No matter how clear-cut your claim may seem to you, the insurance company’s claims adjuster often interprets the language of the insurance policy at issue in ways that minimize or even exclude coverage for valid claims. Always remember when dealing with a claims adjuster that your insurance company is a for-profit business, and it is in the corporation’s self-interest to avoid paying out claims. The insurance adjuster is NOT your friend.

What Rules Must the Claims Adjuster Follow?

All insurance policies issued in Florida contain an implied obligation on behalf of the claims adjuster and insurance company to treat the insured with “good faith and fair dealing.” That means that if you make a claim for coverage, the claims adjuster cannot simply deny payment without articulating a legitimate reason.

The claims adjuster is required to thoroughly investigate your claim and consider all of the facts and circumstances before making a coverage determination. However, the goal remains to make a profit, and that goal is reached by collecting premiums and paying the least amount of claims possible.

What are Some of the Issues that Arise with Claims Adjusters?

Some of the behaviors that insurance adjusters engage in that give rise to customer dissatisfaction (and in many cases legal action) by the insured include:

  • A refusal to pay a claim, or a lowball offer in response to a claim;
  • Lengthy, unreasonable delays in claim processing;
  • Overly burdensome requirements for verification of a claim (excessive documentation requirements); and
  • Fraud or misrepresentation related to adjustments or appraisals

Many more types of behavior can give rise to valid claims, but these are the more popular issues we see. Sometimes issues like these can be resolved with a strongly worded letter or a phone call to the supervisor of the claims adjuster with whom you are dealing. If your claim has been wrongfully denied, however, or if you are unable to resolve your issues after trying by phone and letter, you may need to seek legal advice and assistance.

Florida’s Civil Remedy Statute

Florida has a civil remedy statute that outlines the insurance company’s good faith and legal obligations owed to its policyholders, provides options to the policyholder in the event of a dispute, and describes how to resolve an insurance coverage dispute.

You can even seek compensation for damages under the civil remedy statute, if the claims adjuster is found to have engaged in unfair competition or unfair or deceptive acts. If the claims adjuster does not attempt to settle your claim in good faith, you can bring a lawsuit under the civil remedy statute.

If the claims adjuster does act in bad faith, you may have the right to bring a claim under the civil remedy statute or a common law bad faith claim in court. Insurance coverage disputes can be quite complex.

If you are having an issue with a claims adjuster that you have been unable to resolve and would like to discuss what you should do next, call our Broward County insurance claim lawyers at (954) 767-6333 or use our convenient online contact form.