Insurance Disputes

Insurance companies recognize the lawyers who will “go to bat” for their clients and “take it all the way.” Likewise, insurance companies also know which lawyers would rather settle a case, despite it being worth more than the insurance company’s “top offer.” Getting the best possible results for your case requires having a lawyer with a great reputation who is not afraid to take on the BIG insurance companies. We are not afraid to take cases to trial. This fact forces the insurance companies to take our demands seriously.

The insurance companies keep track of the lawyers who never take cases to trial, and as a result they often make lower, unfair offers to the clients represented by those lawyers. The Law Offices of Nicholas Taldone prepare every case as if it will go to trial even though the vast majority of cases do settle.

Mr.Taldone has personal experience in handling disability claims since several of Mr. Taldone’s family members’ professional careers were cut short by devastating disabilities. Mr. Taldone knows how to navigate the disability claims process whether under an individual policy or an employer group policy.

Legal issues may arise under property insurance policies on coverage of the policy, filing claims, claims processing, and claims denial issues, including litigation. The Law Offices of Nicholas Taldone assists consumers on such issues including damage claims arising from hurricanes, floods and fires. Once your claim is finalized, we will assist you to achieve your goal, whether it is repairing the damage or selling your damaged home or property.

Our Firm will perform a thorough analysis to determine whether sinkhole activity is responsible for damage to your home, business, or property, We utilize independent geologists and structural engineers to obtain the most accurate evaluation of the cause of your damage and use reputable firms to provide estimates on the costs of repair.

FREQUENTLY ASKED QUESTIONS

DO YOU TAKE INSURANCE DISPUTE CASES ON A CONTINGENCY FEE BASIS?

Yes. We work on a contingency fee agreement, which means that we are paid an attorney’s fee only when we are successful in achieving results for our clients.

We invite you to schedule a free confidential evaluation of your claim with this office

What law applies to my denied insurance claim?

Generally, the law of the state in which the policyholder’s property was damaged applies. Similarly, with regard to a disability claim, the law of the state of residence of the policyholder will apply. However, if you have disability or life or health policy is through your employer, most employer-provided insurance policies are governed by the Employee Retirement Income Security Act of 1974 (“ERISA”). ERISA provides extremely strict deadlines and guidelines. If a claimant does not adhere to these strict guidelines and deadlines, the result can be disastrous for him or her. Unfortunately, while insurance carriers are not free to ignore their obligations under ERISA, often claimants are unaware of their rights and violations go unchallenged. If your group insurance policy is governed by ERISA, you must exhaust your administrative remedies prior to filing a lawsuit.

While appealing to the insurance company that already denied your claim may seem like a fruitless effort, ERISA appeals should never be taken lightly. This is because, in most circumstances, the only information that you are able to present in a lawsuit is the information provided to the insurance company during the application and appeals process. Accordingly, if your claim is denied, you are not just submitting an administrative appeal, but preparing your case for trial.

Most insurance companies never explain this to claimants and unfortunately, many ERISA-governed claims are lost because of it. Most claimants would never think of preparing to face their insurance company at trial without the help of an experienced attorney. However, by preparing their own administrative appeal, they are doing just that. If you fail to present all of the information you would normally present at trial in your appeal, you will likely never have an opportunity to do so.

Here are some legislative sites you may find of interest. You should also visit www.dol.gov/general/topic/healthplans, which is the U.S. Department of Labor’s website, for more information.

It is important to have an attorney with ERISA experience.

The attorneys at Law Offices of Nicholas Taldone prepare our client’s appeal as if we are preparing for a lawsuit. We expend the time, resources, and knowledge of the law necessary to prepare each of our client’s appeals.

In disability insurance claim litigation who are potential witnesses?

• Testimony from our clients, treating physicians, co-workers, employers and family members
• Expert medical opinions
• Independent Medical Examination reports that we obtain for our clients
• Vocational rehabilitation reports and other expert reports
• A thorough examination of our client’s unique situation and the law that applies to their claim

WHAT ARE SOME TIPS FOR PURCHASING INSURANCE

Don’t Purchase Homeowners Insurance Solely On Price; Do Purchase Through A Reputable Agent

There is probably no consumer product that is more valuable to consumers but is understood less than insurance. So the first order of business is to purchase insurance through a reputable agent. Obtain recommendations of at least two agents from relatives and friends. Do an internet search on these names to see if you come up with any lawsuits by their clients. In Florida, all insurance agents are regulated by the Florida Department of Financial Services, Office of Insurance Regulation. Licensed agents can be found on their website at www.fldfs.com. This common regulation does not mean that one is as good as another. Just as with doctors, lawyers, or any other profession, there is a wide disparity in the quality of insurance agents. Also check with the Better Business Bureau for any complaints.

Interview your prospective agents and ask questions such as their education and experience, and licenses and industry-related designations. There is an alphabet soup of titles that insurance agents hold so be prepared to ask about the criteria for achieving these additional designations. In your interviews make sure you tell your prospective agent you are relying on them for their expertise and you expect they will listen to your needs and address them. Also advise you expect them to explain what the policy covers and more importantly what it does not cover.

With regard to insurance policies, do not shop solely on price. There are differences between insurance policies. Some policies are “cheap” because they have more than usual exclusions, and/or lack additional coverages via endorsement. You can get started in evaluating insurance companies through AM Best ratings (www.ambest.com) and Moody’s (www.moodys.com). Obtain multiple quotes and have your agent explain any differences in the policies. Your agent should give you a list of all the riders each carrier provides; bundling riders may earn you a discount. Ask how replacement-cost coverage is handled.

Go Over The Questions and Your Answers On The Application for Insurance

If your home suffers a loss, and there is an issue with the claim, the information of the insurance application will take on paramount importance. If there is inaccurate information with regard to an important fact on the application, the insurance company can rescind the policy. Yes, the company will return your premium but your claim worth thousands of dollars will be denied. Typically, inaccuracies on policies occur because: 1) the person applying for insurance either intentionally or mistakenly puts down inaccurate information; 2) the insurance agent writes down the wrong information; or 3) the insurance agent in a casual way tells the applicant to “fudge” the information. All of these can allow the insurance company to deny a claim that would otherwise be paid. The fact that the mistake was due to carelessness rather than an intentional “lie” does not matter. Similarly, blaming the insurance agent or one of his staff for preparing the answers on the application will not prevent the insurance company from denying the claim.The bottom line is to make sure you check the application for accuracy. Don’t just sign the application without reading it. If you see something wrong, change it.

There are readily available sources about your home’s repair history. When you purchased your home, your seller had a duty to disclose “material defects”. You can also check with the building department of your town to determine if construction permits were issued for repairs. In Florida, you can also determine if your property had been investigated for a possible sinkhole via the local building department.
As you can glean from the foregoing, the answers on the application are not simply based on what you knew but you need to check to make sure the answers are correct based on available records.

BUY REPLACEMENT COVERAGE FOR OLDER HOMES

Insurance is designed to rebuild the home you have. But especially with older homes, newer, tougher building codes can make an exact replacement impossible unless you pay more than the cost of your original home. If your home is less than 10 years old, 10% of dwelling coverage for code updates probably suffices — verify that your policy includes it.

For older homes, and in disaster-prone areas where codes change more rapidly, upgrade your policy to include 20% for “ordinance and law.”. The cost also varies widely by carrier; some price it high because some companies would prefer not to insure older homes. To help pay for this, you may want to increase your basic deductible. Going from a $500 to a $1,000 deductible will cut your homeowners premium at least 10%. Now that home prices are increasing again it is also a good idea to make sure you are not underinsured. If the policy coverage drops below 80% of the full replacement cost of your home, your insurance company may reduce the amount it will pay on a claim.

BE WARY OF TOO MANY CLAIMS

Because insurance companies track how many claims you file, be careful about making claims on your policy. (Insurance companies use information from “claims history databases” like Comprehensive Loss Underwriting Exchange (CLUE) to help gauge the insurance risk to potential clients.) A good rule of thumb is if your claim exceeds your deductible by $200 or less, consider not filing the claim. While you will pay for the loss out of pocket, the payments will probably be less than the premium increase you could incur later. This will he to maintain a good claim record and ensure your ability to stay insured for major or catastrophic losses.

BE RESPONSIBLE

Before you gripe about the insurance company, make sure you fulfill your responsibilities. Review the policy with your agent when you receive it to ensure it is what meets your needs. Keep a file of all paperwork you completed online or received in the mail and signed—as well as any other documents related to your insurance, including the policy, correspondence, copies of advertisements, premium payment receipts, notes of conversations and any claims submitted. Pay the premium on time. Most insurers don’t offer a grace period for paying the premium; the due date is the due date.

Make a household inventory. Go through each room; write down and take pictures or videos of everything in the room. Inventory everything, including valuable items such as antiques, electronics, jewelry, collectibles and guns. Store your home inventory in a secure place at another location, such as your workplace, a safe deposit box, a relative’s house or online. Annually review and update your home inventory, including your pictures/videos. Also update your inventory when you buy new items. Keep receipts with your home inventory for all repairs and new items you buy, for proof if you file a claim.