When An Insurance Company Denies a Claim for Home Damages

In Florida, an insurance policy is considered a contract between you and your insurance company. Generally, one looks to the contract to determine the extent of coverage agreed upon.  But the analysis cannot stop there.  A review of the exclusions from coverage must also be analyzed to determine what the insurance company is not responsible for covering.  When there is an ambiguity in the language of the insurance policy between what is covered and what is not covered, Florida Law generally provides a framework to challenge a denial of coverage and such contracts are generally construed in favor of the insured for coverage.

Further, if an insurance company wrongfully refuses to pay a claim, denies a claim, offers an insufficient amount, or unreasonably withholds insurance coverage benefits, it can be considered bad faith or a breach of contract of insurance. Insurance companies are  required to act in good faith with regard to their insured and the processing of their claims.  As the insured, whatever type of insurance policy you purchase (Homeowner’s, Life, Auto, General Liability, Business-Related, Disability, Long Term Care, etc.), in most instances the insured is entitled to the full benefits for the policy if a claim is covered.  Wrongful denial of a claim, or bad faith by an insurer can include, but is not limited to:

  1. Failure to properly investigate claims;
  2. Improper attempts to reduce the payment of claims;
  3. Failure to provide a defense of a lawsuit when required by the policy;
  4. Delay in processing claims;
  5. Failure to pay a claim that rightfully should be paid;
  6. Taking unreasonable stances with regard to interpretation of your policy language.

You may have a cause of action against your insurance company if any of the above occurs when you notify your insurer of a claim.  The denial of a claim by the insurance company does not automatically entitle you to bring a lawsuit.  If such denial is proper and in accordance with the terms of the insurance contract, claims can be properly denied.   However, insurance policies can be complex documents, filled with language which can confuse insurance customers and seem to benefit the insurance companies at the expense of the insured.  When an insurance company commits bad faith, or wrongfully handles a claim, the insured may be able to recover not only coverage under the policy, but also damages for the wrongful handling of the claim, and their reasonable attorney’s fees and costs. The nuances of these claims can be daunting to most people, and it is wise to hire an attorney to represent you at the very beginning, especially if the amount at issue makes economic sense. Representing yourself in a dispute with an insurance company could lead to accepting an unfair offer from the insurance company and leave you without proper coverage.

The information contained in this article is provided for educational and informational purposes only.  The content of this article is not and should not be construed as legal advice, an offer to perform legal services on any matter, and should not be construed to form an attorney-client relationship.  This article should not be construed as a legal opinion on any specific facts or circumstances. The information contained in this article is intended for general information purposes only, and you are urged to consult a lawyer concerning your own situation and any specific legal questions you may have.