Florida Insurance Law Blog

Lawsuit Filed for Sinkhole Damage

Mark Nation — Wed, 07 Mar 2012 07:23:15 -0500

My client recently noticed cracking in the walls and foundation of his home. He asked his homeowners insurance company to inspect for possible sinkhole activity affecting his home. The homeowners insurer retained an engineer and a geologist to inspect the home and perform sinkhole testing. The insurance company's engineer and geologist concluded that there was no sinkhole. However, even a cursory review of the data from their inspection and testing clearly reveal the presence of sinkhole activity.

Although it was clear from the insurance company report that sinkhole activity was present, I sent their report to an expert I trust for review. The expert who reviewed the insurance company report confirmed the presence of sinkhole activity.

As a result, I filed a lawsuit against the homeowners insurance company for breach of contract. In cases like this, there are never any out of pocket fees or costs for my client. And, in many of my insurance cases, if I win, I can force the insurance company to pay my fees and costs. If I lose, I work for free.

In any event, my promise to you is that I will review any insurance denial for free!

Lawsuit Filed for Wind Damage to Roof

Mark Nation — Wed, 07 Mar 2012 07:16:43 -0500

My client, who lives in eastern Volusia County, suffered wind damage to his roof during a significant unnamed storm on January 25-26, 2011. He submitted the claim to his homeowners insurer. As often happens, the homeowners insurance company hired an engineering firm to inspect the roof and prepare a report. As often happens, the engineer hired by the homeowners insurance company wrote a report that said there was no wind damage. As often happens, that report is flat out wrong.

I was retained, and had a certified roofer inspect my client's roof. My videoagrapher videotaped the entire inspection. The roof shows clear signs of wind damage, including bent and creased shingles, torn shingles, and debris under the shingles.

Yesterday, I filed a lawsuit against the homeowners insurer for breach of contract. As in most of my insurance cases, I charge my client nothing. If I win, the insurance company owes my fees and costs, and if I lose, I work for free.

Water Damage to Tile Floors

Mark Nation — Tue, 29 Nov 2011 10:37:01 -0500

Tile floors are cemented into place when they are installed. Water intrusion at a home can often result in floor tiles becoming loose. The technical term for this is "debonding" of the floor tiles. Debonding occurs when water breaks the seal between the tile and the concrete which bonds the tile to the floor.

Debonded tiles can happen whenever there is water intrusion in or around tile floors. Frequent causes are broken toilet supply lines, broken ice maker lines, leaking windows or walls, and broken washing machine lines. Debonded tiles also occur when water is used to put out a fire.

Debonded tiles are covered under most homeowners insurance polices in the State of Florida. Also, importantly, often the tiles cannot be resealed, but have to be removed. When tiles are removed, they frequently crack. If you cannot match the new replacement tiles with your old tiles then your homeowners insurance company must replace all contiguous floor tiles. Your homeowners insurance company will often not tell you about this matching requirement.

It is easy to determine if you have debonded tiles. You can determine if tiles are debonded by simply tapping on the tiles with a broom handle of screw driver handle. Properly affixed tiles will sound and feel solid. Loose tiles will have a hollow sound when tapped, and will feel loose.

Lawsuit Filed Against Homeowners Insurance Company for Wind Damage to Tile Roof

Mark Nation — Tue, 29 Nov 2011 07:54:44 -0500

My client, a local lawyer, sustained substantial wind damage to his tile roof as a result of the severe unnamed storm that hit our area on March 30, 2011. He submitted the claim to his homeowners insurance company. The insurance company had his roof inspected by an engineering firm that found that his tile roof - which had been in place for about 15 years without any problems - had been improperly installed.

Based on the engineering report, the homeowners insurer denied the claim. The insurer and the engineering firm it hired ignored the facts that: 1) prior to March 30, 2011 the roof was working perfectly; and 2) during the storm, many of his roof tiles were blown off and others shifted.

Yesterday, I filed a lawsuit against the insurance company for breach of contract. I suspect that once the insurance company hires a lawyer he will tell the insurer to settle this case.

The important lesson for homeowners in this case is that you still have options even if your insurance company hires a professional engineer who writes a report against you. My promise is simple: I will review any insurance denial for free. Never evaluate an insurance company denial on your own. What may seem like a bullet-proof denial to you, may really be simple to overcome.

As with most of my roof cases, if I win, the insurance company will be required to pay my fees and costs, and if I lose, I'll work for free.

Third Circuit Rules in Favor of Personal Injury Victim in ERISA Lien Case

Mark Nation — Fri, 25 Nov 2011 10:04:19 -0500

In US Airways, Inc. v. McCutchen, 2011 WL 5557411 (3rd Cir. Nov. 16, 2011), an ERISA plan sought reimbursement of 100% of what it had paid for medical bills for a car crash victim even though the victim had not been fully reimbursed because of limited liability coverage. The lawyers for the car crash victim claimed that the ERISA plan should reduce its claim pro rata for attorneys fees and costs. The ERISA plan administrators refused, and demanded reimbursement of 100% of what it had spent.

The ERISA plan eventually filed a lawsuit against the plan beneficiary seeking 100% reimbursement. The language of the plan states that the ERISA plan was entitled to reimbursement “for amounts paid for claims out of any monies recovered from a third party….”

Section 502(a)(3) of the ERISA Act allows an ERISA Plan to sue plan beneficiaries in cases like this, but they can only sue for “appropriate equitable relief.” The District Court determined that based on the Plan language that the ERISA Plan was entitled to 100% reimbursement. The District Court based its decision on the language of the Plan and refused to apply traditional equitable defenses to the Plan’s claims, such as the defenses of unjust enrichment and windfall. The plan beneficiary appealed to the 3rd Circuit.

The 3rd Circuit reversed. Citing the U.S. Supreme Court’s recent holding in Cigna Corp. v. Amara, ____ U.S. ____ (2011), the Court noted that an ERISA Plan’s ability to recover was statutorily limited to “appropriate equitable relief.” According to the Court, “appropriate equitable relief” required the District Court to apply defenses that are available in equity actions. The Court held:

Applying the traditional equitable principle of unjust enrichment, we conclude that the judgment requiring McCutchen to provide full reimbursement to U.S. Airways constitutes inappropriate and inequitable relief. Because the amount of the judgment exceeds the net amount of McCutchen’s third-party recovery, it leaves him with less than full payment for his emergency medical bills, thus undermining the entire purpose of the Plan. At the same time, it amounts to a windfall for U.S. Airways, which did not exercise its subrogation rights or contribute to the cost of obtaining the third-party recovery. Equity abhors a windfall.

Two important points need to be mentioned. First, the McCutchen Court specifically recognized that its holding conflicted with the 11th Circuit’s holding in Zurich American Ins. Co. v. O’Hara, 604 F.3d 1232 (11th Cit. 2010) which required 100% reimbursement from a tort victim. In rejecting the 11th Circuit’s reasoning, the 3rd stated:

While our sister circuits pay homage to this language, they appear to reason that its requirement has been met so long as the suit can be properly characterized as an equitable action, without also asking whether the relief sought in the action is “appropriate” under traditional equitable principles and doctrines. But the Supreme Court has rejected a permissive reading of this language that would mean “all relief available for breach of trust at common law” because “[t]he authority of courts to develop a ‘federal common law’ under ERISA is not the authority to revise the text of the statute.” Mertens, 508 U.S. at 258–59 (citation omitted). By categorically excluding the equitable limitations that § 502(a)(3)’s reference to equitable remedies necessarily contains, the Shank and O’Hara courts depart from the text of ERISA. See Knudson, 534 U.S. at 211 n. 1.

Moreover, as the Supreme Court recently demonstrated in Cigna, the importance of the written benefit plan is not inviolable, but is subject—based upon equitable doctrines and principles—to modification and, indeed, even equitable reformation under § 502(a)(3). 131 S.Ct. at 1879 (finding that the District Court’s “reformation of the terms of the plan, in order to remedy the false or misleading information CIGNA provided .... [was within] a traditional power of an equity court”). While the basis for the reformation in Cigna was intentional misrepresentations by the employer and fiduciary, the broader and more relevant point is that when courts were sitting in equity in the days of the divided bench (or even when they apply equitable principles today) contractual language was not as sacrosanct as it is normally considered to be when applying breach of contract principles at common law. We do not suggest that U.S. Airways’ conduct was fraudulent or dishonest in the way that Cigna’s was, but equitable principles can apply even where no one has committed a wrong.

Second, the plan language in the O’Hara case specifically stated that the Plan would not reduce its claim by its pro rata portion of attorneys fees and costs. Whereas, the McCutchen Plan language did not specifically address fees and costs, but only stated that the Plan was entitled to be reimbursed out of “any monies recovered.” Thus, depending on the language of the ERISA Plan, a court could still follow the 3rd Circuit while still bound by the 11th Circuit’s holding.

However, in truth, such a distinction is not really intellectually honest. In reality, the 3rd and the 11th Circuits have addressed this important issue in two divergent ways. The 11th Circuit has thus far said that courts must follow the specific plan language; while the 3rd Circuit has said that the plan language is tempered by traditional equitable defenses.

Hopefully, the Supreme Court’s holding in Cigna v. Amara coupled with the 3rd Circuit’s decision in McCutchen will cause the 11th Circuit to revisit its decision in O’Hara.

Lawsuit Filed Against Homeowners Insurance Company for Deficient Sinkhole Remediation Plan

Mark Nation — Tue, 22 Nov 2011 19:01:10 -0500

After back-to-back trials which ended last week, I've been quite busy meeting with new clients. In this case, my client's homeowners insurance company confirmed that his house was suffering from damage from sinkhole activity. The insurance company hired an engineering firm to prepare a sinkhole remediation plan. On its face, the remediation plan appeared deficient.

I sent the insurance company's remediation plan to a geotechnical engineer for review. The review confirmed that the insurance company's remediation plan was indeed deficient. It failed to include sufficient grouting and failed to utilize underpinning.

Today, I filed a lawsuit against my client's homeowners insurance company in order to force the insurance company to pay for an appropriate remediation plan.

As with most of my insurance cases, if I win, the insurance company will be required to pay for my hourly fees and costs, and if I lose, I'll work for free.

Lawsuit Filed for "Collapse" Damage

Mark Nation — Tue, 22 Nov 2011 16:43:30 -0500

My client owns a business which operates out of a wooden building which was built in 1956. Recently, upon arriving at the business, my client noticed that ceiling was sagging. Upon further inspection, it was determined that one of the wood trusses had cracked. The one cracked truss, has now led to another cracked truss. Because of the problem, the building is uninhabitable.

My client reported the claim to his property insurer. The property insurer summarily rejected the claim, alleging that the cracked truss was due to old age, and poor construction.

Today, I filed a lawsuit against the property insurer under the collapse coverage. The collapse coverage contained in most policies is quite broad and allows recovery if there is a sudden falling down or caving in or a building or any part of a building. The cracking of the truss was sudden, and certainly constitutes a "part of a building."

As with most of my insurance cases, if I win, the insurance company will be responsible for my fees and costs, and if I lose, I'll work for free.

Lawsuit Filed For Short Term Disability Benefits

Mark Nation — Tue, 22 Nov 2011 07:16:40 -0500

My client took out a short term disability policy in December of 2010. He then suffered a stroke in May of this year. His short term disability carrier denied the claim, asserting that the stroke was a preexisting condition.

You won’t be surprised to hear that I filed a lawsuit against the STD carrier for breach of contract. I can’t wait to see how they prove that a stroke that occurred in May 2011, preexisted an insurance policy taken out in December 2010.

As with most of my insurance cases, if I am successful, the insurance company will be required to pay my hourly fees and costs, and if I lose, I’ll work for free.

Lawsuit filed Against Homeowners Insurer for Improper Sinkhole Repair Technique

Mark Nation — Tue, 22 Nov 2011 07:08:26 -0500

My client’s homeowners insurance company has confirmed that a sinkhole is damaging his home. Additionally, several of his surrounding neighbors have sustained significant sinkhole damage. The insurance company retained an engineering firm to come up with a sinkhole remediation plan. The plan suggested by the insurer’s engineering firm is inadequate in two very significant respects.

First, it does not take into account that the sinkhole is not simply under my client’s home. The sinkhole is under several homes, including my client’s next-door-neighbor who has a huge void under their home. This sinkhole is huge and will take a lot of grout to remediation. A lot more than what the insurance company recommended.

Second, the proposed sinkhole remediation plan does not incorporate underpinning which will be absolutely necessary given the characteristics of this particular sinkhole.

Additionally, the insurance company has refused to pay for living expenses that my client has incurred because the house is unlivable.

Yesterday, I filed a lawsuit against my client’s homeowners insurance company. There are two claims in the lawsuit. In Count 1, I am asking that the court declare that the insurance company’s sinkhole remediation plan is inadequate. In Count 2, I am asking that the insurance company be forced to pay for the correct type of remediation plan, and pay for the additional living expenses my client has already incurred.

As with most of my insurance cases, if I am successful, the insurance company will be required to pay my hourly fees and costs, and if I lose, I’ll work for free.

Successful Trial on Homeowners Case

Mark Nation — Tue, 22 Nov 2011 07:01:26 -0500

My clients sustained lightning damage to electrical items in their home. A few weeks later, someone stole their truck from their driveway and torched it. The truck contained a significant amount of Ham Radio equipment as well as other items. They filed claims with Allstate, their homeowners insurance company, for the lightning damage, and also for the stolen/burned items from the truck. (Yes, most homeowners policies cover items stolen from your car).

Because of the amount of electronics and radio equipment involved, as well as what Allstate claimed were other irregularities, Allstate put its Special Investigations Unit on the claims. Prior to us becoming involved, Allstate took 3 recorded statements from our client, and received photographs and documents that supported the claim. Then Allstate set my clients for an Examination Under Oath. At that time we were retained.

Allstate claimed that it had requested our clients to fill out a Sworn Statement in Proof of Loss prior to them retaining us. After we were hired, we requested blank POL forms to fill out, as well as a copy of the policy. Neither was provided to us.

Our clients sat for their EUO’s. The day after the EUO’s were completed, we wrote a letter to Allstate asking if they needed anything else in order to evaluate the claim. They did not respond to that letter. So, we waited, and waited, and waited. Ninety-two days after their EUO’s with no word from the insurer we filed suit.

Allstate defended by claiming that the insureds had failed to timely file a sworn statement in proof of loss, and that the insureds had committed fraud in the presentation of the claim.

The case went to a jury trial in October. We won.

Just prior to the case going to the jury, the judge dismissed Allstate’s claims of fraud. The jury then determined that while the insureds did not file the POL forms, Allstate was not prejudiced by that failure. In other words, Allstate had all the information it needed to evaluate the claim.

I want to thank our fantastic clients who would not back down.

Because we were successful, Allstate will be required to pay all of our fees and costs incurred in prosecuting the case.

Lawsuit Filed for Insurance Company Refusing to Pay the Right Amount for Water Damage

Mark Nation — Wed, 19 Oct 2011 06:17:28 -0500

One of the most common types of homeowners claims is for water damage. And, one of the most common types of claim denials or underpayments I see is for water losses.

In many cases, the insurance company will deny the claim and assert that it is not covered, or will low ball the damage. Typical illegal denials include where the insurance company says that the water loss is due to wear and tear, or improper maintenance, or that the leak was caused by a plumber. These are covered losses under your policy, although the insurance company may tell you otherwise.

Yesterday, I was retained by a homeowner who had a water leak. The estimate for repairs was around $32,000. The insurer agreed that the loss was covered, but then low balled the damage at $13,000. The adjuster told my client that was all he was going to pay "no matter what." Upon hearing this, most people go away. I'm sure that is what the adjuster was hoping.

Instead, I filed a a breach of contract lawsuit against the insurance company. If I win, the insurance company will be required to pay my fees and costs, and if I lose, I'll work for free.

Please know that I promise to look at any insurance denial for free. Even if you think there is no way to overturn the denial; even if the insurance company has an engineering report against you; even if you think the insurance company is right...let me look at that denial for free.

Fighting the good fight.

Lawsuit Filed Against Homeowners Insurer for Failing to Pay for Roof Damage

Mark Nation — Wed, 19 Oct 2011 06:02:01 -0500

My client's slate roof was damaged by wind in a severe March 30, 2011 unnamed storm. I have many, many roof cases arising from this severe wind event. Several tiles were blown off during the storm. Thankfully, there is no leaking yet. Nor, does there have to be in order to force your insurance company to replace your roof.

My client submitted the claim to his homeowners insurer. His insurance company sent out an engineer who wrote an extensive report which concluded that the roof was not damaged in the storm, but instead needed to be replaced because it was old. I am convinced that in many of these cases the insurance company gets the report it wants and hopes the homeowner just goes away. Sadly, many do. This one did not.

Yesterday, I filed a breach of contract suit against my client's homeowners insurer. I've probably handled over 1,000 of these roof cases over the past 21 years. This is actually one of the easier ones.

What is most disconcerting is that I know that most homeowners just go away after receiving an engineering report from the insurance company. That is why I promise to look at any insurance denial for free!

Further, in most of my insurance cases, if I win the insurance company has to pay my fees and costs, and if I lose, I'll work for free!

Do not go it alone. Every insurance case I've won has one thing in common. The insurance company refused to pay. Most of the time, there is an extensive engineering or other expert report explaining why the insurance company doesn't owe anything. That denial letter is not the end of the inquiry, it is just the beginning.

Claim Filed Against Homeowners Insurer for Extensive Water Damage to Home

Mark Nation — Thu, 06 Oct 2011 15:35:32 -0500

My client was having her roof replaced in July of this year. Unfortunately, during the tear off process, the roofers left the roof open when they finished working for the day. As you can imagine, there was a large storm that evening. My client's home was inundated with water. Her ceilings caved in, and her walls, carpets and other items throughout the house were destroyed. Additionally, she hasn't been able to live in the house since July, and her pets have had to be boarded at a kennel since July.

Hoping to take care of this on her own, she submitted the claim to her homeowners insurance company the day of the loss. Since then, she has received one letter from the insurance company acknowledging the claim, and nothing else.

Out of frustration, she finally decided to get some help and ended up in my office this morning.

These types of losses are covered under most standard Florida homeowners insurance policies. Yes, even the pet boarding.

If you are getting nowhere with your insurance company, whether its homeowners, business owners, life, health, or disability insurance, we can help. I will look at any insurance denial (or delay) for free!

Insurance Lawsuit Filed for Homeowner Due to Hail Damage to Her Roof

Mark Nation — Thu, 06 Oct 2011 15:18:45 -0500

My client purchased a standard Florida homeowners insurance policy when she bought her home in 2006. At the time of the purchase her mortgage company required a home inspection. The home inspection revealed that the roof was in good shape with no noticeable damage. In 2010, she noticed that several of her neighbors were having their roofs replaced at the same time. She asked one of the roofers performing the work to inspect her roof. The roofer found that her roof had substantial hail damage.

Although she does not know when the hail storm occurred, we know it was after she purchased the home, and that she had the same insurance company the entire time she has owned the home.

She reported the claim to her homeowners insurance company which sent an inspector out to look at the roof. The insurance company's inspector determined that there was no hail damage. (An inspection of the roof reveals that there is indeed hail damage.)

Today, I filed a lawsuit against her homeowners insurance company to require them to replace my client's roof. I have been successful on claims like this even when we cannot pinpoint exactly when the storm occurred. However, in this case, I suspect I will be able to determine when the storm occurred from either a neighbor, or retaining the services of a forensic meteorologist. I routinely utilize the services of a forensic meteorologist to determine when a home or business has been hit by hail or strong winds.

Although my client's roof is almost 20 years old, there is no such thing as "pro-rating" a roof. Most homeowners policies in Florida are for "replacement cost." Thus, if the roof is storm damage and needs to be replaced then the insurance company owes to replace the entire roof with no deductions for age.

I always front all the costs involved in cases like this, and if I am successful, the insurance company will have to pay my fees and costs, and if I lose, I'll work for free.

Also, please remember that I will look at any insurance denial for free!

Attended Another Sinkhole Neutral Evaluation Today

Mark Nation — Tue, 04 Oct 2011 17:28:20 -0500

My client's homeowner's insurer retained the services of a geotechnical engineering firm and geologist to perform a sinkhole investigation at my client's home. The insurance company's engineers and geologist wrote a report concluding that there was no sinkhole activity at the insured's home. However, while the engineering/geologist's report concludes that there is no sinkhole activity, the data in the report proves that there is a sinkhole. Plus, the report seems to omit some very important information that one would expect to be in a statutorily compliant sinkhole investigative report.

Unfortunately, insureds are not capable of reading and understanding the finer points of a sinkhole investigation report. Once I received the report, we filed a lawsuit against the homeowners insurer for improperly denying the existence of a sinkhole. Immediately upon receiving the lawsuit, the insurance company demanded "neutral evaluation."

The neutral evaluation took place today at the insured's home. It seems the the neutral evaluator picked up on many of the issues which I had previously spotted in the insurance company's report. One thing the neutral evaluator mentioned is that he may require more testing before he issues a final report. Hopefully, he will ultimately find that this home is indeed suffering damage from sinkhole activity. However, even if the neutral evaluator finds against us this lawsuit will proceed.

There are two things I'd like you to take from this post:

1) If you suspect potential sinkhole activity is damaging your home or business, DO NOT drop the claim simply because the insurance company's "experts" conclude there is no sinkhole activity. EVERY SINKHOLE CASE I'VE EVER WON HAS AN INSURANCE COMPANY EXPERT REPORT DENYING SINKHOLE ACTIVITY. I will look at any insurance denial for free!

2) DO NOT request neutral evaluation. If you do, and the evaluator finds against you, the insurance company will want to explain to the jury how you picked neutral evaluation, and how you picked the neutral evaluator. This can be quite damaging in any claim that we later file on your behalf.

Attorneys Fees Against FIGA

Mark Nation — Tue, 04 Oct 2011 16:59:46 -0500

I learned many years ago the problem with getting your attorneys fees from FIGA. I won a case against an insurer and was awarded a sizeable attorneys fee after a fee hearing. The day after the fee order was entered the insurance company went under. They were ultimately taken over by the Florida Insurance Guaranty Association - FIGA. While FIGA was required to pay my client's claim for the damage to her home, it was not required to pay my fees. My fees were simply an unsecured claim against the assets of the insolvent insurer to be paid once they sold their desks, phones, filing cabinets and unused paper clips. I was never paid.

Pursuant to Florida Statute Section 631.70, FIGA is not responsible for an insured's attorneys fees or costs "except when the association denies by affirmative action, other than delay, a covered claim or a portion thereof."

In Florida Insurance Guaranty Association v. Messina, ____ So.3d ____ (Fla. 4th DCA August 24, 2011), the insured sued FIGA, and FIGA filed an answer and affirmative defenses denying coverage. Soon thereafter, FIGA settled the claim, but denied that the insured's attorney was entitled to fees and costs. According to FIGA it had not denied the claim by "affirmative action" because it "did not really contest coverage." The Court disagreed, and held that FIGA's answer and affirmative defenses denying coverage constituted denying the claim by "affirmative action." Go figure.

Insured Homeowner Sues Sinkhole Engineers

Mark Nation — Tue, 04 Oct 2011 14:59:12 -0500

In Alderman v. BCI Engineers & Scientists, Inc., ____ So.3d ____ (Fla. 2^nd DCA Sept. 2, 2011), the insured homeowner hired BCI Engineers & Scientists, Inc. (BCI) to 1) perform a subsurface sinkhole investigation; and 2) supervise the remediation of the sinkhole activity. The insured also filed a claim with State Farm, his homeowner’s insurance company, for losses due to sinkhole. State Farm agreed to pay the sinkhole claim, and the remediation commenced. Some time during the process, the insured entered into a settlement agreement with State Farm releasing State Farm and any of its “contractors” and “privies” from any claims “in relation to the filing of insurance claims.”

Unfortunately, the remediation went poorly, resulting in significant damage to the insured’s home. The homeowner brought suit against BCI for breach of contract and negligence.

BCI moved for summary judgment alleging the release with State Farm applied to it, and that the insured had failed to prove that BCI have violated any applicable standard of care. The trial court granted BCI’s motion for summary judgment and threw the case out of court. The homeowner appealed.

The 2^nd DCA reversed. BCI’s argued that the release applied to it because it was “contracted” with State Farm during the remediation phase. In point of fact, State Farm had “approved” BCI’s budget. But, the Court determined that this approval did not make it one of State Farm’s contractors. Therefore, the release did not apply to it. The Court also pointed out that the release didn’t apply to BCI because BCI’s contract with the homeowner was not “in relation to the filing of insurance claims.”

The Court went on to hold that the homeowner had provided expert testimony from a geotechnical engineer that BCI had indeed failed to meet the applicable standard of care.

Declaratory Judgment Action For Coverage

Mark Nation — Thu, 22 Sep 2011 08:21:13 -0500

My client bought liability insurance for his business. When he presented a claim, his insurance company denied the claim and has voided the policy for what it says were "material misrepresentations" on the application for insurance.

Specifically, the insurer says that my client misrepresented that he renovated hotel rooms and that he subbed out much of the work. According to the insurance company, my client only advised them that he performed "demolition" work. If what the insurance company said is true, then it probably properly denied the claim and voided the policy. However, they are wrong.

Like almost all applications for business liability coverage, the application which my client filled out contains a place for the insurance agent to insert a business "classification code." The classification code is a number which corresponds with a certain type of business operations. The business classification code on my client's application related to demolition and subcontracting the renovation of buildings - precisely what he does for a living. Therefore, the very application which the insurance company is relying on, proves that the insurer is wrong.

The insurance company filed a declaratory judgment action against my client seeking a judicial determination that it can void the policy for this "material misrepresentation." I am defending the dec action claiming that there was no misrepresentation at all.

As with most of my insurance cases, if I win, the insurance company will have to pay my fees and costs; and if I lose, I'll work for free.

Another Lawsuit Filed For Roof Damage Due to March 30, 2011 Storm

Mark Nation — Thu, 22 Sep 2011 06:28:20 -0500

On March 30, 2011 a severe unnamed storm hit Central Florida with high winds, rain and hail. Since then I have filed at least 20 lawsuits against various homeowners insurers for wrongly denying roof damage claims. Most of those cases were immediately settled by the insurance company as soon as they received the lawsuits.

Yesterday, I settled another one, and filed another lawsuit on a new one. In most of these cases, the insurance company has hired a roof consultant or an engineer to say that the roof is old and has no wind damage. In each of the cases, I have been able to document that the roof was fine before the March 30 storm and sustained severe wind damage as a result of the storm.

The team I assemble in these cases typically includes a qualified roofer, an engineer, and a forensic meteorologist.

In almost all of my roof cases, the insurance company is required to pay my fees and costs if I win, and if I lose I work for free.

Lawsuit Filed Against State Farm Florida for Wind Damage to a Roof

Mark Nation — Wed, 17 Aug 2011 16:52:31 -0500

My client's home is insured by State Farm Florida. On July 1, 2010, there was a significant wind event in east Orange County, Florida. My client submitted the claim to his homeowners insurer. The homeowners insurer hired an engineering firm to inspect the house. The engineers hired by the insurance company wrote a report that there was no wind damage on the roof, and that any problems with the roof were due to the fact that the roof was over 20 years old.

However, prior to the July 1 storm the roof was not leaking and was otherwise functioning fine. The roof has substantial wind damage. (Such damage is relatively easy to see. For an article I wrote on how to determine if a roof has wind damage click here http://www.floridainsuranceblog.com/articles/insurance-coverage-homeowners/roof-claims/ The article also has a video showing a roof inspection, and how to prove wind damage to a shingle roof.)

In many homeowners claims, an insurance company will hire engineering firms to write them a report. Often those reports are quite favorable to the insurance company. If this happens to you DO NOT get discouraged. The fact that an engineering firm says that there is no wind damage, or no sinkhole damage, etc is not the end of the inquiry, IT IS JUST THE BEGINNING. Essentially, every insurance case I've ever won started with a denial letter.

My deal with people is simple: Never evaluate an insurance denial on your own. I will look at any insurance denial for free. If the insurer is correct I will let you know, and if they are wrong I will let you know that also.

In this case, because of the refusal to pay for the wind damage, I filed a lawsuit today for breach of the insurance policy.

As with most of my insurance claims, if I win this case the insurance company will have to pay my fees and costs, and if I lose, I'll work for free.