No doubt, if you ever had an insurance claim, you have seen the ominous words at the bottom of a check or insurance claim form which say: “Anyone who prepares or makes any written statement to any insurer for payment knowing that such statement contains any false, incomplete, or misleading information concerning any fact or thing material to such claim commits a felony of the third degree.”
Holy smokes! You think: “If I accidentally put down a wrong phone number or an address out of order I’m subject to being arrested?” Well, that’s what the insurance company would like you to think. This is intimidation on a statutory level. The fact is though, if there is anybody committing fraud on a regular, frequent, daily basis it is insurance companies. Fortunately for now, there is a law on the book that spells out exactly what insurance companies cannot do. “Why is that you say?”
Why? Why would an insurance company do something that would leave its insured exposed to a big verdict when it could pay the limits? Well, it’s summed up in the phrase: “loss payables.” Loss payables are the money insurance companies pay out for claims. They discovered many, many years ago, the way to keep rich is not pay claims. In short, all insurance companies’ goals are: 1. Take your premium money, as much as it can as often as it can. 2. Invest it and make money. 3. Pay as little as possible on claims and the people or companies it owes (that includes the lawyers it hires). That means an insurance company reduces it loss payables and does this through a variety of tricks. I use the word “tricks” precisely because that’s what it is. Over the many years, the insurance companies have developed these, refined and re-invented. They are slippery in the policies used, dishonest in protecting the people who have the policies and in the treatment of claimants who only ask for fair and reasonable payment for what has been taken in the injury.
The insurance company will “nickel and dime” you. They are most often not fair and reasonable. They are certainly not forthright. They use tricks to not pay fair and reasonable claims. Sometimes they are even outright dishonest.
Legislatures in years gone by have passed many laws to protect consumers. There are still two laws that say what an insurance company can’t do. Even though insurance companies are powerful as they are, the trial lawyers of this state and I still have these two laws with which can bring the most abusive insurance company to heel. The two laws I’m talking about are Florida Statutes 626.9541 and 624.155.
Florida Statutes 624.155 is a statute that is under attack in every legislature session there has been since the day it was enacted. Why do insurance companies pay millions to their legions of lobbyists in Tallahassee every year to weaken this law? Because it allows me and other real trial lawyers to sue when your insurance company doesn’t protect the insured. It’s called, and boy is this accurate, the Florida Bad Faith law. It makes sure your insurance company honors the promise it made when it took your insurance premiums.
It works like this: A person has an incident and has $50,000.00 in insurance to protect. The injured person contacts the first person’s insurance company. Let’s say the second person has $50,000 in bills and has lost $5,000 in work and won’t be able to do his job again. If this injured person asks to be paid by the insurance company and the insurance company doesn’t pay the $50,0000 to protect this person it promised to protect, it is not honoring the contract that “under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.”
When the injured person sues the insured person because the insurance company didn’t pay it’s coverage and the injured person gets a verdict of say $2,000,000.00, then the insured person (who caused the injury) has a claim against his or her insurance company for “Bad Faith.” This sensible law allows the insured to go after his insurance company for what he or she now owes the injured person. The insurance company also must pay attorney fees, costs and sometimes- punitive damages to make an example of it so it protects the next insured who injures somebody. I have had several cases where the biggest insurance companies just don’t care and expose their insureds to big judgments. It’s pretty sad when a insurer leaves its insured to have a huge verdict against him or her but instead didn’t want to pay it’s coverage limits.
There another statue like bad faith that allows insurance companies be exposed when they screw claimants or their own insureds (who they were paid to protect). It’s the second law I mentioned, Florida Statutes 626.9541. This law is a “laundry list” of stuff insurance companies have done before but can’t do now because representatives of Florida’s citizens in years gone by made these sneaky tricks illegal. Here they are in order of appearance:
An insurance company can’t:
626.9541(1)(i)(3)(a) Fail to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(b) misrepresent pertinent facts or insurance policy provisions relating to coverages at issue.
626.9541(1)(i)(3)(c) Fail to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(d) Deny claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(e) Fail to admit or deny full or partial coverage of claims, or fail to provide a written statement that the claim is being investigated.
626.9541(1)(i)(3)(f) Fail to promptly provide a reasonable explanation for denial of a claim or for a compromise settlement in writing to the insured.
626.9541(1)(i)(3)(g) Fail to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(3)(h) Fail to clearly explain the nature of the requested information and the reasons why such information is necessary.
626.9541(1)(i)(3)(i) Engage in unfair claim settlement practices
626.9541(1)(o)(10) Charge additional premium for motor vehicle comprehensive or uninsured motorist coverage because the insured was involved in a motor vehicle crash or was convicted of a moving traffic violation.
626.9541(1)(o)(11) Cancel or issue a non-renewal notice on any insurance policy or contract without complying with procedure required under the Florida Insurance Code.
626.9541(1)(o)(12) Impose or request an additional premium, cancel a policy, or issue a non-renewal notice on any insurance policy or contract because of any traffic infraction when adjudication has been withheld and no points have been assessed pursuant to s. 318.14(9) and (10).
And finally, an insurance company can’t:
626.9541(1)(o)(3)(a) Impose or request an additional premium for a policy of motor vehicle liability, personal injury protection, medical payment, or collision insurance or any combination thereof or refusing to renew the policy solely because the insured was involved in a motor vehicle accident unless the insurer’s file contains information from which the insurer in good faith determines that the insured was substantially at fault in the accident.
The problem you have with these laws is if your lawyer doesn’t know them or isn’t going to take the time to enforce them in your favor because he or she has so many cases coming in from the billboards, TV and radio commercials, they do you no good. Change that with a call to me.
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