Insurance Coverage Disputes

Insurance Coverage -

1. Denials and disputes involving any and all coverage based on policy exclusions, conditions, definitions, endorsements, construction or interpretation of policy language
2. Cancellation of insurance coverage

There are many reasons an insurance company denies a claim, or refuses to defend a claim. Most of the time the reason is that the claim does not fall within the definition of “occurrence” or covered event as described and defined in the policy. Whether the denial of coverage is valid many times depends on the interpretation of the particular policy language by the Florida courts. Since most insurance policies contain similar, and many times identical definitions, terms, exclusions and conditions, based on forms purchased for use from the Insurance Services Organization (ISO), there are generally appellate court opinions determining when and how insurance policy language applies to various fact patterns. Nonetheless, since the facts of any particular claim may not neatly fall within the ruling of an authoritative court decision, there is much litigation over insurance coverage issues in the Florida courts.

Cancellation of insurance policies is strictly regulated under Florida Law. Private automobile insurance policy cancellation is governed by Florida Statutes, Section 627.728 , which, in summary, allows cancellation of a policy for nonpayment of premium, misrepresentation or fraud, or the suspension or revocation of the license of an insured driver. (Within the first 60 days after the policy is issued, cancellation may be for any reason.) The notice must be delivered to the insured 45 days in advance of the cancellation unless it is for nonpayment, in which case a 10 day notice is required. The statute requires 45 days notice to the insured of the insurer’s intent not to renew a policy, and prohibits nonrenewal based “entirely” on the, “sex, occupation, marital status, residence, military service, or age of the insured, or on the principal place of garaging the insured vehicle in this state, or based on any combination of such factors”. For commercial vehicles, property insurance, marine insurance and umbrella or excess policies, cancellation and nonrenewal is governed by Florida Statute, Section 627.4133. F.S. 627.4133 also requires 10 days notice for cancellation for nonpayment, and 45 days notice of cancellation for other stated reasons, with a 20 day notice requirement for polices in effect greater than 90 days when the reason for cancellation is other than nonpayment. NOTE: For property insurance Section F.S. 627.4133 provides:

With respect to any personal lines or commercial residential property insurance policy, including, but not limited to, any homeowner’s, mobile home owner’s, farmowner’s, condominium association, condominium unit owner’s, apartment building, or other policy covering a residential structure or its contents:

(a) The insurer shall give the first-named insured at least 45 days’ advance written notice of the renewal premium.

(b) The insurer shall give the first-named insured written notice of nonrenewal, cancellation, or termination at least 100 days before the effective date of the nonrenewal, cancellation, or termination. However, the insurer shall give at least 100 days’ written notice, or written notice by June 1, whichever is earlier, for any nonrenewal, cancellation, or termination that would be effective between June 1 and November 30. The notice must include the reason or reasons for the nonrenewal, cancellation, or termination, except that:

1. The insurer shall give the first-named insured written notice of nonrenewal, cancellation, or termination at least 120 days prior to the effective date of the nonrenewal, cancellation, or termination for a first-named insured whose residential structure has been insured by that insurer or an affiliated insurer for at least a 5-year period immediately prior to the date of the written notice.

With regard to the return of premiums post cancellation, Florida Statutes, Section 627.7283 provides that when a policy is cancelled mid-term, the insurance company must refund any unearned premium to the insured within 30 days after the effective date of the policy cancellation or receipt of notice or request for cancellation, whichever is greater. Many times an insurance policy is cancelled by an insured because other coverage is found with a different insurance company. Since virtually all automobile insurance policies provide that coverage terminates on the day other similar coverage is purchased/effective, there may arise an issue concerning from what date the cancelled policy issuing insurance company must provide a refund.