Frequently Asked Questions and Answers

We understand that many of our clients do not have the resources or means to pay lawyer fees out of pocket. This is why we offer a free consultation. In the great majority of cases, if we decide to go forward with your case, I will work on a contingency fee basis. This means that if there is no recovery on your claim, you do not pay fees for our services or costs advanced by our office. Furthermore, under certain circumstances your insurance company will become responsible for paying your attorney's fees and costs. Since not all insurance claim cases are alike, please contact our office to discuss your case in more detail.

A Special Investigative Unit (SIU) is a department within an insurance company that investigates insurance claims for possible policyholder fraud.  Typical cases of insurance fraud include staged auto theft, arson, or inflated property damage to home or car.  Many SIU investigators have law enforcement experience along with insurance knowledge.  Many auto, boat, motorcycle or truck theft claims are automatically referred to the SIU department.

A signed agreement in which the policyholder agrees to and understands that the continued processing to the claim in question will not be construed as an admission of liability by the insurance company.  This agreement is commonly used when questions arise as to the amount of the claim or whether the insurance policy covers the claim whatsoever.  Non-waiver agreements are typically executed when auto, motorcycle, boat or truck theft claims are involved.    

For a totaled auto insurance claim, it is an agreement whereby the policyholder releases to the insurance company the lien free Certificate of Title upon receipt of insurance claim payment.  Guarantee of title are typically executed when auto, motorcycle, boat or truck theft claims are involved.

An Affidavit of Vehicle Theft is a lengthy questionnaire furnished to a policyholder upon filing an auto, motorcycle, boat truck or other motor vehicle theft claim.  The questionnaire encompasses questions regarding the insured, vehicle ownerships, vehicle description, vehicle condition, and damage and theft details.  It can also include various personal and financial questions.  The affidavit is signed, witnessed and notarized.  Affidavit of vehicle theft is typically executed when auto, motorcycle, boat or truck theft claims are involved.  

Most homeowner's insurance policies provide that you must submit proof of the damage claimed. The most effective way of demonstrating your damages to the insurance company is by documenting the before and after condition of your property. The best way to document all your personal contents and condition of your home is by taking photographs and video of the inside and outside of your home. Make sure you take pictures and video of everything you can, including your roof, garage, attic, inside of closets, basements, etc. Do the same for your personal contents, including your flat screen tv, home appliances, all furniture, etc. Periodically update your photograph and video catalogue as you complete new property improvements and add property contents. Keep all receipts of personal property and home improvements. Ensure you safeguard at least one copy of your personal and video catalogue off site, such as a bank safe deposit box. Planning ahead of time will be the key to proving your losses to the insurance company and providing you some peace of mind during this difficult moment.

Miami insurance claims attorney J.P. Gonzalez-Sirgo offers free consultations to discuss your insurance claim denial. J.P. will evaluate your insurance claim and discuss with you if you have a viable claim against your insurance company. On most cases, our office will work with you on a contingency fee agreement. Meaning if there is no recovery on your insurance claim, you pay zero fees, including costs advanced by our office to litigate your insurance claim.  Furthermore, Florida law states that if an insured has to sue his insurance company and succeeds, the insurance company is responsible for paying your attorney's fees and costs. Since not all insurance claim cases are alike, please contact our office to discuss your case in more detail.

Most homeowners, business owners and auto polices contain provisions entitling you to certain rights. One of these rights is in the "Appraisal" provision in your policy. Before you request or agree to the appraisal process, you may want to first discuss your case with our office.

Miami insurance claims attorney J.P. Gonzalez-Sirgo is available to help you with the following insurance related issues:

Handling your initial claim with your insurance company

Bad Faith insurance claims

Denied claims

Supplemental claims (after your first claim)

Low ball estimates

Dealing with insurance company adjusters

Many other issues

A "public adjuster" is any person, who, for money, commission, or any other thing of value, prepares, completes, or files an insurance claim form for an insured or third-party claimant or who, for money, commission, or any other thing of value, acts or aids in any manner on behalf of an insured or third-party claimant in negotiating for or effecting the settlement of a claim or claims for loss or damage covered by an insurance contract or who advertises for employment as an adjuster of such claims, and also includes any person who, for money, commission, or any other thing of value, solicits, investigates, or adjusts such claims on behalf of any such public adjuster.

A public adjuster may not give legal advice. A public adjuster may not act on behalf of or aid any person in negotiating or settling a claim relating to bodily injury, death, or non-economic damages.

Please read Florida Statues Chapter 626, Part VI for further information related to legislation of Public Adjusters and the unauthorized practice of law thereof.

Whether or not you have hired a licensed public adjuster, insurance claims attorney J.P. Gonzalez-Sirgo can still prosecute your insurance claim. As a matter of fact, our office routinely works with licensed public adjusters side-by-side to successfully process insurance claims, including litigation when necessary.

Yes, our office can help you with your flood insurance claim. You will never be responsible for any of our legal fees or our costs if we are not successful. Furthermore, you will never be asked to pay for costs up-front. If we are successful in your insurance claim, you will only pay a small percentage of the insurance settlement, usually as low as 10%. In cases where litigation (lawsuit filed) is necessary, fees increase to 40% and costs of litigation are extra. Since almost all flood insurance policies fall under a federal flood insurance program, the lawsuit would have to be filed in federal court. Because of this, federal law does not allow the insured to recover attorneys fees and costs even if you win your flood insurance case. Therefore, in flood insurance cases, attorney fees and costs would be deducted from the proceeds of the insurance settlement. However, there are flood insurance policies that were issued by a private insurance carrier and not the federal flood insurance program. Under these private carrier flood policies, your rights to recover attorney fees and costs may differ from the federal flood insurance program. Since not all flood insurance claims are alike, please call our office to arrange a free consultation with insurance claims attorney J.P. Gonzalez-Sirgo to discuss your case in more detail.

Most insurance policies will have a provision entitling the insurance carrier to require that the insured(s) submit to an Examination Under Oath (EUO) or Sworn Statement during the carriers investigation of the claim.

Typically, such a statement is conducted by a lawyer retained by the insurance company. In theory, the purpose of the EUO or Sworn Statement is to allow the insurance carrier an opportunity to get certain questions answered by the insured under oath and to further the insurance company's investigation of the claim. Often, the request for an EUO or Sworn Statement comes with a request from the insurance carrier for the insured to produce extensive records, many of which are only tangentially relevant to the claim. Failure to comply with the insurance company's request for an EUO or Sworn Statement will be grounds for a denial of your claim. Unfortunately, some insurance carriers seem to use EUO's or sworn statements as an opportunity to intimidate and harass insureds. In my experience, attending an EUO or Sworn Statement without obtaining the advice of an experienced attorney in these matters or failing to prepare for the EUO or Sworn Statement, will detrimentally affect your claim. Examination Under Oath and/or Sworn Statement provisions in insurance policies are considered conditions precedent to coverage which the insured has a duty to comply with. Insurance companies make requests for Examinations under Oath/Sworn Statements in many types of insurance claims.

This means that the insurance company wants to ask you questions presumably about facts relevant to your claim and that they want to record this interview with you. Usually it will be the adjuster for the insurance company that will be asking you the questions. In my experience, the adjuster will usually call you on a spontaneous and not prearranged basis to ask you these questions and record the conversation. It is possible that this is a strategy by the adjuster to catch you unprepared for these statements. This recorded statement can be very well used against you in the future and be used for a basis in denying your claim. Claims adjusters are skilled and experienced at asking questions and framing questions in a way where they can obtain favorable answers and support insurance company decisions. My recommendation is that you consult an experienced lawyer in handling insurance claims before you provide such a recorded statement to the insurance company.

Company employee adjusters are employed by the Insurance Company to represent the company in dealing with your loss and damages. The Company Adjusters main responsibility is to protect the interests of the Insurance Company, not your best interests.

Independent Adjusters are hired as "independent contractors" by the Insurance Company to represent the company in dealing with your loss and damages. The Independent Adjusters main responsibility is to protect the interests of the Insurance Company, not your best interests.

Florida Statues 626.874, titled "Catastrophe or emergency adjusters," reads as follows:

(1) In the event of a catastrophe or emergency, the department may issue a license, for the purposes and under the conditions which it shall fix and for the period of emergency as it shall determine, to persons who are residents or nonresidents of this state, who are at least 18 years of age, who are United States citizens or legal aliens who possess work authorization from the United States Bureau of Citizenship and Immigration Services, and who are not licensed adjusters under this part but who have been designated and certified to it as qualified to act as adjusters by independent resident adjusters or by an authorized insurer or by a licensed general lines agent to adjust claims, losses, or damages under policies or contracts of insurance issued by such insurers. The fee for the license shall be as provided in s. 624.501(12)(c).

(2) If any person not a licensed adjuster who has been permitted to adjust such losses, claims, or damages under the conditions and circumstances set forth in subsection (1), engages in any of the misconduct described in or contemplated by ss. 626.611 and 626.621, the department, without notice and hearing, shall be authorized to issue its order denying such person the privileges granted under this section; and thereafter it shall be unlawful for any such person to adjust any such losses, claims, or damages in this state.

Catastrophe and emergency adjusters also work for the Insurance Company. Their main responsibility is to protect the interests of the Insurance Company, not your best interests.

You can verify if a Public Adjuster is licensed by going to the Florida Department of Financial Services.

According to FAPIA's website, you should hire a Public Adjuster if you have just suffered an insurance loss, from a fire, hurricane or some other traumatic event, and you may not feel confident in representing yourself and your interests before an Insurance Company. Consider these three points.

1. It is up to you to prove the extent of your loss to the Insurance Company.

 

A typical insurance policy is dozens of pages long and contains numerous provisions and stipulations written in technical and legal terms. Additionally, it contains various forms and endorsements which are constantly changing from year to year. Most Insureds have difficulty in understanding all of them. To be compensated for your loss, there are certain conditions which must be satisfied. Failure to do so could reduce your settlement amount or even cause your claim to be denied.

2. No matter how organized you and your documentation is, filing and receiving payment on a claim can be a time consuming and tedious process.

If you are not sufficiently organized and your loss documented, you may not realize the compensation you have paid for and are entitled to receive.

3. A Public Adjuster has the experience, knowledge and expertise to obtain your maximum entitlements under your policy.

Remember that the Insurance Company Adjuster is representing the insurance company. It is not uncommon for the Insurance company to misinterpret their own insurance policy or forget to apply case law or Florida Statutes which supersede their own policy. A Public Adjuster will know current laws as they affect insurance losses and how to best represent you. A Public Adjuster has resources to help you through the maze of estimating, documenting, and filing your insurance claims.

Only by carefully reviewing the condominium association insurance policy can one determine what is covered. Usually covered under this policy are the "common areas" of the building. Check with your association to see what is covered and what is not covered.

The inside of your condo unit will not be covered by the condominium association insurance policy. The inside of your condo unit will be covered by your individual condo insurance policy.

Your condominium board of directors will have to file an insurance claim for damages sustained to the "common areas" of your condominium.

You will have to file a separate insurance claim with your insurance company for damages sustained to the inside of your condo unit.