Provided By Christopher M. Tuccitto, Esq.

The “Tort Reform” ushered in by the passage of House Bill 837 (HB 837) on March 24, 2023, marked a significant shift in Florida tort law, particularly in the realm of Personal Injury Protection (PIP) lawsuits. Among the most impactful changes introduced by the bill was the elimination of one-way attorney’s fees for plaintiffs, a provision that had long been a cornerstone of Florida’s PIP litigation framework. The removal of this benefit has altered the strategies of personal injury attorneys, medical providers, and insurance companies, reshaping the way PIP claims are handled and litigated.

Before HB 837, Florida’s one-way attorney’s fee provision allowed plaintiffs who prevailed in PIP lawsuits to recover their legal fees from the defendant insurance companies. This provision, governed by Florida Statutes §627.428, incentivized attorneys to take on PIP claims since they could litigate cases without worrying about their clients’ ability to pay. The law was designed to level the playing field, ensuring that individuals and medical providers had access to legal recourse against insurance companies that underpaid or denied legitimate claims. However, insurance companies and lawmakers argued that the one-way attorney’s fee rule contributed to excessive litigation and inflated claims. HB 837’s enactment removed this provision, fundamentally changing the dynamics of PIP lawsuits.

With the elimination of one-way attorney’s fees, plaintiffs, including medical providers pursuing unpaid claims, must now shoulder the cost of their own legal representation, regardless of whether they win or lose. This creates significant challenges as many claimants are unable to afford legal fees, discouraging them from pursuing litigation. Smaller medical practices that previously relied on PIP lawsuits to recover unpaid bills are now struggling to take legal action against insurers. In addition, attorneys have become extremely selective in the PIP cases they accept, focusing only on those with high-value claims and clear-cut liability. Previously, insurers faced strong financial incentives to settle PIP claims quickly to avoid paying the plaintiff’s attorney’s fees. Without this pressure, insurers are now more inclined to delay or deny claims, knowing that claimants now bear the full cost of litigation. Disputes over medical bills and coverage are taking longer (if ever) to resolve, leading to increased financial strain on healthcare providers. In addition, policyholders injured in car accidents are finding it more difficult to obtain fair compensation for their medical expenses.

Without the safety net of one-way attorney’s fees, Florida has seen a sharp decline in PIP lawsuits. This has had several ramifications. Fewer legal challenges have emboldened insurers to take a stricter approach to claims processing. The volume of PIP-related court cases has decreased precipitously, limiting claimants’ ability to fight unfair denials. While the overall cost of PIP litigation declined, it has come at the expense of injured parties and medical providers who lack the resources to litigate.

The elimination of one-way attorney’s fees under HB 837 has dramatically altered Florida’s PIP litigation landscape, shifting financial risks onto plaintiffs and reducing the pressure on insurers to settle claims expediently. While this change was intended to curb excessive litigation, it also presents new challenges for injured parties, medical providers, PIP attorneys, and personal injury attorneys. Stakeholders must adopt proactive strategies, from improving documentation to strengthening negotiations with insurers. Understanding these shifts is essential for ensuring fair outcomes for those affected by motor vehicle accidents in Florida.

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Provided By Christopher M. Tuccitto, Esq.
Partner at Florida Advocates
754-290-3803
chris@fladvocates.com
www.fladvocates.com

As a Florida medical provider, the work often involves treating patients injured in car accidents and submitting bills to Personal Injury Protection (PIP) insurers. When insurers fail to pay claimsin full or act unfairly, providers might find themselves drawn into class action lawsuits. These lawsuits aim to address widespread insurer misconduct, but they aren’t always the best path forevery provider. Let’s examine the pros and cons of participating in, and opting out of, classactions involving PIP claims.

The Pros of Participating in PIP Class Actions

• 1. Strength in Numbers A key advantage of a class action is the collective power itprovides. When numerous medical providers join forces, the sheer volume of claims strengthens the case against the insurer. This collective pressure often leads to settlementsthat may not be achievable through individual lawsuits.
• 2. Minimal Time Investment By joining a class action, you delegate much of the legal work to the class attorneys. You won’t need to appear in court or handle extensive documentation. This is particularly appealing for busy providers who lack the resources to manage a prolonged legal battle.
• 3. Access to Experienced Counsel PIP Class actions are handled by attorneys with significant experience in PIP litigation and insurance law. This ensures the case is in capable hands, increasing the likelihood of a favorable outcome.

The Cons of Participating in PIP Class Actions

• 1. Limited Control As a class member, you have little say in how the case is managed. Decisions about settlements, legal strategy, and court filings are made by the lead plaintiffs and their attorneys. If the provider is dissatisfied with these decisions, there is limited recourse.
• 2. Potentially Lower Recovery Class actions aim to distribute settlements equitably among all members, which can result in lower payouts compared to pursuing an individual lawsuit. For providers with substantial claims, this might be a significant disadvantage.
• 3. Lengthy Process Class actions often take years to resolve. If a provider is seeking a quick resolution to their PIP disputes, this route may test their patience.
• 4. Release of Claims Settling a class action typically requires the provider to release the insurer from liability for all related claims, even those not fully compensated by the settlement. This may bar the provider from seeking additional remedies in the future.

The Pros of Opting Out of PIP Class Actions

• 1. Greater Control By opting out, the provider retains complete control over the case. The provider and their attorney can decide on legal strategies, whether to settle or litigate, andwhat recovery amount is acceptable.
• 2. Potential for Higher Recovery Individual lawsuits often yield higher payouts, especially for providers with substantial claims. The case won’t be diluted by the need to share asettlement with numerous other providers.
• 3. Tailored Representation Opting out allows the provider to hire an attorney who’s fully focused on the case and specific concerns. This personalized approach often leads tobetter outcomes.

The Cons of Opting Out of PIP Class Actions

• 1. Time-Consuming Unlike class actions, individual lawsuits require active involvement. The provider may need to provide extensive documentation, attend court hearings, andspend significant time on your case.
• 2. Weaker Bargaining Position Standing alone, the provider lacks the collective weight ofa class. Insurers may be less inclined to settle or offer favorable terms when negotiating with individual providers.

Final Thoughts

Whether to participate in or opt out of a PIP class action depends on the provider’s specific circumstances. If the provider’s PIP claims are relatively small and they are looking for a low-risk, low-effort resolution, joining a class action might be the best option. On the other hand, ifthe claims are substantial and the provider is willing to invest time and resources, opting out and pursuing an individual case may yield a better outcome.

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By: Christopher M. Tuccitto, Esq.,
Managing Partner at Florida Advocates, A Private Law Firm
754-290-3803, chris@fladvocates.com

PIP Billing for Unlisted Services: A Guide for Medical Providers

As medical providers in Florida strive to comply with the complex landscape of billing Personal Injury Protection (PIP) insurance, the question of how much to bill for services lacking established reimbursement amounts under the Medicare Part or Workers’ Compensation fee schedules looms large. The intricacies of this issue are particularly relevant following a recent court decision that shed light on insurance company obligations to pay for unlisted services.

PIP insurance is a crucial component of Florida’s no-fault insurance system, designed to cover medical expenses for individuals injured in automobile accidents, regardless of fault. According to Section 627.736, Florida Statutes, PIP insurers are expected to reimburse medical providers for “all reasonable expenses” incurred during treatment. This broad mandate raises significant questions when the services rendered do not align with pre-established reimbursement schedules.

Florida law stipulates that when available, reimbursement amounts should adhere to existing fee schedules set forth by Medicare or Workers’ Compensation. However, the reality is that some medical services—especially specialized treatments—do not have corresponding amounts listed in these schedules.

In August 2023, the Fourth District Court of Appeal issued a pivotal ruling in the consolidated cases of Safeco Insurance Company of Illinois v. MD Now Medical Centers, Inc., LM General Insurance Company v. MD Now Medical Centers, Inc. a/a/o Lisa Lugo, and Liberty Mutual Insurance Company v. MD Now Medical Centers, Inc. These consolidated appeals raised important concerns regarding the obligations of PIP insurers to reimburse medical services without established reimbursement amounts under Medicare or Workers’ Compensation.

The Court reiterated that while PIP reimbursement should reference these established fee schedules, when possible, it is not strictly bound to them. The ruling established that PIP insurers must have a methodology for determining reimbursement for an unscheduled service that is done by comparing the billed code(s) with clinically similar codes found in the Current Procedural Terminology (CPT) Manual or the Healthcare Common Procedure Coding System (HCPCS) Manual. This ruling is particularly significant because it clarifies that providers may seek reimbursement of their charges even if the charges do not have an established reimbursement amount.

Given the court’s affirmation of reimbursement for unlisted services, medical providers must implement comprehensive strategies for billing PIP insurance when it comes to these unlisted services. The basis for this strategy should involve:

1. Assessment of Market Rates: Providers should research and document the standard fees for similar services within their region. Using industry benchmarks will help establish a fair and justifiable billing rate.

2. Documentation of Medical Necessity: Each service should be accompanied by thorough documentation demonstrating its necessity. Clear medical records can substantiate charges and enhance the provider’s position during potential disputes with insurance companies.

3. Billing Procedures: Adopt transparent billing practices by breaking down services into detailed line items. This approach not only helps justify the total charges but also provides clarity for both the insurer and the patient.

4. Engagement with Insurers: Providers should be proactive in communicating with PIP insurers regarding their billing practices, especially when services do not fit neatly into existing reimbursement structures. Open dialogue can help prevent disputes and promote timely payment.

As Florida’s medical providers face the challenges associated with PIP billing for services without predetermined reimbursement amounts, the recent 4 th DCA ruling provides ammunition for medical providers who are seeking reimbursement for unlisted services. By emphasizing reasonable billing practices, thoroughly documenting services, and being prepared to justify charges, providers will increase the likelihood of PIP reimbursement for these unlisted services. This not only ensures they receive fair compensation but also enhances the overall integrity of the healthcare system in Florida.

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Provided By Christopher M. Tuccitto, Esq.

While it doesn’t occur too often, it’s practically inevitable if you’re a Florida medical provider who treats patients for Personal Injury claims that you will eventually receive a request from a Personal Injury Protection (PIP) insurance carrier for a refund of a supposed overpayment. In the realm of PIP insurance, medical providers often find themselves grappling with refund requests from insurance companies. These requests can be daunting, prompting providers to question their legal standing and obligations. However, it's crucial for Florida medical providers to understand their rights and defenses, particularly the concept of detrimental reliance.

Detrimental reliance, also known as detrimental estoppel, is a legal principle that comes into play when one party reasonably relies on the actions or representations of another to their detriment. In the context of medical providers and PIP insurance companies, this principle holds significant weight.

When a medical provider renders services to a patient covered by PIP insurance, they do so under the assumption that they will be compensated for their services in accordance with the terms of the insurance policy. This reliance on the insurance coverage is not only reasonable but also essential for the provider to continue offering care to injured individuals.

However, complications arise when PIP insurance companies retroactively seek refunds for previously paid claims. In such cases, medical providers may invoke the defense of detrimental reliance to resist these refund requests. By demonstrating that they reasonably relied on the representations of the insurance company regarding coverage and payment, providers can assert their right to retain the compensation they received for services rendered.

It's important to note that detrimental reliance is not a blanket defense and must be supported by evidence. Medical providers should maintain thorough documentation of all communications with the insurance company, including claim submissions, payment receipts, and any correspondence regarding coverage or reimbursement policies.

Additionally, medical providers should be prepared to demonstrate the detrimental consequences they would face if forced to refund payments already received. This may include financial losses, disruption of patient care, and/or damage to professional reputation.

In navigating refund requests from Florida PIP insurance companies, medical providers should also be mindful of legal requirements and procedures. Consulting with experienced attorneys specializing in PIP Insurance claims can provide valuable guidance and representation throughout the process.

Ultimately, the defense of detrimental reliance serves as a crucial safeguard for Florida medical providers facing refund requests from PIP insurance companies. By understanding and asserting this defense, providers can protect their rights, uphold their professional integrity, and continue to prioritize the care of their patients.

In conclusion, while refund requests from Florida PIP insurance companies can be challenging, medical providers have legal recourse in the form of the defense of detrimental reliance. By leveraging this defense and seeking appropriate legal counsel, providers can navigate these requests with confidence and uphold their commitment to patient care.

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Provided By Christopher M. Tuccitto, Esq.

2024 Legislative Update

Thankfully, the 2024 legislative session has ended without inflicting any cataclysmic changes on the Personal Injury industry. Although none of them passed, there were some bills introduced in this session that are worth our attention, because they may be resurrected in future sessions.

Motor Vehicle Insurance ̶ HB 653 and the identical SB 464 is a perennial effort to do away with Personal Injury Protection (PIP) coverage under Florida’s No-Fault insurance law and replace it with bodily injury (BI) liability coverage. The primary difference between PIP and mandatory BI is that under PIP, someone injured in an auto accident seeks coverage first under their own PIP policy, whereas under mandatory BI, someone injured in an auto accident would seek recovery from a responsible third party’s (other driver’s) BI coverage. The bills are like the bill vetoed in 2022 by Governor DeSantis and filed again 2023. Last spring’s bills were never heard by a committee and neither of these bills received a hearing this session.

Insurance Claims ̶ HB 731 passed its first committee on February 6 by a 15-1 vote in the House Insurance & Banking Subcommittee. It requires insurance companies to report to the Office of Insurance Regulation (OIR) the recovery of funds from automobile claim judgments, settlements, and attorney fees and costs, as well as repayment of claims paid from unlawful acts. OIR, in turn, would be required to consider recovery of those funds in reviewing companies’ rates. The bill also specifies that a policyholder’s payment of a deductible or copayment is not a condition of a carrier’s payment obligations. There is a similar bill in the Senate (SB 1024) that never received a hearing.

Litigation Financing– SB 1276 and HB 1179 are identical bills to regulate third-party financing of lawsuits against businesses. The bill requires a court’s consideration of potential conflicts of interest that may arise from the existence of a litigation financing agreement in specified circumstances; prohibits specified acts by litigation financiers; requires certain disclosures related to litigation financing agreements and the involvement of foreign persons, foreign principals, or sovereign wealth funds; and requires the indemnification of specified fees, costs, and sanctions by a litigation financier in specified circumstances, among other provisions. Despite the Senate bill making it through all committees and the House bill getting through its initial committee, neither reached a floor vote.

Attorney’s Fees– SB 1782 and HB 1651 both seek to reestablish the right to attorney’s fees for the prevailing Plaintiff in a PIP lawsuit. As I’m sure you recall, the passing of HB 837 last year removed this right, which was previously in existence since 1896. Unfortunately, despite their noble efforts, neither of these bills have received much traction within the legislature, with neither of them advancing beyond the initial committees that reviewed them in early January.

Worker’s Compensation– SB 362 and HB 161 are related bills that seek to increase a health care provider’s witness fee for a deposition and the reimbursement amounts under Worker’s Compensation for physicians and surgical procedures. Both the Senate and House bill would increase the medical provider’s witness fee to $300.00 per hour. The Senate bill increases the maximum reimbursement for a physician licensed under chapter 458 or chapter 459 and for surgical procedures to 200% of the Medicare allowable amount. The House bill would raise Worker’s Compensation reimbursement amounts to 150% of Medicare. While both bills were advancing through committees in January and February, both the Senate and the House have decided to postpone consideration of these bills, at least temporarily. Due to this postponement so late within the session, neither version had a chance of passing this year.

Based on the above, 2024 was a relatively uneventful year for our industry when it comes to legislative changes. Lately, it seems that no change is good for us, although it would’ve been nice to have attorney’s fees reinstated in PIP lawsuits. Maybe this bill will gain greater traction in future sessions if it is reintroduced. We shall see. Stay tuned.

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Provided By Christopher M. Tuccitto, Esq.

A recent decision by Florida’s Fourth District Court of Appeal (4 th DCA) is a winner for medical providers who have had services denied by a Personal Injury Protection (PIP) insurer because the code billed does not have an established reimbursement amount under Medicare or Florida Workers’ Compensation. The case was a consolidated appeal requesting reversal of the trial court’s order in favor of MD Now Medical Centers, Inc. which required insurers to reimburse MD Now for billed urgent care center facility fees under Code S9088. (See Safeco Ins. Co. v. MD Now Med. Ctrs., Inc., Nos. 4D22-846, 4D22-847, 4D22-1486, 2023 Fla. App. LEXIS 5401, at *1 (4th DCA Aug. 2, 2023) )

In each of three cases, the insureds were injured in automobile accidents and received treatment at one of MD Now’s urgent care centers. Each of the insureds assigned their PIP benefits to MD Now. MD Now submitted medical bills to the insurers, who paid all charges except for the urgent care facility fee under Code S9088. MD Now uses this code to bill for services provided in an urgent care center.

The insurers denied payment of Code S9088, claiming it wasn’t a covered expense pursuant to Section 627.736(5)(a)(1)(f), Florida Statutes because it is not reimbursable under either the Medicare or Florida’s Workers’ Compensation Fee Schedules. The insurers asserted that (1) neither Medicare nor Workers’ Compensation have a set fee for Code S9088, and (2) Workers’ Compensation reimburses urgent care centers using the non-facility Maximum Reimbursable Amount (“MRA”).

MD Now argued that Code S9088 was reimbursable under Workers’ Compensation and the Florida Workers’ Compensation Health Care Provider Reimbursement Manual. MD Now contended that codes that do not have a set MRA require insurers to have an established methodology for determining the reimbursement amount. MD Now submitted evidence that Workers’ Compensation insurers consistently reimbursed for Code S9088 in the three years prior to the filing of this lawsuit and that Workers’ Compensation insurers have repeatedly used Code S9088 since 2002 when the code first went into effect.

The 4 th DCA looked to the language of the PIP statute, specifically Section 627.736(5)(a)(1)(f), Florida Statutes, which states in pertinent part: “…if such services, supplies, or care is not reimbursable under Medicare Part B, as provided in this subparagraph, the insurer may limit reimbursement to 80 percent of the maximum reimbursable allowance under workers’ compensation, as determined under s. 440.13 and rules adopted thereunder which are in effect at the time such services, supplies or care is provided. Services, supplies or care that is not reimbursable under Medicare or workers’ compensation is not required to be reimbursed by the insurer.”

The question presented to the 4 th DCA was whether, under Section 627.736(5)(a)(1)(f), Florida Statutes, Code S9088 is a type of service which is reimbursable under Workers’ Compensation such that a PIP insurer is required to pay those charges.

The 4 th DCA affirmed the lower courts’ decisions, holding that reimbursement of Code S9088 is permitted “under a plain reading of the statutes, regulations and applicable reference guide provision.” In their decision, the Court explained that, in conjunction with Section 440.13, Florida Statutes, the Florida Administrative Code Rule 69L-7.020 adopts the Florida Workers’ Compensation Health Care Provider Reimbursement Manual. The Manual stipulates that if a code does not have an established Maximum Reimbursable Amount (“MRA”), the insurer must have a methodology for determining reimbursement for that code that is done by comparing the billed code(s) with clinically similar codes found in the Current Procedural Terminology (CPT) Manual or the Healthcare Common Procedure Coding System (HCPCS) Manual. This means that codes like Code S9088, which do not have established MRA’s, still must be reimbursed by Florida PIP insurers.

The 4 th DCA’s decision will allow medical providers to be compensated if they were previously denied reimbursement for Code S9088 and for other codes that were denied for the same reason. Currently, the 4 th DCA is the only Florida DCA to have ruled on this issue, which means that it applies to the entire State of Florida, unless and until another DCA issues a conflicting opinion.

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Provided By Christopher M. Tuccitto, Esq.

House Bill 837 (HB 837) was signed into law on March 24, 2023, and it stands to dramatically alter the landscape of Florida Personal Injury Protection (PIP) and Personal Injury claims going forward. Despite the law’s passage nearly six months ago, there’s still some confusion about whether medical providers will still be able to file PIP Suits.

HB 837’s passage did not alter Section 627.736, Florida Statute (The PIP Statute) in any way, shape, or form. PIP coverage is still required for all private passenger automobiles registered in the State of Florida. The benefit limits are still the same, the requirements to qualify for coverage are still the same, the billing requirements are still the same, the reimbursement amounts are still the same.

Medical providers still have legal standing to bring a cause of action on a PIP claim if the patient has executed a valid Assignment of Benefits (AOB). As the assignee of a PIP claim, medical providers are still able to file pre-suit demands for unpaid or underpaid, overdue charges. If the insurance company pays benefits in response to pre-suit demands, they still are required to pay the statutory penalty, along with interest and postage cost reimbursement. Medical providers who have accepted an AOB may still file PIP Suits if the insurance company doesn’t pay all the benefits owed after receiving a pre-suit demand letter.

Now, I realize that at this point in the article, I may have confused you with what I’ve stated so far. At this point, you may be saying to yourself: “If the PIP Statute wasn’t altered or abolished, and if medical providers can still file PIP Suits, then why is everyone panicking?” The answer to this question is simple. While the PIP Statute in and of itself wasn’t changed, what was changed was the medical providers’ ability to collect attorney’s fees and costs when prevailing in a PIP Suit. How was this changed? Don’t worry, I will explain.

Section 627.428, Florida Statutes, allowed for one-way prevailing party attorney’s fees for the Plaintiff in a lawsuit against their insurance company. This statute was repealed with the passage of HB 837. Repealing Section 627.428, Florida Statutes, literally takes the teeth out of the ability to enforce the PIP Statute, because without the prospect of collecting separate attorney’s fees and costs, it becomes impossible from an economic standpoint for an attorney to litigate PIP claims. It is unlikely an attorney can work off an acceptable percentage of the PIP recovery because of the relatively small balances being pursued. The legislature did this with the explicit intent of drastically reducing the volume of PIP litigation in Florida.

There is one instance where one-way prevailing party attorney’s fees for the Plaintiff are available; however, this doesn’t apply to PIP claims that have been assigned to medical providers. HB 837 created Section 86.121, Florida Statutes. This new statute states that it will permit an award of attorney’s fees to a named insured, omnibus insured, or beneficiary under a policy in a declaratory relief action after an insurer has made a total coverage denial of the claim. The right is not transferable or assignable to anyone other than the named insured, and a “reservation of rights” is not considered a “coverage denial” under this section.

The legislature made it clear that HB 837 does not impair any right under an insurance contract in effect on or before March 24, 2023. This means that, even if an automobile accident giving rise to a PIP claim

occurs after March 24, 2023, HB 837 would not apply if the underlying insurance contract commenced or renewed prior to March 24, 2023. The Statute of Limitations for PIP breach of contract claims is still five years, so at this time, there’s still a window of approximately 4 ½ years’ worth of older PIP claims that may be pursued with the ability to collect prevailing party attorney’s fees and costs for the Plaintiff in litigation.

So does all of this mean that PIP Suits will go “extinct,” like the dodo? I would say no, but their numbers will be drastically reduced without the ability to collect attorney’s fees and costs.

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By: James D. Underwood, Esq. & Christopher M. Tuccitto, Esq.

The recently enacted and so-called Tort “Reform” law has something bad about it for everyone that will impact medical providers, attorneys, and consumer/claimants alike. Key components of the law include the elimination of attorney client privilege related to any referrals to medical providers by an attorney to their client, the elimination of attorney’s fees from insurers when an insured or their assignee recovers in litigation including all types of claims whether medical, vehicle damage, or even life insurance coverage. Additionally, the legislation eliminates the ability of an individual from recovering damages for injuries from an at fault party if the individual was more than fifty percent at fault for the injuries, provides for additional burdens to bring a bad faith claim against an insurer, and limits the evidence that may be presented to prove the amount of past, current, and future medical expenses related to injuries.

The legislation limits Florida consumers access to courts as it eliminates the ability of first party claimants from having their attorney’s fees covered by their insurer when they recovery wrongfully denied benefits under their policy of insurance. In the past when you were forced to sue your own insurance company or when an assignee sued the responsible insurer for wrongfully denied benefits insurers were required by Florida Statute 627.428 to pay the reasonable attorney’s fees and costs for the necessity of the litigation. This law eliminates this statutory provision and likely will impact all policies of insurance written in Florida after the effective date of the legislation which was March 24, 2023. This elimination of the recovery of attorney’s fees will impact PIP cases, vehicle damage cases, life insurance policy suits, and all suits related to first party insurance claims. Now, claimants will need to compensate their legal representation from their recovery. Many claims that could have been pursued against an insurer in the past will no longer be financially viable as the recovery will be used primarily to satisfy legal representation even if the insurer wrongfully denied payments.

The law changes the evidence that may be used to prove damages as it relates to injuries from charges for incurred medical care to the exact amount already reimbursed by applicable insurance but does allow for any evidence of reasonable amounts billed to the claimant for medically necessary treatment and services. As to future medical expenses, the bill limits the evidence used to prove the amount to what a responsible insurer would pay for those future services, but it also allows for any evidence of reasonable future amount to be billed to the claimant for medically necessary treatment or services. These changes will lower the amount of recovery for claimants across the board, impacting the monies available to cover outstanding medical expenses.

Going forward, it will be interesting to see how the insurance companies handle claims now that the threat of exposure to the claimant/insured for attorney’s fees and costs has been eliminated. For insurance like PIP, which only provides up to $10,000 in coverage, it’s easy to see many scenarios where the insurance companies nickel and dime the medical providers at every opportunity, knowing that it will be economically unfeasible for an attorney to handle a claim against them for a percentage of what amounts to a relatively small amount in dispute.

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By Russel Lazega, Attorney and Author
Article from Russel’s column in the Adventure News

So summer is finally here. Sun-showers are drizzling raindrops and rainbows; the sky is warm and golden and the children are off to frolic and play. Of course, for me—the insurance lawyer—it’s more like: “Holy hurricane season!

The floods are coming, the hurricanes are howling and the carpool kamikazes are ready to start smacking up BMW’s up and down Dixie Highway as the race to be first in the camp pick-up line commences. Yup, summer is sure busy for us lawyer.

Well, here’s how to cover your self for a few of those summer “hazards”:

1. Hurricanes– Many of us are still trying to repair and recover from Hurricane Irma only to hear that as of June 1 hurricane season is back. Check your policy to verify that it lists coverage for windstorms. Some plans (particularly some condominium policies) exclude payment for windstorm damage. So check with you insurance agent and have the agent email you confirmation that you’re insured for windstorms.
2. Flood and mold coverage – These are actually two separate coverages. Flood insurance is its own policy that covers you for damage caused by rising water (such as a river overflowing or storm surge) – it does not generally cover things like broken pipes and damaged/leaking roofs. Those claims require a different policy called homeowner’s insurance, which will typically cover water damage losses. Also remember that many policies now have a limit or exclusion for mold requiring you to secure additional coverage or another policy if you want full coverage for damage from mold.
3. Car Accidents – 2,000 day-campers, a single pick-up and karate lessons at 4:10 sharp – it’s a recipe for car crashes. Verify that your vehicle has liability coverage (to protect you against injury claims of others); comprehensive and collision coverage (to insure your own vehicle for claims of theft, fire or collision damage); and uninsured motorist coverage (to cover your injuries if an at fault driver doesn’t carry enough insurance).

These are all optional coverages that make sense. You may not be ready for the summer madness but at least you can be insured for it!

Russel Lazega is an attorney and author of two of Florida’s most widely distributed legal textbooks on Florida Insurance Law. He also represents accident victims and consumers at war with their insurance companies and is based in North Miami, Dania Beach, Orlando and Tampa, Florida. Questions? Contact: Russ@fladvocates.com.

By Russel Lazega, Attorney and Author
Article from Russel’s column in the Adventure News

The late Senator George Aiken was once asked what the U.S. should do about the long and seemingly hopeless battle in Vietnam. The Senator unflinchingly responded, “Declare victory and get out.” Back here in the state of sunshine, storms and alligators, you might think that philosophy is back when it comes to Hurricane Irma claims.

Insurers proudly declare that they have successfully closed over 90% of all Irma claims. Hailing “victory” against the relentless enemy of contractual obligation, insurers boast that tens of thousands of claims are closed. Yet somehow blue tarps still speckle the landscape and my lobby is filled with clients still seeking help.

Here’s what the insurers don’t want you to know about “closed claims”:

“Closing” a Closing a Claim Doesn’t Mean That the Claim Was Properly Paid

“Closing” a claim does not mean “game over” for the property owner but simply means that the insurance company has unilaterally decided that’s all it wants to pay – which in many cases can be nothing. Claim closures can and should be challenged if they’re wrong.

“Closing” a Claim Doesn’t Mean That You Can’t Still Do Something About It

Just because your insurance company has declared “victory and got out” doesn’t mean that the war is over. There are numerous options and weapons that a policyholder can use to fight back—even if the claim has been closed, including:

1. Appraisal – If your insurance company hasn’t paid what’s owed, most policies provide an informal option to resolve your claims dispute through an appraisal process. Appraisal is usually fast, final and most lawyers handle appraisals on a contingency basis of between 10% – 20% of the recovery. So there no legal fees to you unless you win.
2. Litigation – Sometimes, baseball diplomacy just works—especially against an unyielding insurer. Florida has stiff penalties against insurers who get sued over wrongful denials/reductions—namely, the insurance company will likely have to pay your attorney a hefty attorney’s fee on top of what they owe you if the insurance company owes any money on the claim. A skilled insurance attorney will typically never charge for the consult and may take the case for no out of pocket fees to you (waiting to pursue fees against the insurance company).

Remember, that even if your insurance company has declared victory and “case closed”—for us insurance lawyers at war in the land of crocodiles and catastrophe claims, the battle rages on.

Russel Lazega is an attorney and author of two of Florida’s most widely distributed legal textbooks on Florida Insurance Law. He also represents accident victims and consumers at war with their insurance companies and is based in North Miami, Dania Beach, Orlando and Tampa, Florida. Questions? Contact: Russ@fladvocates.com.

By Russel Lazega, Attorney and Author
Article from Russel’s column in the Adventure News

So the holidays are just around the corner and if you ask any knowledgeable five-year-old she’ll tell you that Santa is hard at work preparing a spreadsheet of the latest “must-have’s” for children around the globe. But what’s Ol’ Saint Nick putting on the list for himself? There’s one thing that he probably hasn’t considered that maybe he should – insurance and some new cost-saving options like:

• Comprehensive and Collision coverage—Reindeer sleighs are a dangerous instrumentality so consider what may happen if they ram a roof or clip a car. This optional policy will cover damage caused to the policyholder’s vehicle and to the property of others and can include coverage for fire and theft of the sleigh and its contents. Save money by adding multiple vehicles or showing your safe driving record.
• Liability Coverage—What if Rudolph’s headlight goes out and some unfortunate motorist or pedestrian comes nose to nose with a 425-pound sleigh-guide? Not to worry if Santa bought coverage then North Pole Mutual will cover bodily injuries to persons injured in the accident. Santa may even get a discount on this coverage from some insurers if he allowed the insurer to install GPS tracking in his vehicle to monitor his global trek and driving habits.
• Uninsured Motorist (“UM”) Coverage—So Caribou meets Caravan in sunny South Florida where no one seems to carry enough coverage – not to worry Santa spent the extra Shekels to buy UM coverage to provide for his injuries should a driver with less-than-adequate insurance wrongly cross his path.

So remember to have fun this holiday season and stay safe. Santa’s got you covered.

Russel Lazega is an attorney and author of two of Florida’s most widely distributed legal textbooks on Florida Insurance Law. He also represents accident victims and consumers at war with their insurance companies and is based in North Miami, Dania Beach, Orlando and Tampa, Florida. Questions? Contact: Russ@fladvocates.com.

By Russel Lazega, Attorney and Author
Article from Russel’s column in the Adventure News

“Welcome to Beautiful South Florida!” No really, that’s what the truck that rear-ended my client’s new Nissan says on it. To add insult to injury, the truck’s insurer is now taking longer than the cable company’s service department to respond to the claim.

So what’s a stranded South Floridian to do?

Here are a few options from a lawyer who taught many insurance companies the tricks of the trade:

• Check if you have Comprehensive and Collision coverage. While drivers are typically required to carry a minimum of $10,000 in property damage coverage (covering damage you cause to the property of others), many people purchase optional comprehensive and collision coverage allowing you to submit the claim to your own insurer for payment. If you bought this coverage your insurance company pays the claim and pursues the negligent party to get its money back.
• Why Would I Look to My Insurance If I Wasn’t At-Fault? The upside is: (a) you will likely get prompt service because you are covered regardless of who is at fault; (b) you will likely get better service because you are their customer (unlike dealing with someone else’s insurance company that’s looking out for their customer and their pocket); and (c) your insurance company will get reimbursed from the other party so they’re less likely to nickel and dime you on quality repairs.
• What’s The Downside? Typically it’s better to look to your own insurer (you paid for it after all) but: a) you’re responsible for the deductible (usually between $250-$1,000) and will have to wait for your insurer to try to recover that expense for you and b) if you’ve had multiple claims recently your insurance could go up or be cancelled (typically only if you’ve had 2 or more claims within the past 18 months).

So, if you’ve been welcomed to Miami with a typical South Florida “Bang!” look first to your insurer and if that doesn’t work then law firms like mine offer free consults.

Russel Lazega is an attorney and author of two of Florida’s most widely distributed legal textbooks on Florida Insurance Law. He also represents accident victims and consumers at war with their insurance companies and is based in North Miami, Dania Beach, Orlando and Tampa, Florida. Questions? Contact: Russ@fladvocates.com.

By Russel Lazega, Attorney and Author
Article from Russel’s column in the Adventure News

Okay, so maybe I’m the only lunatic who thinks about insurance around the holidays. And maybe that’s why my Wheaten Terrier has a cozy spot in our king-sized bed and I have a nice view of the house from the Pet-mate Indigo Doggie Igloo.

But seriously, after serving as legal counsel to accident victims for close to 25 years I see the same sad story year after year—a client is seriously injured in an accident but the person responsible has little or no insurance. To add insult to injury, accident cases (especially ones involving uninsured drivers) seem to pile up around the holidays.

Merry Ho Ho Christmas from the people who brought you Murphy’s Law.

So besides staying safe what else can you do to cover yourself this winter?

One thought that’s often overlooked is to check that you have uninsured motorist (“UM”) coverage. UM Coverage is often also called “Underinsured Motorist” coverage because it will also protect you if the at-fault driver has insurance but not enough to cover your loss (or has no insurance at all). Put simply, this optional policy kicks in to pay the difference between the amount of your claim and the amount you recovered from the at-fault party (at least up to the limits of your policy).

Have more than one car?

Consider “stacking” your UM coverage – which is an option that allows you to add together the value of your stacked policies to give you more coverage for less money. Believe me, more than a few clients have thanked their lucky stars for this extra coverage as sometimes it’s the only recovery available.

So remember, think about making sure that your family has the right insurance coverage in place this holiday month and then stop at the jeweler on the way home from the insurance agency. Everyone but the dog will be glad that you did.

Russel Lazega is an attorney and author of two of Florida’s most widely distributed legal textbooks on Florida Insurance Law. He also represents accident victims and consumers at war with their insurance companies and is based in North Miami, Dania Beach, Orlando and Tampa, Florida. Questions? Contact: Russ@fladvocates.com.

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Learn More about: Hurricane Claims Denied Cape Coral

Florida is in the process of recovering from the impact of Hurricane Ian, which made landfall on October 6, 2022. The storm brought heavy rainfall and flooding, damaging homes, businesses, and infrastructure across the state.

In the aftermath of the storm, emergency responders and local officials are working to assess the damage and provide support to affected communities. Many residents have been displaced from their homes and are seeking temporary shelter, while others are beginning the process of cleaning up and rebuilding.

The recovery effort is expected to be a lengthy and challenging process, with many communities facing significant damage to critical infrastructure such as roads, bridges, and power lines. In some areas, flooding has made it difficult for emergency responders to reach those in need, highlighting the importance of disaster preparedness planning.

Despite the challenges, Floridians are known for their resilience and determination in the face of natural disasters. Communities often come together to support one another during these difficult times, providing assistance to those in need and working to rebuild and recover.

Looking ahead, it is clear that climate change will continue to pose a significant threat to Florida and other coastal states. Rising sea levels, increased hurricane activity, and more frequent and severe heat waves are just a few of the impacts that are expected in the coming years.

To address these challenges, it will be important for governments, businesses, and individuals to take action to reduce greenhouse gas emissions, invest in climate-resilient infrastructure, and prepare for the impacts of climate change. A coordinated effort from all sectors of society will be necessary to build a more sustainable and resilient future.

The recovery process from a natural disaster like Hurricane Ian can be physically and emotionally taxing on individuals and communities. In addition to the immediate impacts of the storm, residents may experience ongoing stress and trauma as they work to rebuild their lives.

It is important for government officials and organizations to prioritize mental health support in the wake of natural disasters. This can include providing access to counseling services, offering support groups, and training local responders to identify and address mental health needs.

In addition, Hurricane Ian has once again highlighted the need for improved disaster preparedness and response. This includes developing better warning systems, improving evacuation plans, and strengthening critical infrastructure to withstand extreme weather events.

As the impacts of climate change continue to intensify, it is clear that natural disasters like Hurricane Ian will become increasingly frequent and severe. To address these challenges, it is essential that individuals, businesses, and governments work together to build more resilient communities and mitigate the impacts of climate change.

Florida Advocates – A Private Law Firm

If you need to file a claim with the help of a knowledgeable property insurance claim attorney, give us a call today at 754-290-3803.

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Learn More about: Denied Insurance Claims Fort Myers

The aftermath of Hurricane Ian has left many residents of Southwest Florida frustrated and angry. The high number of rejected or unpaid insurance claims has left many struggling to rebuild their homes and businesses. The fact that many residents are still waiting for payments or have had their claims rejected has only added to the already significant financial and emotional toll that the hurricane has taken on the community.

In addition to the difficulties with insurance claims, the storm has also highlighted the vulnerability of many homes and businesses in the area. While some residents have been able to rebuild with the help of insurance payments and federal aid, many others have been left with damaged homes and properties that they cannot afford to repair. This has led to a growing sense of frustration and anger, as residents feel that they have been left to deal with the aftermath of the storm on their own.

Many residents have called for changes to the insurance industry in the wake of Hurricane Ian. Some have called for tighter regulations on insurance companies, while others have advocated for better education for homeowners about the limitations of their policies. Still, others have argued that the federal government needs to do more to help residents in the aftermath of major disasters like hurricanes.

Despite the challenges that residents are facing, there are also signs of hope in Southwest Florida. Many individuals and organizations have come together to support those affected by the storm, providing everything from food and shelter to financial and emotional support. While there is still a long way to go in the recovery process, many residents are hopeful that they will eventually be able to rebuild and move on from the devastation of Hurricane Ian.

According to data from the state Office of Insurance Regulation, almost 40% of insurance claims related to Hurricane Ian in Southwest Florida have been rejected or remain unpaid. A total of 683,456 claims were submitted, with 62% having been paid, 13% still open but not paid, and 25% closed without payment. In Lee County, where the storm caused the most damage, over 30% of claims have been denied or remain unpaid. Some residents have reported being offered only minimal compensation for their homes, while insurance companies have cited flood damage, not covered by most policies, as a reason for denial.

Due to many years of intense storms, most of the national insurance carriers have pulled away from Florida. They have been replaced by regional carriers with smaller financial reserves. To limit payouts to policyholders after Hurricane Ian, these companies have been aggressively altering the work of licensed adjusters. Consequently, homeowners have been left footing much of the bill for repairs.

TIn addition to the economic impact, Hurricane Ian has also had a significant psychological impact on many residents. The stress of dealing with insurance claims, the loss of homes and possessions, and the ongoing recovery process has taken a toll on the mental health of many in the community. This has led to a growing recognition of the need for mental health services in the aftermath of major disasters like hurricanes, as well as greater awareness of the importance of addressing the psychological impact of these events.

Despite the challenges, there have also been some positive developments in the aftermath of Hurricane Ian. The storm has brought together individuals and organizations from across the community, highlighting the strength and resilience of the people of Southwest Florida. It has also provided an opportunity for policymakers and community leaders to address longstanding issues such as flood insurance and disaster preparedness, with the hope that lessons learned from Hurricane Ian can be applied in future disasters.

AUltimately, the recovery from Hurricane Ian will be a long and difficult process. However, the resilience and determination of the people of Southwest Florida offer hope that the community will eventually emerge from the devastation of the storm stronger and more united than ever before.

If you are fighting with your insurance company to get your claim paid, call us today to advocate on your behalf. We will fight for you!

Article Source: https://www.washingtonpost.com/climate-environment/2023/03/11/florida-insurance-claims-hurricane-ian/

Florida Advocates – A Private Law Firm

If you need to file a claim with the help of a knowledgeable property insurance claim attorney, give us a call today at 754-290-3803.

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Learn More about: Fort Myers Business Interruption Insurances

Inland Florida has experienced severe flooding due to Hurricane Ian, which made landfall on October 6, 2022. The state was saved from the worst impacts of the hurricane until the very end, when the storm’s heavy rainfall caused flooding in many areas.

Hurricane Ian was initially forecast to hit Florida’s east coast, but it eventually made landfall on the state’s west coast, causing significant flooding in inland areas. The heavy rainfall caused rivers and creeks to overflow, leading to widespread flooding.

Many communities in central Florida were affected by the flooding, with some areas experiencing water levels as high as six feet. Emergency responders were deployed to assist with evacuations and rescue operations, and many residents were forced to seek temporary shelter.

Arcadia, which is 50 miles north of Fort Myers and roughly 50 miles east of the Gulf Coast, was initially affected by the Category 4 storm as it moved east, delivering hurricane-force winds and severe rainfall to the state’s interior. The Peace River spilling over its banks as it makes its way through Arcadia on its route to the Gulf of Mexico dealt a second blow.

The river, which is typically a slow-moving body of water where kayakers and alligators cohabit, overwhelmed portions of the city and many of the nearby farms and cattle ranches.

While Florida is no stranger to hurricanes, the flooding caused by Hurricane Ian was particularly severe due to the storm’s slow-moving nature and heavy rainfall. As climate change continues to increase the frequency and severity of extreme weather events, it is likely that Florida and other coastal states will continue to experience significant impacts from hurricanes and other natural disasters.

Efforts are underway to mitigate the impacts of these events, including infrastructure upgrades, disaster preparedness planning, and initiatives to reduce greenhouse gas emissions. However, it will take a concerted effort from governments, businesses, and individuals to address the challenges posed by climate change and build a more resilient future for all.

In addition to the flooding, Hurricane Ian also brought high winds and storm surges to Florida’s coastlines. Coastal communities experienced significant damage to buildings and infrastructure, and many residents were forced to evacuate in advance of the storm.

Despite the challenges posed by Hurricane Ian, Florida’s emergency responders and local officials were well-prepared to handle the storm’s impacts. The state has a comprehensive disaster response system in place, which includes emergency management agencies, local first responders, and volunteer organizations.

In the aftermath of the storm, many residents and businesses in affected areas are working to rebuild and recover. The process of recovering from a natural disaster can be long and difficult, but communities often come together to support one another during these challenging times.

Looking ahead, it is clear that climate change will continue to pose significant challenges for Florida and other coastal states. Rising sea levels, increased hurricane activity, and more frequent and severe heat waves are just a few of the impacts that are expected in the coming years.

If you are fighting with your insurance company to get your claim paid, call us today to advocate on your behalf. We will fight for you!

Florida Advocates – A Private Law Firm

If you need to file a claim with the help of a knowledgeable property insurance claim attorney, give us a call today at 754-290-3803.

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Learn More about: Hurricane Ian Insurance Claim Lawyers Fort Myers

As communities across Florida begin to recover from the impact of Hurricane Ian, officials are working to assess the extent of the damage caused by the storm. The hurricane made landfall in Florida on October 6, 2022, bringing heavy rainfall and high winds to many parts of the state.

According to initial reports, the storm caused significant damage to homes, businesses, and infrastructure in affected areas. Many homes were flooded, and some were destroyed by high winds and falling debris. In addition, widespread power outages were reported across the state, leaving many without electricity in the days following the storm.

In response to the impact of Hurricane Ian, emergency responders and volunteers have been working around the clock to provide support to affected communities. This has included distributing food and supplies, providing shelter for those who have been displaced from their homes, and working to clear debris from roads and other areas.

Looking ahead, officials are urging residents to remain vigilant and take precautions as they work to recover from the storm. This includes staying alert for potential hazards like downed power lines and standing water, as well as following guidelines for safe clean-up and recovery efforts.

While the impact of Hurricane Ian has been significant, the response effort has highlighted the resilience and strength of Florida’s communities and the dedication of emergency responders and volunteers who are working to support those in need. As the state continues to recover from the storm, it will be essential for individuals, businesses, and governments to work together to build more resilient communities and mitigate the impacts of climate change..

The impact of Hurricane Ian on Florida and other coastal states serves as a stark reminder of the growing threat of climate change and the urgent need for action. As the planet continues to warm, extreme weather events like hurricanes are likely to become more frequent and severe, leading to greater risks and impacts for communities around the world.

To address these challenges, it will be essential for individuals, businesses, and governments to work together to build more sustainable and resilient communities. This can include investing in renewable energy sources, improving infrastructure to better withstand extreme weather events, and taking steps to reduce greenhouse gas emissions and mitigate the impacts of climate change.

In addition, it will be important to prioritize equity and inclusivity in disaster response efforts, ensuring that all members of affected communities have access to the support and resources they need to recover and rebuild. This can include providing language and cultural support to non-native speakers, supporting marginalized and low-income communities, and working to address underlying social and economic inequalities that can exacerbate the impacts of natural disasters.

AUltimately, the impact of Hurricane Ian and other extreme weather events underscores the urgent need for collective action to address climate change and build a more sustainable and resilient future for all. By working together and taking bold steps to address this global crisis, we can create a safer, more equitable, and more sustainable world for generations to come.

If you are fighting with your insurance company to get your claim paid, call us today to advocate on your behalf. We will fight for you!

Florida Advocates – A Private Law Firm

If you need to file a claim with the help of a knowledgeable property insurance claim attorney, give us a call today at 754-290-3803.

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Bonita Springs Deputy Mayor Accesses Damges By Hurricane Ian

In the aftermath of Hurricane Ian, which made landfall in Florida on October 6, 2022, communities across the state are working to assess and recover from the storm’s impact. Bonita Springs, a city in southwest Florida, was among the areas hardest hit by the hurricane.

The storm brought heavy rainfall and high winds, causing widespread damage to homes, businesses, and infrastructure in Bonita Springs. Trees and power lines were downed, and many roads were blocked by debris and flooding.

In a statement to NPR, Bonita Springs Deputy Mayor, Steve McIntosh, described the extent of the damage in the city. McIntosh reported that many homes and businesses were without power, and that several roads were impassable due to flooding and debris.

Note: Florida Advocates is a law firm can help you with insurance claim attorney. The firm is the first place to call if you need your insurance company to pay your claim.

Despite the challenges posed by the storm, McIntosh emphasized the resilience of the community and the dedication of local officials and emergency responders. He noted that the city had activated its emergency response plan in advance of the storm and had worked to evacuate vulnerable populations and provide support to those in need.

As communities across Florida work to recover from the impact of Hurricane Ian, it is clear that the storm’s aftermath will be felt for weeks and months to come. However, the response effort has highlighted the importance of disaster preparedness planning and the crucial role of local officials and emergency responders in ensuring the safety and well-being of their communities.

Looking ahead, it will be essential for individuals, businesses, and governments to work together to build more resilient communities and mitigate the impacts of climate change. With continued investment in disaster preparedness and response, Florida and other coastal states can better adapt to the challenges posed by extreme weather events and build a more sustainable and resilient future for all.

Note: Florida Advocates is a law firm can help you with insurance claim attorney Fort Myers. The firm is the first place to call if you need your insurance company to pay your claim.

The impact of natural disasters like Hurricane Ian can be felt beyond the physical damage and economic costs. Disasters can also lead to long-term social and psychological impacts on individuals and communities, especially those who experience the greatest impacts and who are most vulnerable.

For example, low-income and marginalized communities often face greater risks and more severe impacts from natural disasters, due to factors such as inadequate infrastructure, lack of access to resources, and historical patterns of discrimination and inequality.

To address these issues, it is important for disaster response efforts to be inclusive and equitable, taking into account the needs and perspectives of all community members. This can include ensuring that resources and support are accessible to all, regardless of income, language, or other barriers.

In addition, it is essential to recognize the role that climate change plays in exacerbating the impacts of natural disasters. As the planet continues to warm, extreme weather events like Hurricane Ian are likely to become more frequent and severe, making it even more important for individuals, businesses, and governments to prioritize climate action and work together to build a more sustainable and resilient future.

Note: The Plumber Fort Lauderdale is being provided by House Electric and Plumbing. The company provides both commercial and residential plumbing services.

Florida Advocates – A Private Law Firm

If you need to file a claim with the help of a knowledgeable property insurance claim attorney, give us a call today at 754-290-3803.

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Learn More about: Hurricane Claims Denied Fort Myers

Our insurance companies are failing us! Imagine making payments for decades to your insurance company and when you finally make a claim after suffering extreme damage you are treated as poorly as described below.

Apparently, per the article written by the Washington Post, the recommended estimates for repair from the insurance adjusters are being seriously reduced and recalculated once presented to the insurance company. Some are  reduced to such extreme that it falls below the deductible amounts so that no payment is be forthcoming to the homeowners.

This is what has been happening on the southwest coast of Florida. After major disasters such as Hurricane Ian, insurance companies usually contract with third-party independent adjusting firms to help with the hundreds of thousands of claims. The licensed adjuster, who is trained to assess damaged homes, visits the homes, prepare their reports, take pictures, and submit their final recommendation for the claims. However, it has been found that their reports are being whittled down to significantly less than the original submission. An example is a roof being partially repaired instead of being totally replaced. The justification used is that there was already wear and tear on the roof and the damage was not completely due to the hurricane. It is important to note that the changes are made without the adjuster’s knowledge or consent, but their names remain on the final report, according to documents seen by The Washington Post.

Based on feedback from adjusters and insurance industry experts the normal insurance claims process does not work this way. Normally, the field adjusters collaborate with their co-workers in the office to make minor changes and discuss the claims. Sometimes they may need to alter line items if, for example, the carrier has evidence that damage was from a prior event. That is how the system is supposed to work.

This is NOT what has been happening after Hurricane Ian. Local adjusters who have been contracted by regional insurance carriers say that managers have been changing their work. Their recommended totals are being lowered, the descriptions of damage are being rewritten and the accompanying photos are being deleted without their approval. All of these actions are done to devalue damage of the insurance crisis in Florida.

Due to many years of intense storms, most of the national insurance carriers have pulled away from Florida. They have been replaced by regional carriers with smaller financial reserves. To limit payouts to policyholders after Hurricane Ian, these companies have been aggressively altering the work of licensed adjusters. Consequently, homeowners have been left footing much of the bill for repairs.

The adjusters, attorneys and policyholder advocates allege that the independent adjusting firms were internally lowering estimates under the direction of the insurance carriers who contracted them. However, the company said that it has reasons for altering claims and that estimates are revised/collaborated throughout the entire industry at the direction of the insurance carriers.

Per the insurance carriers, the flailing insurance industry market is blamed on lawyers and contractors who they state have taken advantage of the system to sue carriers, inflate estimates and use roofing scams to profit from these disasters. The carriers contend that they are the real victims! The victims of fraud and bad behavior.

Florida’s insurance market has been leaning toward collapse for years. After multiple storms in 2005, several big carriers pulled back coverage in the state. Newer, smaller, and lesser financed companies emerged and began to operate in the state. 2017 was also one of the costliest hurricane seasons ever. Hurricane Michael battered Florida the following year.

Adjusters then started to see carriers greatly reduce damage estimates, fully deny roof replacements often and force claims of a certain value into litigation. Payouts started to get delayed or not come at all, adjusters and attorneys said. At the same time, insurance rates kept rising fast. As the claims continued to pile up and remain unpaid, adjusters keep getting calls from increasingly frustrated and anxious policyholders.  For many people, there were still no answers, no habitable home and dwindling savings.

It would seem that reducing a valid claim estimate without factual basis “is potential fraud.” In most cases, if a field adjuster has done his job correctly and broken down every line in great detail, the desk adjuster will not need to make significant changes. It’s usually a “smooth process with communication between the two employees.

If you are fighting with your insurance company to get your claim paid, call us today to advocate on your behalf. We will fight for you!

Florida Advocates – A Private Law Firm

If you need to file a claim with the help of a knowledgeable property insurance claim attorney, give us a call today at 754-290-3803.

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Accident is becoming rampant and as such a call for alarm. Quite a number of people have involved in accidents on the street of Washington and didn’t get justice because they do not know the right thing to do. If you have ever been involved in a road accident and you are clueless of what to do, here are the things you should know:

What should be my first action?

• Put into a written document every scene that played out in the accident scene such as name, witness, insurance agents, and their company name in the event of a lawsuit filed for compensation.
• Consult an experienced injury attorney before talking to the insurance company involved.
• Make sure you tell the person who supposedly caused the accident that resulted in you being injured, about your intention of filing the lawsuit.
• Protect any form of evidence you have by all means.
• Get copies of the police report from the agency investigating by paying a non-refundable $10.50 in the case of a written document.

Log on to the www.wsp.wa.gov and check the “Hot Topics” menu and click on “Collision Reports” to request for the report, however, the payment still applies. If you do not have an internet facility, write to the Washington State Police providing your details and the accident details. If they have already investigated the accident, they will send you the report and if not, they will investigate and give you feedback.

Who should be blamed?

• The responsibility of taking care of medial expense by the accused
• The refusal of responsibility by the accused person
• The injury you incurred
• The person being responsible truly
• However, if both of you are guilty of the situation, the cost will be shared by both of you as stated under Washington comparative negligence law.

What is the Worth of my Claim?

The accused person is responsible for the following:

• All medical expense which covers the previous, current and future
• Unavoidable time loss at your work
• Damaged property
• House help agent payment during the time of nursing your injuries
• Where there is disability he is liable
• Emotional and mental distress that has affected your relationship with family and friends
• Changes in your earnings in the future and any other cost
• It is important to hire an experienced attorney in order to prove your case.

What if the accused person doesn’t have insurance, or the insurance can’t pay all?

Under any circumstances, you will be paid by the ‘underinsurance company’ or by the person who caused your accident. The “First Party” package, UIM/UM which is clearly stated on the Declaration page of the insurance policy will cover you and if you do not, you must write for a waiver coverage.

How long does it take to file a Legal Claim?

You have the time frame of three years to file a lawsuit, if you do not during this period; your claim is no longer liable for court hearing. Read more on the UIM/UM for further clarification.

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