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Tropical Storm Hermine | A Quick Reference Compliance Guide to Adjusting Storm Related Claims in Florida

September 3, 2016

By Anaysa Gallardo Stutzman and Christine Renella

  • Once a wind storm is named as a hurricane by the National Weather Service, and a warning or watch for any part of Florida is issued, all wind losses in the state from that time until 72 hours after the last warning or watch for the state has ended are treated as hurricane losses - and the hurricane deductible and all hurricane requirements are applied. § 627.4025(2).
  • Provide necessary claim forms and instructions, including an appropriate telephone number to the insured at the outset of a claim. § 627.70131(2).
  • Within 10 working days after receiving proof of loss statements, you must begin your investigation. § 627.70131(3).
  • Within 14 calendar days from receipt of a claim communication, the insurer shall review and acknowledge receipt of the communication. § 627.70131(1)(a).
  • Within 14 days after receipt of an initial communication, any insurer issuing a personal lines residential property policy must provide the policyholder with a Homeowner Claims Bill of Rights. § 627.7142.
  • Within 30 days after the insurer knew or should have known of a defense, issue a reservation of rights to the insured by certified mail. § 627.426(2).
  • Within 30 days of any written request after the policyholder has submitted a complete proof of loss statement, the insurer shall provide confirmation that the claim is covered in full, partially covered, denied, or shall provide a written statement that the claim is being investigated. § 627.7142
  • Within 90 days, pay or deny a claim or a portion thereof. § 627.70131(5)(a).
  • Within 20 days after settlement is agreed upon in writing, payment of that settlement must be made. § 627.4265.

Other Considerations 

  • Fla. Stat. 624.155 is clear, unambiguous, and creates a civil cause of action to "any person" who is injured as a result of an insurer's bad faith dealings.
  • Within 90 days after a loss, a policyholder must submit a written proof of loss to the insurer. § 627.612
  • A claim, supplemental claim, or reopened claim under an insurance policy that provides insurance for loss or damage caused by the peril of windstorm or hurricane is barred unless notice was given to the insurer in accordance with the terms of the policy within 3 years after the hurricane first made landfall or the windstorm caused the covered damage. § 627.70132
  • AOB Gotcha! - The Florida Supreme Court has recognized that provisions in insurance contracts requiring consent to assignment of the policy do not apply to assignment after the loss. An assignee has a judicially recognized right to sue on a breach of contract claim (arising from the scope of assignment) and as such steps into the shoes of the named insured for purposes of bringing a claim against and insurer for benefits assigned to the assignee.
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