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Insurance Coverage Information
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When an insurance company declines to pay a claim or a bill, the policyholder may have legal remedies.
If an insurance company denies or delays payment of a claim filed under an insured’s (a person covered by the policy or who is entitled to benefits under the policy) insurance policy, the policyholder can hire an attorney to file a lawsuit against the insurance company to enforce the terms of the policy.
Some reasons for denial of payment -
HEALTH INSURANCE
Not a covered procedure or treatment
Preexisting condition
Misrepresentation, omission or concealment of fact or
incorrect statement on the application
Rescission or reformation because of post-claim underwriting
LIFE INSURANCE
Misrepresentation, omission or concealment of fact or
incorrect statement on the application
PROPERTY AND CASUALTY INSURANCE
Uncovered peril
The insurance company may have to pay for the policyholder’s attorney’s fees and costs if the lawsuit is successful
If the case is successful, the insurance company may have to pay:
The policyholder’s claim;
Interest on the claim; and
The policyholder's attorney’s fees and costs.
Legal basis for payment of attorney’s fees is Section 627.428(1), Florida Statutes:
Upon the rendition of a judgment or decree by any of the courts of this state against an insurer and in favor of any named . . . . insured or the named beneficiary under a policy or contract executed by the insurer, the trial court . . . shall adjudge or decree against the insurer and in favor of the insured or beneficiary a reasonable sum as fees or compensation for the insured's or beneficiary's attorney prosecuting the suit in which the recovery is had.
Statutory Interest
The insurance company may have to pay interest on the unpaid claim.
The legal basis for the payment of interest is Section 55.03, Florida Statutes. The interest rate is set by Florida’s Chief Financial Officer each year. The interest rate for 2008 is 11%. The interest rate has been between 6 and 11% per annum for last 10 years.
George Bedell, P.A.
2525 Park City Way Tampa, FL 33609
813-875-6100
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