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Insurance Company Denies Coverage Because Of A Difference In Claim Value


When an insurance company evaluates a claim, two kinds of problems can happen for the homeowner. The first problem is that the claim is wrongfully denied. This means that the insurance company says there is no coverage, when in fact the policy says that there should be coverage.

The second problem is when the insurance company says that there is coverage but there is a dispute over the amount of loss, or the value of the claim.

But the Florida Supreme Court is about to make a determination as to what happens when the dispute is so vast—that is, the difference in value that the homeowner and insurance company give, is so different, that the insurer denies coverage.

How Does This Situation Happen?

Imagine that you have damage to your home. The insurance company says that it is, in fact, covered. They give you a value of what they think the damages are. But it’s a lowball offer—you know the value of damages is much, much higher. So you give the insurance company your estimate of the damages.

Your estimate is so much higher than the insurance company’s, the insurance company says that you’re not just overestimating the cost of your damages—you’re actually blatantly lying to them. Because lying or falsifying an insurance claim is against the insurance policy, the insurance company says they’re done—they are now completely denying coverage, as you have, according to them, violated the terms of the policy.

So, you’ve gone from the insurance company accepting that there is coverage, but disputing the value or amount of coverage, to the insurance company now saying there is no coverage, because of what they say, if fraud.

Problems With Denials of Coverage

As you can imagine, when the insurance company denies coverage, it creates a long, drawn out lawsuit. The homeowner isn’t getting damage appraised. The insurance company isn’t even talking about amounts—to get them to do that, you first have to sue, and get the court to agree that there is coverage under the policy.

Getting an Appraisal When There is a Denial of Coverage

Can a court order that the insurance company do an appraisal of the damage to the homeowner’s property, as is required by the policy, even though the insurance company is denying coverage? Normally they cannot.

But this is a different situation, where the insurance company first admitted coverage but then denied because of the difference in the estimates of the damage. In that case, can a court still order an insurance company to do an appraisal, in light of the insurance company’s denial? This is the very question that the Florida Supreme Court will have to resolve.

If it rules in the insurance company’s favor, homeowners could find this denial tactic used more often by insurance companies, in attempts to delay and stall homeowner claims.

Contact the Miami property damage insurance attorneys at Velasquez & Associates P.A. today if you have a dispute with your property insurance company.



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