there have to be in order to force your insurance company to replace your roof.   

My client submitted the claim to his homeowners insurer.  His insurance company sent out an engineer who wrote an extensive report which concluded that the roof was not damaged in the storm, but instead needed to be replaced because it was old.  I am convinced that in many of these cases the insurance company gets the report it wants and hopes the homeowner just goes away.  Sadly, many do.  This one did not.

Yesterday, I filed a breach of contract suit against my client's homeowners insurer.  I've probably handled over 1,000 of these roof cases over the past 21 years.  This is actually one of the easier ones. 

What is most disconcerting is that I know that most homeowners just go away after receiving an engineering report from the insurance company.  That is why I promise to look at any insurance denial for free!

Further, in most of my insurance cases, if I win the insurance company has to pay my fees and costs, and if I lose, I'll work for free!

Do not go it alone.  Every insurance case I've won has one thing in common.  The insurance company refused to pay.  Most of the time, there is an extensive engineering or other expert report explaining why the insurance company doesn't owe anything.  That denial letter is not the end of the inquiry, it is just the beginning. 

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