I want to thank Florida Public Adjuster Michael Platts for penning this excellent commentary. 

By Michael W. Platts

I have recently been involved in three cases which bring up a very interesting yet disturbing trend. All three are relatively small insurance claims. In each case, the insurance carriers have chosen to deny these claims without (from my perspective) performing a fair, impartial, proper and thorough investigation.

Let’s take the first claim: This is a small water loss to a mobile home. The owner, a full-time student, had moved to the Midwest to continue her studies and had periodically rented the home out to seasonal tenants. The insurance company refused to extend coverage based upon erroneous information that the home had been vacant for an extended period of time.

After we went to the length of providing the carrier with an affidavit from the last tenant as well as a statement from a neighbor who periodically checked in on the property, the insurance company still stood by their denial for long-term damage which should have been visible to the insured.

Once the insurance company’s “final decision” had been reached, I recommended to the insured that she have a Civil Remedy Notice (CRN) filed with the State of Florida. She chose one several first party insurance attorneys I provided who proceeded to file the notice in its proper form with the State. Typically, attorneys will file a CRN for policyholders at no charge with the reasonable expectation that if further legal pursuit is necessary, they will have an inside track in being retained because of their knowledge of the claim. It was only a matter of weeks before an associate with a very prominent insurance defense firm contacted the plaintiff’s attorney with the upshot being that the claim is being settled for the entire demand amount plus attorneys fees.

The second claim is remarkably similar. An older Tampa home incurred a water leak which originated within an exterior wall cavity. The resultant water ran into the home damaging contents and personal property.  Citizens Property Insurance Corporation denied this claim essentially because they said that it occurred over a period of time. They made no provision whatsoever for whatever damage(s) which would have and did occur during the onset of the hidden leak.

Again, after their “final denial” I recommended to our client that he contact a specialist attorney to file a civil remedy notice on his behalf. He chose one several first party insurance attorneys I provided him and accordingly, the Notice was filed with the State. As of this writing, the claim has been transferred to a new Citizen’s adjuster and it appears likely that it will be settled in the near future.

The third act in our little trilogy involves a residence in Pinellas County which incurred roofing damage from a storm. In a case with eerie similarity to the first one, the insurance carrier has denied the bulk of the claim based upon the assessment of their independent field adjuster that the roof did not incur wind damage. How he was able to ascertain this after temporary mitigation repairs were implemented is beyond my comprehension. As in the first case, an affidavit was provided the insurance carrier. In this situation, the affidavit was from the licensed general contractor who did the actual repairs and discovered the nature of the loss. He witnessed the fact that solar panels emplaced upon a flat roof had been torn loose, their fastening attachments bent very obviously from wind.

Yet, even after this documentation and proof as to the proximate cause of loss (And lets’ face it, he had already been paid for the repairs and no longer had a dog in the fight other than seeing justice done), the carrier still insisted that the underlying cause of loss was wear and tear.

In this case, despite repeated attempts and requests to get my client to choose an insurance attorney for the purposes of filing a Civil Remedy Notice, she has yet to do so, to my knowledge. My plan is to communicate with this policyholder again, re-iterating the importance of this next step and reminding her to take it before the statute runs on her claim.

The thrust of this blog is that it is becoming necessary in many cases to have a Civil Remedy Notice filed with the State of Florida for claims which in my opinion (with nearly 30 years of experience in the industry), could have simply been settled if a fair, unbiased and reasonable investigation had been initiated, conducted and concluded. In the past, these types of claims would have been settled quickly and the policyholder would have been made whole. Instead, the carriers have potentially exposed themselves to extra-contractual damages which could be well in excess of the policy limits much less the costs of covered damages. They are also running up claim processing costs and increasing their legal bills.

Let us know what you think.