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Insurance Claims

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Insurance companies are highly regulated by federal, state, and local laws, rules and ordinances. Despite the high degree of regulation, sometime insurance companies forget that they must work on behalf, not against, their policyholders. When presenting a claim to an insurance company, these are some rules to keep in mind:

1. The insurance industry is complex and policyholders are vulnerable and depend on their insurance company to do the right thing.

2. The insurance company must treat the interests of the policyholder the same way it treats its own interest.

3. The claim examiner has the responsibility of assisting the policyholder with the claim.

4. By Florida law, the insurance company must create and implement reasonable standards for the prompt investigation and evaluation of claims.

5. By Florida law, the insurance company must thoroughly investigate your claim.

6. By Florida law, the insurance company must objectively investigation your claim.

7. The insurance company may not ignore evidence that supports coverage.

8. The insurance company must fairly, reasonably and promptly pay the claim if payment is warranted.

9. By Florida law, the insurance company cannot misrepresent facts or policy provisions.

10. The insurance company cannot attempt to settle the claim for an unreasonably low amount.

11. The insurance company cannot have an unreasonable interpretation of its contract.

The general public does not realize that the vast majority of claims for personal injury, premises liability, automobile collision, nursing home abuse, medical error, and wrongful death, are covered by insurance policies. As a matter of fact, most personal injury law firms will not pursue injury cases if there is no insurance to cover the claim.

Insurance companies have vast resources to lobby the legislature and to influence public opinion with massive media and advertising campaigns. Insurance companies are either publicly or privately owned business that are designed to generate profits. Paying reduced amount on claims help generate profits to these companies. The way you and your attorney present and pursue your claim can have a direct effect on its value.

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