Frequently Asked Questions and Answers
- Page 1
How much will it cost to retain the services of insurance lawyer J.P. Gonzalez-Sirgo to help with the denial of health insurance benefits?
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 health insurance case, we 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 health insurance claims are alike, please contact our office to discuss your case in more detail.
If you retain our services, how long will it take to resolve your insurance claim?
It will depend at which stage of the insurance claims process you retain our office. If you retain our services for the initial claims presentation stage and the insurer honors the claim from the beginning, then your claim should be resolved fairly quickly. If you retain our services after your insurance claim has been filed but the insurance company is delaying your claim or your claim has been underpaid or denied, then a lawsuit may be necessary. At times, after an insurance company receives our lawsuit, they will offer to engage in settlement discussions in order to avoid litigation. However, your insurance company may elect to litigate the case. Although we will do our best to prosecute your claim expeditiously, it is impossible to predict the life span of the litigation as all claims are unique. We may be able to provide you with a better timeline once we know the facts of you claim. Call us for a free consultation.
Your insurance contract is lost or incomplete, can we help file your insurance claim?
Absolutely. If you can't locate all or parts of your insurance policy and have an insurance claim, please contact our office for a free consultation and evaluation. Once we are retained, we will obtain a complete and certified copy of your insurance policy directly from the insurance company.
Can insurance claims attorney J.P. Gonzalez-Sirgo help you with a denied or underpaid insurance claim that dates back many years?
Possibly. But we will need more details. We have been successful in prosecuting claims that stem from losses occurring many years prior to our representation. Call us for a free free consultation.
You handled your own insurance claim and cashed the insurance company's check. You have now started repairs and realize that the money that you received from the insurance company is not enough to complete all the necessary repairs. Can Miami insurance claims attorney J.P. Gonzalez-Sirgo still help you?
Depending on the facts of the claim we often can help. After we evaluate your claim and determine that your insurance claim was underpaid, we may be able to re-open your insurance claim. For a free consultation and case evaluation, please contact our office to discuss your situation in more detail.
A covered insurance loss just occurred, what should you do?
It depends on the type of insurance claim that you are experiencing. You can contact our office for a free consultation at (305) 461-1095. As for our fees and expenses, 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, we 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.
Your insurance claim has been denied, what can insurance claim lawyer J.P. Gonzalez-Sirgo do for you?
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.
Your insurance company lowballed you on your insurance claim, what can you do?
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.
What kind of insurance problems can insurance claims attorney J.P. Gonzalez-Sirgo help you with?
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
What is a licensed Florida Public Adjuster?
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.
If you have already hired a licensed Public Adjuster for the filing of your insurance claim, can you still hire J.P. Gonzalez-Sirgo, P.A.?
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.
You just received a letter from your insurance company in Florida requesting that you submit to an Examination Under Oath/Sworn Statement. What does this mean?
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.
The adjuster handling your claim just called asking to take your recorded statement. What does this mean?
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.
Who are Company Employee Adjusters and Independent Adjusters?
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.
What is a Catastrophe or Emergency Adjuster?
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.
How can you verify if your Public Adjuster is licensed?
You can verify if a Public Adjuster is licensed by going to the Florida Department of Financial Services.
Should you hire a Public Adjuster?
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.
Are Low Claim Offers An Act Of Insurance Bad Faith?
Yes."Lowballing" an insured is an act of insurance company bad faith.
What Are Some Examples Of Insurance Bad Faith?
An insurance policy is a contract. In exchange for your premiums, the insurance company promises to pay your valid insurance claims. When the insurance company fails to meet its obligations and act in good faith according to the insurance policy and Florida law, insurance bad faith is said to exist. If insurance bad faith can be proven, Florida law allows the insured to collect damages, attorney fees and costs, and in some cases punitive damages.
Some examples of Insurance Bad Faith conduct include:
- Insurance company denies your valid claim
- Insurance company ignores or delays paying your claim
- Insurance company underpays or lowballs your claim
- Insurance company unjustifiably suspends or cuts-off payments on your previously approved claim
- Insurance company interprets ambiguous language in your policy in its favor to avoid paying your claim
- Insurance company purposely conceals or misrepresents benefits that you are entitled to under your insurance policy
- Insurance company attempts to dissuade you from filing your legitimate claim
- Insurance company engages in insurance fraud
- Insurance company engages in other malicious and dishonest conduct
Your Insurance Claim Was Denied - Do You Have A Bad Faith Claim?
Maybe. But not all insurance claim denials are made in bad faith. Your insurance company, however, may have an invalid basis for denying your insurance claim. Whether you are the victim of bad faith should be determined by a lawyer experienced in handling bad faith insurance claims after review of the specific facts of your case.