Insurance companies will gladly sell you policies, but when it comes time to pay out, they have vested interest in denying as many claims as they can.
If you feel that a legitimate insurance claim has been unfairly denied, there are courses of action your attorney can take to ensure that the insurance company pays what is owed under the insurance policy.
Breach Of Contract
Traditionally, the only way an insured could enforce the contractual obligations of an insurance company was to sue for breach of contract. A breach of contract action requires an insured to prove:
- that the insurance company had a contractual obligation to pay for loss
- that the insured actually incurred a loss, and
- that the insurance company failed to pay for the loss.
Much of the time, the insurer’s action may not reach the level of bad faith conduct if its interpretation of certain policy provisions to exclude coverage of your claim is reasonable. In these cases, the best way to handle the situation is to establish in court that the policy should be interpreted in a way as to include coverage of your claim.
This is still a common way to enforce an insurance company to pay your claim, but it is now often used in conjunction with newer Florida statutes that deal specifically with bad faith or unfair denials of insurance claims.
Bad Faith Statutes
Under Florida law, an insured may sue the insurance company for acts of bad faith or unfair claims settlement practices. Bad faith acts consist of the following:
- violations of the unfair insurance trade practices act,
- not attempting in good faith to settle claims when the insurer could and should have done so,
- making claims payments without identifying the coverage provisions under which the payments are being made,
- failing to promptly pay undisputed amounts.
Unfair claims settlement practices are also considered bad faith acts, but they are narrower in scope. Insurance companies can be sued for bad faith for engaging in any of the following activities:
- failing to adopt and implement standards for the proper investigation of claims,
- misrepresenting facts or insurance policy provisions relating to the claims,
- failing to act promptly in responding to communications about the claims,
- denying claims without conducting reasonable investigations,
- failing to provide reasonable explanations in writing for the reasons for denial of a claim, or
- failing to promptly notify the insured of additional information necessary to process a claim.
- Failing to clearly explain the nature of the requested information or the reasons why the information is necessary.
The benefits of a bad faith action over a traditional breach of contract action is the damages that are available. If you win a breach of contract action, the damages will be limited simply to what the insurance company owes you under the policy.
However, under a bad faith claim, you are entitled to the benefits of the policy, consequential losses suffered because of the insurer’s failure to pay the claim, including emotional distress and attorney fees, and in certain cases, punitive damages..