Your Insurance Company Is Denying Your Claim? Get It In Writing

J.P. Gonzalez-Sirgo
Founder of J.P. Gonzalez-Sirgo, P.A.

The cost of homeowners insurance coverage in Florida is expensive.  Homeowners are justifiably frustrated and upset when their claims for property damage are denied after a loss.  There are many exclusions, limitations, conditions and restrictions in homeowners policies that insurance companies rely on to deny claims.  However, the language of policies can be so complex that it can be difficult to determine whether a particular hazard is covered.  Frequently, language that may clearly seem to exclude a particular hazard or loss will be negated by other sections of the policy. 

A decision by the Third District Court of Appeals provides an example of how a policyholder might be misled into forgoing or abandoning a claim because of confusing policy language.  In the case of Cheetham v. Southern Oak Ins. Co., 114 So.3d 257 (Fla. 3d DCA 2013), the Florida policyholders experienced water damage to their residence when a pipe broke due to deterioration over a span of years.  Insurance carriers routinely try to deny such claims based on the “wear and tear” exclusions included in most policies. 

While the language and policy provision discussion in the case was lengthy and complex, the court began its analysis by outlining some key policy interpretation principles that can benefit homeowners.  The court reasoned that if the relevant language is susceptible to two reasonable conflicting interpretations with one indicating that a peril is covered and the other indicating that the peril is excluded, the policy should be considered ambiguous.  When the policy is ambiguous, the salient policy provisions must be strictly construed against the insurance company that drafts the policy and liberally to favor the policyholder.  The court relying on prior decisions also indicated that “exclusionary” provisions must be even more strictly construed against an insurance company.

Because the court in Cheetham concluded that conflicting provisions created ambiguity regarding whether the plumbing back up from the burst pipe was covered under the policy, the court construed the policy liberally in favor of the insured.  Although not every dispute over the interpretation of a policy will result in a decision that benefits the policyholder, this decision illustrates the importance of seeking legal counsel from an experienced Florida insurance coverage attorney who can parse the dense language of a policy to identify provisions that may cover your claim.  When your claim is denied by your insurer, you need to insist on a written explanation that includes reference to any policy provisions, exclusions and language relied on by the insurance company in reaching its conclusion.  Even if the language makes it appear that the policy does not provide coverage, an experienced Miami claims attorney can scour the policy for other provisions that may entitle you to coverage.

You can reach Miami Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].

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