Florida Homeowners’ Policy and Claims Bill of Rights Draft Released by Florida Consumer Advocate: Protecting Against Insurance Adjusters

Posted By on August 6, 2013

Last Update: 02/01/16

Florida homeowners pumping water away from their home after Hurricane Katrina. Wikimedia Commons Public Domain Image.

 

Awhile back, Florida’s Chief Financial Officer, Jeff Atwater, appointed Robin Smith Westcott to be the Florida Insurance Consumer Advocate. At that time, Atwater explained that Westcott’s job was to be “… committed to holding insurance companies accountable and to ensuring consumers get exactly what they pay for and are protected from fraud and abuse.” 

As part of that mandate as head of the Consumer Advocacy Office, a new Homeowners’ Policy & Claims Bill of Rights Working Group was created by Ms. Westcott earlier this year.

Consumer Advocates and Insurance Representatives Meet to Discuss Bill of Rights for Insurance Claimants and Policyholders in Florida

That Working Group brought together consumer-rights groups and insurance industry people to address issues that Westcott had learned from Floridians across the state during a series of consumer forum meetings where Florida homeowners came to tell their stories of the problems they had experienced in filing an insurance claim here in the State of Florida.

After hearing all these complaints about (1) filing insurance claims, (2) getting them to move through the process within the insurance company, and (3) to get paid (finally), the Working Group was formed. Explaining why she was forming this group, Westcott said, “Consumers should not be victimized by poor claims handling and unscrupulous business practices by those seeking to exploit homeowners when they are most vulnerable”.

Poor Claims Handling and Unscrupulous Insurance Company Practices Are Focus of Working Group

The Working Group of Consumer Advocates and Insurance Representatives were to address the following problems:

  • Adjusting & Investigating the Claim – Examinations Under Oath
  • Post-Claim Underwriting & Material Misrepresentation on the Application
  • Solicitation of Consumers within 48 – 72 Hours of a Loss and Policyholders’ Requirement to Mitigate Damages
  • Assignment of Claims and Unauthorized Adjusting of Claims
  • Insurers’ Right to Repair – Safeguards and Warranties for Consumers
  • Non-Renewal of Policies – Post-Claim but Prior to Repairs
  • Mortgage Company Withholding of Funds for Repairs for Loans in Arrears and Guarantee 100 Percent Replacement Cost
  • Mediation and Appraisal.

This weekend, the news reports were that the Florida Insurance Consumer Advocate’s office was finalizing a “Policy And Claims Bill Of Rights” out of the work done by the Working Group.  A draft of that final Bill of Rights has been shared with the public and one local news station has published the draft online as a pdf.

Draft of the New Policy and Claims Bill of Rights Released This Week

Included within the Bill of Rights recommendations are the following — and these are, of course, recommendations. The Working Group is not creating new rules, new regulations, or new laws that Florida insurance adjusters and Florida insurance companies must follow.

It’s a public policy statement and the industry should take notice of it; however, this isn’t going to form the basis of a federal grand jury investigation or a private Florida civil lawsuit if the insurance company fails to comply.

If the Florida Legislature takes these recommendations as suggestions for future legislation, then new laws may result from these recommendations to protect Florida insurance claimants in the future.   And, if an insurance company can be shown to be aware of these recommendations and then fail to follow them, a Florida personal injury attorney can address that intentional disregard of these Recommendations as part of any claims lawsuit brought against the company by a dissatisfied claimant.

Check Out the Bill of Rights Draft in Detail Here — Is There Enough Protection for Florida Homeowners?

From the July 29, 2013 draft of the Homeowners’ Policy and Claims Bill of Rights (those of particular note are in red):

All Claims

  1. Include a standard “cooling off” period of 72 hours for contractual services beyond emergency remediation measures.
  2.  For all emergency mediation, any contract for services must have a detailed, itemized statement of the scope of work and quote for all materials and services to be rendered. Any variance for an additional 20% or more from the original scope of services and quote must be presented to and approved by the homeowner or any assignment beyond the initial quote is invalid.
  3. Companies should not be restricted from sending an adjuster immediately upon notification of a claim.
  4. A company claims adjuster should make an initial inspection of the property and provide the consumer with an initial estimate within 36 hours of notification of a loss. Failure to inspect and deliver the initial estimate will result in a presumption that all charges for remediation and repairs made within the 36 hours after the notification are valid and payable for covered claims.

Assignment of Claims and Unauthorized Adjusting of Claims

  1. Assignments of benefits for any repairs should be restricted to Coverage A, dwelling policy limits.
  2.  In order to be a valid assignment, the assignee or homeowner must notify the insurance company in writing within 72 hours of the execution of the assignment.
  3.  Additional review and enforcement for DFS in unauthorized adjusting cases, with clearly defined limitation for contractors barred from adjusting.

Adjusting and Investigating the Claim – Examinations Under Oath

  1. Establish statutory standards for scheduling and conducting EUO’s.
  2.  Codify existing case law for conducting EUO’s.
  3.  Limit the number of recorded statements taken of the homeowner.

Post-Claim Underwriting & Material Misrepresentation on the Application

Limit the review of underwriting rules regarding credit or criminal history to the 90-day underwriting period and disallowing the use of these issues as “material misrepresentation” at the time of a claim.

Alternative Dispute Resolution (ADR)

  1. Combining the mediation, neutral evaluation and appraisal processes to reflect a stronger alternative dispute resolution process for consumers.
  2.  Increase regulatory review by DFS with stronger licensing requirements, qualification criteria, and standards of conduct.
  3.  Adoption of rules of new ADR process to include rules similar to the Rules of Civil Procedure that give more structure to the process. (e.g. requirements for disputes regarding coverage and damages be separately stated, certain document requests and/or notices provides prior to ADR.)
  4.  Enforceability of property owner presence for all ADR proceedings.

Insurers’ Right to Repair – Safeguards and Warranties

  1. Establish standards for Right to Repair Programs and for Managed Repair Programs.
  2. Required warranties for work provided under Right to Repair.
  3. Establish dispute resolution for parties not satisfied with work performed under these programs.

What Should You Do?

A good piece of advice if you have been harmed by your insurance adjuster, is to at least speak with an experienced personal injury lawyer before you file a claim to learn about some of the issues that can arise with these claims, including the type of evidence needed to prove a claim and the type and amount of damages you can recover. Most personal injury lawyers, like Alan Sackrin, will offer a free initial consultation (over the phone or in person) to answer your questions.

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Do you have questions or comments? Then please feel free to send Alan an email or call him now at (954) 458-8655.

 

 

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