Insurance Claim Frequently Asked Questions

Q. What are the Fees and Expenses

A. We handles virtually every case on a contingency fee basis, unless the client requests other arrangements.  Under our standard contingency fee agreement, if there is no recovery, there are no fees or costs owed to us.  In addition, Florida law provides that if a policyholder sues his/her/its insurance company, to recover on a Florida issued policy, the insurance company must pay a reasonable attorney’s fee if the insured is successful in the suit.  There are some policies, such as certain flood policies and policies issued outside of the state, which may not qualify for an attorneys’ fee award.  We routinely advances all costs associated with the litigation and only charges those costs to the client/policyholder in the event of a recovery.

Q. I have a small insurance claim, but my insurance company will not pay. Won’t it cost me more to pursue the claim than I can recover?

A. No, not if your lawyer will work on a contingency basis; that is, no costs or attorneys fees unless you recover.

Q. My insurance company has agreed to pay my claim, but has offered me less money than I believe I am entitled. What can I do?

A. Many insurance policies, including almost all homeowners, business owners and auto policies, contain appraisal provisions. “Appraisal” is a process of determining the amount of the loss. Typically, the insured appoints an appraiser, the insurer appoints an appraiser and the two appraisers agree on an umpire. If there is no agreement as to an umpire, a court may determine the umpire. Usually, then, the appraisers separately value the loss and submit differences, if any to the umpire. Agreement by 2 of the 3 will typically finally determine the amount of loss.  Before you demand or agree to appraisal, you may wish to consult with an attorney who can review your specific situation.

Q. I purchased my policy a few years ago and paid all premiums. Now I have a loss and my insurer says it will not pay because there is a mistake on my application. What can I do?

A. Immediately seek the assistance of qualified counsel. Florida Statute Sec. 627.409 provides that a misrepresentation, omission, misstatement, or concealment in an application for insurance may prevent recovery. The incorrect information may prevent recovery even if it was innocently given, or given with the good faith belief that the information was true!! However, there are exceptions to this rule. Moreover, certain insurance policies provide that such a defense cannot be raised with respect to a loss that occurs more than 2 years after issuance of the policy (or policy change). Note that most policies containing such provisions are life and disability policies. ALLEGATIONS OF MISREPRESENTATION(S) IN AN APPLICATION FOR INSURANCE ARE VERY SERIOUS AND YOU SHOULD IMMEDIATELY SEEK THE ASSISTANCE OF COMPETENT COUNSEL!!

Q. My insurance company wants to take my recorded statement. Should I cooperate?

A. Yes, most policies of insurance, particularly homeowners and business owners, require an insured to cooperate and to give a statement if requested. However, use good judgment and seek professional assistance if the interview is more than a few basic questions about your loss. For example, if you have suffered a fire loss and your insurer begins to ask you questions about your finances, debts, flammable liquids in your home, etc.; you may wish to reschedule your statement and seek professional assistance. Your insurer may believe the loss to be intentional and may suspect you are responsible. In all cases where your “adjuster” is from your insurer’s “S.I.U. (Special Investigative Unit), you should seek legal advice. “S.I.U.” units are typically devoted to suspected fraudulent claims. In such cases, ask your adjuster, on tape, for a continuation of the statement to a time that your attorney can be present.

Q. If I have done nothing wrong, why do I need an attorney?

A. Because, unfortunately, the issue may not be whether you have actually done something “wrong”, but rather, whether your insurer suspects you may have done something wrong. There are numerous “red flags” (so called by insurers) which may alert an insurer of a potentially fraudulent claim. If your insurer “finds” one or more of those red flags, you may be in for quite an ordeal, even though your claim is completely legitimate.

Q. I gave my insurer a recorded statement; but now I have been asked to appear for an “examination under oath” (sworn statement). What is this? Must I attend?

A. Typically, all homeowners and business owners’ policies contain provisions allowing an insurer to take the sworn testimony of one or all insured. This is a contractual provision and some courts have held that an insured’s failure to comply results in a breach of contract and the insurer will owe nothing for the claim. In our experience, in the vast majority of claims where an insurer requests such an examination, the insurer suspects fraud, either in the occurrence of the loss (such as arson), the claim (exaggerated) or the application (misrepresentation, concealment, etc.). In substance, if the policy so requires, you must attend the examination and bring the documents which you are reasonably required to bring. An examination under oath is usually a several hour ordeal where you are questioned, under oath (a court reporter typically records the proceeding) about a broad range of issues. The examination is often conducted by an attorney representing the insurance company.  Do not go to an examination under oath without competent, experienced legal counsel.

Q. The adjuster introduced me to a contractor who could repair my home. Does this mean that the insurance company is supervising or standing behind the repairs?

A. No. It is not unusual for insurance companies to have relationships with contractors who provide repair estimates to insurers. Please understand that quite often, the same contractor provides estimates to insurance companies over and over again on various losses. This creates a relationship where the contractor is relying upon the insurance company for future income and sometimes the contractor’s estimates reflect this relationship. If you are introduced to a contractor by your adjuster, please further understand that when the smoke clears, you may find that you have executed an “authorization for repair”, which is a contract between you and the contractor, leaving the insurance company out of the mix. If the contractor then does shoddy work or if he attempts to repair a structure which can’t be repaired (damaged more than 50%, etc.) you may find your only remedy is against the contractor. Your insurance company will claim that you entered into a separate contract with the contractor over which the insurer has no control.

Q. The problem(s) I have are not addressed in your FAQ. How can I get help?

A. Contact Us 561-247-0797 or info@arslawgroup.com

Q. If I need to hire an attorney, how much will it cost?

A.  We never charge for a consultation.  Please call us, and after discussing with you the specifics of your claim we will gladly answer all of your questions regarding fees and costs