Having insurance can serve a number of uses, depending on the type of policy you are insured under and the reasons for which you require insurance in the first place.
After getting into an accident or suffering property damage at no fault of your own, policyholders are generally eligible to file a claim with their insurance company in order to receive compensation—based on coverage requirements and other stipulations detailed in their individual policy.
Filing a claim for damages that have come from an environmental disaster, property damage, or another incident for which you are insured is common. These incidents can often result in significant financial strain without insurance, on top of other physical or psychological distress. Securing compensation from insurance, however, is not always easy.
Sometimes insurance companies, from auto insurance, to health insurance and property insurance companies can undervalue, underpay, deny, or otherwise mismanage insurance claims that come their way. In times of stress, this is the last issue that individuals and business owners want to have to deal with.
At Florin|Roebig, our insurance claims attorneys are committed to helping policyholders dispute claims issues they are having with their insurers—whether it be for hurricane damage, an auto accident claim, health insurance claim, or property damage.
Speaking to an experienced lawyer about your situation can give you a better idea of what your legal options are and how you can get the most out of your insurance claims settlement.
Types Of Insurance Disputes
There are many different types of insurance claims that individuals can file, based on the nature of their situation and whether they are filing on behalf of a personal matter or for business.
One common characteristic that spans all types of insurance companies is how frustrating it can be to deal with adjusters and other points of contact within these companies. Many insurance companies espouse mottos that claim to take care of their policyholders and treat them as family—but in practice, this is not always the case.
Lawyers who have experience handling insurance claim disputes can attest to the fact that no policyholder is immune to the potential frustration of dealing with an insurer who is attempting to underpay or deny a filed claim.
Individuals, small-business owners, and even representatives of large corporations may face issues receiving fair and timely compensation. This can happen to people in a variety of situations, whether filing a claim in the aftermath of an accident, a storm, a medical procedure, or other costly circumstances.
Common types of insurance disputes include:
- auto insurance claims
- business interruption claims
- commercial property insurance claims
- condominium property insurance claims
- disability insurance claims
- government and municipality claims
- health insurance claims
- hotel damage claims
- hurricane insurance claims
- life insurance claims
- long-term care insurance claims
- residential property insurance claims
- restaurant insurance claims
Reasons For Insurance Claim Denials
Insurance companies may cite a variety of reasons for why they’ve decided to deny or seemingly undervalue claims. For people who are lawfully seeking compensation for damages, this can be confusing and become a tricky situation to navigate.
Upon receiving an unexpected denial or low payout offer, policyholders may often ask themselves questions such as:
- Am I being unreasonable in my request?
- Did I overestimate how much my insurance claim is worth?
- Is there any reason why I might be considered liable for covering my own damages?
There are reasons why an insurance company may deny a claim filed by a policyholder. Depending on the language that is used in the policy, and the types of coverage offered, insurers may interpret a claim to be ineligible, or otherwise interpret the coverage in such a way that it reduces the payout owed to the policyholder.
Common reasons insurance companies give when denying or undervaluing a claim include:
- the insurance company has determined that no covered loss occurred
- their adjusters have determined your losses to be ineligible for coverage, or excluded from your policy
- the damages are determined to fall below the policy deductible
- their adjusters claim the damages are less than what the insured is claiming
How Insurance Claim Mismanagement Can Occur
Not every issue that policyholders find themselves facing with their insurance company is necessarily a denial or undervalued claim. Mismanagement of claims, or unnecessary complication of the claims process, are also issues sometimes experienced by insured parties.
Insurance companies are meant to provide fair judgments and act in good faith when responding to claims filed by their policyholders. However, as companies that have a financial stake in preserving their cash reserves, sometimes insurance providers may not act in good faith.
Examples of insurance issues that might lead to a dispute include:
- mishandling information relevant to the claim
- misinterpreting the circumstances (including resulting losses) that prompted the insured to file the claim
- overlooking types of coverage offered in the insurance policy (resulting in a denied or undervalued claim)
- drawing out the claims process unnecessarily
- ineffective communication with the policyholder
- denying a claim without offering a reasonable explanation
- failing to pay medical providers or other specialists after the policyholder has paid their premiums and hit their deductible
If you’re concerned that your insurance claim has been mishandled, or that your insurer is attempting to reduce the amount of money you’re owed, you may have several options to dispute and resolve the issue.
What To Do If You’re Experiencing Insurance Claim Issues
In some cases, insurance companies will only investigate a claim if the policyholder steps up to take legal action against them for mismanagement. This is not an easy task to take on.
Insurance claims often involve technical and legal concepts that can be difficult for the average person to navigate and dispute on their own. This is advantageous for the insurance company, as they can use the complexity of the claims process to confuse or manipulate policyholders that are attempting to dispute a settlement.
If you’re experiencing an insurance claims issue, one step you can take to resolve the issue is to file a complaint with the agency in your state that oversees insurance companies. This can put your dissatisfaction with the company—and their handling of your claim—on record.
However, this does not guarantee that the issue will be resolved. Your state agency may take your side, or they may side with your insurance company.
The most effective action you can take to resolve an insurance claims issue is to consult with an insurance claims lawyer who has experience handling insurance disputes. A lawyer can provide you with a general overview of your legal options and explain what you can expect to achieve out of an insurance claims dispute.
Can You Sue An Insurance Company For Claim Denial?
Insurance companies are obligated to pay out fair claims submitted by policyholders. They must follow the terms outlined in the contract or policy, act in good faith of this agreement, and avoid unfair tactics.
State laws may apply, but you could potentially sue an insurance company for:
- delaying an investigation into your claim
- conducting an inadequate investigation
- failing to approve a claim within the agreed-upon timeframe
- failing to explain why your claim was denied
- denying or refusing to pay a claim where liability is reasonably demonstrated
If you have any reason to think your claim could be unfairly denied, you may want to contact an insurance lawyer. Document your correspondences with your insurance company and maintain your records to help your lawyer hold the company liable for unfairly denying your claim.
At Florin|Roebig, our team can help you recover fair compensation for a variety of losses associated with your property, from natural disasters to theft and vandalism.
Practice Areas And Types Of Loss
Florin|Roebig specializes in insurance claim litigation to hold insurance companies responsible for when claims are denied or undervalued. Our law firm is experienced with insurance claim litigation and has helped policyholders receive the fair outcome they deserve. From natural disaster claims to homeowner’s claims, our law firm practices all aspects of insurance litigation
Natural Disaster Damage Claims
Natural disasters may be covered under different property insurance policies. However, filing a property insurance claim after one of these potentially catastrophic events can be difficult. Insurance companies may dispute policy limits, the cost of repairs, and the overall physical damage.
During a hurricane, high winds are responsible for fallen trees and flying debris, which can pose serious risks to property owners. Rain and floods from hurricanes can also do significant damage. In 2018, more than nine million homes were at risk for hurricane damage.
Depending on where you live, your homeowner’s insurance policy may cover damage caused by a hurricane. However, if you live in a hurricane-prone area, then you may have purchased an additional policy to further cover the risk.
Insurance coverage for hurricane damage may depend on:
- your homeowner’s insurance policy
- where you live
- the extent of damage to your property
- how the hurricane caused damage to your property
How much an insurance company pays after filing a hurricane damage claim depends on the limits and deductibles listed in your insurance policy. Your claim settlement will also depend on the exact wording of your policy.
Tornadoes are violent and can cause long swaths of destruction. On average, about 1,200 tornadoes occur in the U.S. each year. Tornadoes can form into a condensation funnel that’s composed of water droplets, debris, and dust. A tornado is the most violent of all storms, and the extent of damage to your property can be severe.
Your property may be damaged by a tornado from flooding, fallen trees, high winds, or debris. How your property is damaged will determine how your insurance company deals with the claim.
An insurance claim for tornado damage may fall under standard homeowner insurance policies. However, some policies may exclude wind damage and other specific details may apply. For example, limits, which detail the maximum amount your insurance company can pay toward your loss, could put a cap on what’s covered to repair the damages.
Wildfires are natural disasters that occur with alarming frequency. In the United States, wildfires have increased by 400 percent since 1970. States like California, Colorado, and Arizona are most at risk for experiencing wildfire property damage.
Damage caused by wildfires may be covered under your homeowner’s insurance policy. Dwelling coverage may help with repairs to your home, while personal property coverage could replace any belongings you lost during the fire.
However, limits and deductibles could restrict you from receiving what it actually costs to repair or rebuild your home and replace everything you lost. With the amount of claims insurance companies are seeing as the result of increasing wildfires, make sure your payout is fair and in line with your policy.
People who live in earthquake-prone areas understand how damaging these events can be.
Although an earthquake can happen anywhere on earth, the states at high risk for earthquakes include:
- Puerto Rico
Standard homeowner insurance policies do not cover earthquake damage. However, some damages that result from an earthquake, like fires for example, may be covered.
People who live in regions where earthquakes commonly occur can purchase an additional policy to cover earthquake damage. Some states, like California, require insurance companies to offer this additional insurance when you purchase insurance for your home.
Earthquake insurance should cover damage to your home and any belongings that were lost. If you experience earthquake damage, document the damage when possible and file a claim with your insurance company as soon as you can after the event.
Storm Damage Claims
If your property is damaged in any kind of storm, then your insurance may help cover certain losses. Many standard homeowner’s insurance policies cover general storm damage caused by lighting strikes, fallen trees, snow and ice, wind, and hail.
The specific kinds of storm damage that are covered will depend on the insurance policy. After a storm, it’s crucial to document all the damage that occured. Take photos or videos and gather records of any work you completed on the property prior to the storm.
Winter Storm Damage
Winter storms damage property throughout certain parts of the United States. Winter storms can include high winds, lake-effect snow, snow squalls, ice storms, and freezing rain, all of which can do significant damage to your property.
Like all storm damage, it’s important to document the damage once the storm passes and it’s safe to go outside.
Hail damage can occur in any part of the United States. These small pellets of ice are common in midwestern states and can be almost two inches in size.
In 2017, the NOAA recorded over 6,000 hail storms in the U.S. Out of all the states that experience hail damage, hail loss claims are filed the most in Texas and Colorado. There were over 800,000 hail damage claims filed in Texas from 2016 to 2018.
Researchers estimate that, in 2017, over 10 million properties in the U.S. were affected by one or more storms where hail caused damage. Hail damage may not always be visible, but may include cracked or damaged shingles, bent roof vents, and other structural damage.
High winds can occur during severe storms like hurricanes or tornadoes, but can also be damagining in their own right. To classify as damaging wind, also called “straight-line” winds, the wind must exceed 50-60 mph.
The most damaging winds occur during thunderstorms. Those most at risk of wind damage include people living in thunderstorm-prone regions, especially those living in mobile homes.
If your property is damaged from high winds, then document all the damage and do not make any repairs until you contact your insurance company.
Flooding can cause extensive damage, so it’s important to purchase an appropriate insurance policy if your home or building is in a flood zone. Structures can flood because of heavy rain, melting snow, drainage problems, and storms.
Flood damage requires special insurance. Because some areas are more prone to flooding than others, some homeowners and businesses must purchase special coverage through the National Flood Insurance Program (NFIP).
Flood insurance with the NFIP may have been offered alongside your home insurance policy. However, NFIP coverage is separate. It may be in place to help pay for repairs to your home, as well as replace personal belongings that were damaged by the flood.
Homeowner/Commercial Property Loss Claims
Although natural disasters and storms may involve filing a claim with your commercial or homeowner’s insurance, other losses are also specifically covered under a standard policy. Like any loss claim, it’s important to document everything you can before filing with your insurance.
An inverse condemnation refers to the government taking hold of private property for public use, but damaging it in some way.
For example, a local government agency widens a street to create sidewalks and bike lanes, but it takes over a local business’s parking lot. Although the government will compensate the business for taking over the lot, the business owner could sue if they claim they’re losing customers and money because there are no longer convenient parking spots.
A common cause for filing a homeowner’s insurance claim, water damage affects 1 in 50 homeowners every year. Water can accidentally discharge from pipes, overflow from the toilet or sewer, or damage property after a severe storm.
Whether water damage is covered under your insurance depends on the insurance policy you have, the source of the damage, and if the water damage was sudden or gradual. Gradual water damage, which happens over time, is not included in most home insurance policies.
Water damage claims are often denied. To avoid a claim denial, make sure you understand the coverage, limits, and deductibles of your policy.
Sinkhole damage can devastate your home or property. A sinkhole refers to a depression in the ground that has no natural surface drainage, which means that water stays inside the hole until it drains underground. Once the underground space becomes too large, then the land surface above it can collapse.
Sinkholes are dramatic, but insurance companies require the sinkhole to meet certain requirements before paying out a claim. If your sinkhole doesn’t meet the requirements, or if you don’t have additional sinkhole coverage, then your insurance claim may be denied.
Fire And Smoke Damage
Firefighters respond to a fire every 24 seconds in the United States. In 2018, it’s estimated that fire departments responded to more than 1.3 million fires. Fires can start because of cooking equipment, electrical problems, heating equipment, accidents, and more.
If your home or belongings are damaged in a fire, you can file an insurance claim. Homeowner’s policies are likely to cover both fire and smoke damage. Smoke damage insurance claims can be more complex than fire claims because of how smoke travels and sticks to things in your home.
Like many loss claims, it’s crucial to document everything that was damaged during the fire. These claims are complex and your insurance is likely to demand lots of paperwork.
Mold is quite common in homes, buildings, and other structures. It grows in places where moisture is present. The majority of mold damage in a house or structure occurs over time.
Although homeowner’s insurance tends to cover mold damage, the damage is only likely covered if it meets specified requirements. This means that, in order to file a mold damage insurance claim, mold damage must have been the result of another “peril” that’s covered under the policy.
Many of these covered perils include sudden or accidental incidents, like bursts pipes or water that suddenly overflows from sewers or other drainage areas.
Some homeowner policies protect artworks that are stolen or damaged. Although lost or stolen art may be covered, it can be difficult for insurers to measure the value of a claim. There could be disagreements over the value of a piece of art, and some art owners could feel they have no say in evaluating the claim.
It can be a good idea to have works of arts appraised to ensure you receive proper compensation should a loss occur. Without a professional appraisal to value the piece of art, you could have a hard time proving the work’s true market value.
Theft And Vandalism
Some property insurance policies may cover theft and vandalism claims. However, the language in your policy matters. Some policies may cover the “willful destruction of property,” while others may detail they will not pay for any damage that resulted from theft.
If your policy does cover theft, you’ll need to show that you owned the property in question. A detailed inventory, as well a receipt of purchase, can help settle a theft claim. While vandalism is covered under most homeowner and commercial insurance policies, some exceptions may apply, including whether or for how long the property was vacant.
Insurance Agent Negligence
Insurance plays a crucial role in our lives and economies, and state and federal laws hold insurance agents to a certain standard of care. If an insurance agent fails to meet their duty of care to you and your claim is later denied, then you can file a claim against the agent for negligence.
It’s the duty of insurance agents to use reasonable diligence, judgment, and care to sell and manage appropriate insurance policies to consumers.
Although state laws vary about the specific duties of insurance agents, your agent may be liable for negligence if they:
- fail to sign you up for the coverage you wanted or needed
- misrepresent what your policy does and doesn’t cover
- fail to accurately complete your insurance application
- fail to pass along your claim to the relevant party after you file it
- fail to notify you that your policy is about to be cancelled
- fail to notify you that the insurance company is having financial issues
If an insurance agent acted with negligence, then you may not be adequately covered. This can have significant consequences because you may be paying for an insurance policy that doesn’t cover what you think it does, which could lead to a denied claim.
Benefits Of Hiring An Insurance Claims Lawyer To Represent You
Insurance companies can be difficult to negotiate with in the process of reaching a payout that is agreeable to both parties.
If you’re experiencing an insurance claims dispute with your insurer, hiring a lawyer who has experience handling these types of cases is the most painless way to resolve the dispute and get the money you’re owed.
At Florin|Roebig, our insurance claims lawyers have extensive experience negotiating with insurance companies to secure you the best possible payout based on the circumstances surrounding your case.
What our top-rated insurance claims lawyers can do for you:
- provide an overview of your legal options
- investigate how your claim was handled by the insurer
- consult with legal and insurance experts
- determine how much your case is worth
- handle communications with the insurer on your behalf
- fight for the best possible settlement
- effectively communicate with you throughout every step of the legal process
How Long Do I Have To Sue My Insurance For A Claims Dispute?
All individuals who wish to pursue legal action against an insurance company for a claims dispute must abide by their state’s statute of limitations. The statute of limitations for insurance claims cases is the amount of time individuals have to file a claim or lawsuit against their insurance company.
Statutes of limitations (SoLs) vary by state and are specific to different areas of law. As recently as 2019, the statute of limitations for the states of Florida, Alabama, and Georgia—for instance—was extended to five years for bad faith insurance claims as a result of a federal court decision made through the Eleventh Circuit Court of Appeals.
Factors that can affect how long you have to take legal action against your insurance company include:
- type of insurance dispute
- state of residence
- whether your dispute qualifies as an exception to your state’s statute of limitations
- state case laws
Statutes of limitations for insurance disputes are not established on a federal level. Check your state’s local laws, or speak to a lawyer who is knowledgeable about insurance disputes, to learn more about how much time you have to take legal action against your insurance company.
Florin|Roebig: Insurance Claim Attorneys Serving The U.S.
Voted one of America’s top law firms, Florin|Roebig is a reliable choice for aggressive and resourceful legal representation—especially when it comes to disputes with insurance companies.
Our insurance claims lawyers have a strong record of securing compensation for insured parties across the U.S. out of our offices in Florida, Texas, Colorado, and Minnesota.
We’re secured over $1 billion for our clients nationwide and offer new clients an initial case evaluation free of charge to discuss their cases in greater detail.
Get Started On Disputing Your Insurance Claim Today
If you’re having trouble getting the payout you’re owed from your insurance company, or believe your insurance has wrongfully denied your claim, the seasoned insurance claims lawyers of Florin|Roebig can help.
Our lawyers can help you resolve your claim with as little stress as possible, but time is of the essence. Don’t wait to begin the process of disputing your insurance claim.
Contact our offices today to schedule a free case evaluation with one of our experienced lawyers to determine your eligibility for taking legal action against your insurer.