Insurance Disputes & Unpaid Claims Lawyers Serving Broward & Palm Beach County
Your Insurance Claim Was Denied. Don’t Lose Hope. Fight Back.
You’ve suffered an unfortunate financial or physical injury and the insurance company you trusted to protect you has denied your claim. Despite faithfully paying your premiums, you now find yourself in the unexpected position of fighting for the coverage you already paid good money for.
If you strongly feel your claim has been unfairly denied or undervalued, it’s crucial that you seek qualified legal representation.
The skilled insurance claims lawyers at John D. Ameen, P.A. know how to combat the “delay, deny, defend” tactics insurance companies use to avoid honoring a valid claim.
With our lead attorney, Mr. Ameen, by your side, you’ll have a distinct advantage. He knows how insurance companies think because he used to represent them early in his career.
Whether through tough negotiation or aggressive litigation, Mr. Ameen is well-equipped to handle and resolve complex claim disputes.
The Law Offices of John D. Ameen represent policyholders who have sought legal action in disputes related to:
- Hurricane-related claims
- Property and casualty claims
- Life insurance claims
- Fire insurance claims
- Disability claims
- Auto insurance claims
- Business insurance claims
- Theft and vandalism claims
Call us today for a free consultation at (800) 555-4011.
We will be your advocate during this difficult time. We will carefully review your insurance policy to determine a course of action that helps you recover maximum benefits.
If a lawsuit is necessary, Florida law requires your insurance company to pay your attorneys fees and costs.
First Party Claim vs. Third Party Claim
An insurance policy is a contract between the insured and the insurance company. The insured is referred to as the “first party,” the insurance company is the second party, and someone who is neither the insured or insurer is considered the “third party.”
A first party claim is a claim you make against your own insurance company. For instance, if you suffer property damage under your homeowners policy and it’s covered, your insurance company has to pay you directly for your losses.
A third party claim is one you make against another party’s policy. For example, if you suffer an injury at work due to the negligence of someone other than your employer or co-worker, you may have a basis for a third-party liability claim.
An example of a potential at-fault third party in the workplace would be a manufacturer or seller of a defective tool or piece of workplace equipment. It’s important to note that third party claims are separate lawsuits from any workers’ compensation you may be eligible for.
Understanding How Insurance Companies Operate
No matter what type of insurance policy you purchase, you are entitled to the full benefits of the policy if you have a covered claim.
If your claim was denied, you have the right to challenge that denial in a court of law. Not all claim denials are upheld in court and insurance companies can be found to have acted in bad faith. If you think your insurance company has made the wrong decision call us for a free consultation.
Insurance companies are generally held to the standard of what a reasonable insurance company would do under the same circumstances. If you suspect that your insurance company has placed making a profit over doing what the policy requires we invite you to contact us for a free consultation. If we win the insurance company may be responsible for paying your fees and costs.
Red Flags When Speaking With An Adjuster:
- They will make you feel taken care of as if their only allegiance is to you
- Offers you a quick and easy settlement even if you do not yet know the full extent of your damages or injuries
- Makes you sign a medical release which allows them to look into your entire medical history
- Asks you to give them a recorded statement in order to “lock in” your testimony
Personal Injury Claim Denials: Don’t Fall Into The Insurance Company’s Trap
If you or a loved one were injured or killed in a serious accident resulting from someone’s negligence or misconduct, then you are legally entitled to restitution for any injuries and losses you sustained.
The attorneys at John D. Ameen advocate on behalf of injured persons in a variety of personal injury cases, including:
- car, motorcycle, and boating accidents
- slip-and-fall accidents
- medical malpractice claims
Recorded Statements After An Accident Can Hurt Your Claim
Giving a recorded statement to an adjuster is not a good idea. Their questions
are designed to get you to say something that can be used against you later.
For example, if you said at the time of the accident that your knee hurt but did not disclose any back pain you were experiencing, they will accuse you of making the back pain up in order to profit from the accident.
Another question an adjuster may ask following an accident is: “How fast was the person that hit you going?” You may respond by saying it was 60 mph because the impact felt so hard. However, the facts may reveal that the other driver was only going 35 mph and the property damage was relatively minor. The adjuster is now starting to build a case characterizing you as an exaggerator.
And, what if they ask you: “Where did the other car come from?” and you say “I don’t know.” Now they can use the he said/she said argument to plausibly excuse the blame from the insurer.
Documenting Your Injuries Is Essential
It’s important to visit a doctor after an accident and tell him/her every single ache and pain you have so that it can be documented.
If you have a follow up appointment and complain about a new injury that you did not mention in that first visit, the insurer will say that the injury was not a direct cause of the accident. The insurance company will not settle a case if they feel you are being dishonest. They know that if the case goes to trial, a jury will punish you with an outrageously low award.
Also, your prior medical history plays a key role in your case. In Florida, if you have a preexisting injury or condition, you are entitled to recover more money – not less. This is because you are more likely to get hurt and need long-term medical care due to your preexisting condition.
Appealing A Personal Disability Claim
If you have become disabled by injury or illness and are no longer able to work, you are entitled to disability benefits. If you have been denied these benefits, don’t be discouraged.
Approximately seven out of ten claims for disability in Florida are denied at the initial claim or disability application level. The good news is that you can appeal your denied claim in a federal court under the Employee Retirement Income Security Act of 1974.
The attorneys at John D. Ameen, P.A. can help you include all necessary evidence in your application that convincingly supports your need for disability benefits.
This evidence can include:
- medical records, including a detailed history of the medical treatment you received
- statements from witnesses who can validate the seriousness of your disability
There are four steps in the claims appeal process:
- Reconsideration. Within 60 days of the Social Security Administration’s decision, we will submit a request to have your claim reconsidered by a disability claims examiner who was not involved in the initial review.
- Hearing. If your claim is in reconsideration, we can request to have the claim reviewed before an administrative law judge in a hearing. During this hearing, you can present your case and include witnesses, experts, and any additional evidence not submitted with your initial claim.
- Appeals Council. If your claim was denied in the hearing before the judge, we can request another hearing in front of the Appeals Council. The Council will either reverse the judge’s decision and approve your request, order a second hearing, or deny your claim.
- Lawsuit. If your claim is denied by the Council, you may be able to file a lawsuit in federal district court seeking benefits.
Are You Experiencing A Property Damage Nightmare?
Did your home, car, or business suffer damage due to a natural disaster, crime, or accident? Did your insurance carrier deny compensation to help you repair and rebuild?
As residents of Southern Florida in the heart of “Hurricane Alley,” we know the devastation storms and natural disasters can be. We’ve also seen our fair share of serious accidents due to dangerous highways, and crimes committed from an increasingly populated coastline.
Here are some some examples of common property damage in Florida:
- Automobile accidents
- Fire damage
- Water damage – pipe burst
- Flood damage — rot, mold, mildew
- Windstorm damage – a storm, hurricane, or tornado can cause roof damage, structural damage, or damage to landscaping
- Vandalism – damage caused by spray paint, broken windows, etc.
- Theft – stolen personal items
- Sinkhole – dissolved soil, sediment and rock can cause the foundation of buildings to collapse, resulting in serious structural damage
Contesting An Unfair Property Claim Denial
The first step to take toward proving an unfair denial is to gather evidence to support your argument.
This could include:
- pictures documenting damages
- receipts or records of any purchases you made to protect your home (security system, fire alarm)
- witnesses testimonies
You can also request independent appraisals if there are disagreements over the value of your property.
It’s very important to establish that you are a safe and responsible owner, and that there was no negligence or recklessness on your part that caused the damage.
If we appeal the claim and it is denied, our attorneys will be fully prepared to take the insurer to court or to a private arbitrator.
Your Life Insurance Claim Has Been Denied. Now What?
Before your loved one passed, they did the responsible thing and bought life insurance
to protect and provide for the ones he/she left behind. Ideally, your insurance company would do the right thing and adhere to your loved one’s wishes.
If a death occurs within the first two years of the policy, beneficiaries should expect that the policy will be investigated to determine if the deceased misrepresented themselves in the claim.
Benefits Denied Due To Misrepresentation of Health History On Original Claim
The insurance company will argue that the insured omitted or did not fully disclose information about health problems and therefore reject the coverage. They will claim that had they known about the omitted health conditions, the policy would never have been issued at the time of the application.
In many cases, we can prove that the insured did not disclose a condition because it never required medical treatment, nor did it contribute to the insured’s death.
Cause of Death Wasn’t Accidental
Many life insurance policies do not pay benefits if they determine the cause of death wasn’t “accidental.” This is common in drinking and driving cases or drug overdoses in which the insurer states that the insured’s recklessness led to his/her death. Often these denials are not legitimate because the insurer improperly defined accidental or was selective about the evidence it used to come to that conclusion.
Unpaid Premiums Mean No Paid Benefits
Often, the policyholder becomes physically or mentally incapacitated and lapses in paying their premiums. After the insured passes away, the beneficiary may find that the insurance company has denied coverage because premiums were left unpaid.
At John D. Ameen, P.A., we understand how emotionally distressing this issue is for you and your family. Our attorneys can investigate whether or not the insurance company submitted a notice of cancellation and extended a grace period during which the policy could have been renewed and premiums paid. If we discover that the insurance company did not send the necessary cancellation notices, they cannot legitimately deny the claim.
Did My Insurance Company Act In Bad Faith?
As a policyholder in Florida, your rights are protected under the Unfair Claim Settlement Practices Act, which regulates the behavior of insurance companies with respect to the payment of claims.
Your insurance company has a duty to handle your claim promptly, reasonably and in “good faith.” If your benefits were unreasonably withheld from you, your insurer has acted in “bad faith.”
Our job as your legal representation is to prove that the insurance company failed to honor its contract and had no reason not to pay.
Florida’s bad faith law is codified in Section 624.155, Florida Statutes. In certain
circumstances, the law allows for the recovery of punitive damages and attorney’s fees and court costs.
Bad faith insurance claim practices include, but are not limited to:
- Failing to promptly and thoroughly investigate a claim
- Unreasonable interpretations in translating policy language
- Refusing to settle the case or reimburse you for the entirety of your loss
- Unreasonable denial of benefits to a claim or termination of an insurance claim that should have been paid
- Unreasonable delay in making payments to the policyholder
- Unreasonable failure to defend a policyholder who has been sued under a policy containing a liability provision
- Unreasonable attempts to under-settle or low ball the payment of a claim
If the Court finds your insurance carrier wrongfully denied your claim, you would be eligible to recover the benefits of the policy for the claim, and possibly consequential losses and damages suffered for emotional distress, lost income and attorney fees. If the insurer exhibited flagrant, intentional and/or gross misconduct, punitive damages may be awarded.
If you have been denied a Florida insurance claim or if you feel you are unfairly treated by your insurance company, contact the law offices of John D. Ameen for a free consultation. Serving residents all throughout Southern Florida including Boca Raton, Fort Lauderdale, Hollywood, Pompano Beach & West Palm Beach.