Do Insurance Regulators Have Any Clue About the Impact Words Have Regarding Coverage?
The answer to this question is—in Florida, they do not or do not care.
The insurance journal reported that Florida’s Office of Insurance Regulation (OIR) approved a new roof coverage endorsement in Florida OIR Approves Roof Endorsements That Could Bar Non-Storm Claims. The endorsement reduces coverage and provides more reasons for denial of otherwise legitimate roof damage.
The alleged reason for the endorsement was to “combat insurance fraud.” The article quoted me questioning the basis the for the endorsement:
A plaintiffs’ attorney argued that Florida OIR should have challenged the endorsement because it will unfairly undercut legitimate claims.
‘The insurance regulator should have asked for examples of how this language combats insurance fraud,’ said Chip Merlin, a Tampa lawyer who represents policyholders. ‘Indeed, a good regulator would go back and ask both insurance companies for these examples about how, without this language, fraudsters were able to get roof claims paid.’
Hail may not show significant impact on shingles until later, after the initial damage loosens granules, exposing the material to deterioration, he said. ‘Most engineers, even those retained by insurers, will say this gradual loss is significant physical loss. However, insurers will point to the policy language to deny the claim,’ Merlin noted.
In the long run, the endorsements may see relatively few challenges in court, thanks to Senate Bill 2A, adopted in December, and House Bill 837, passed in March. Both of those make it more difficult for policyholders to hire plaintiffs’ attorneys, Merlin said.
‘Since the Florida Legislature just did away with policyholders being able to recoup the cost of attorneys fees, and the average roof replacement is $25,000 to $30,000, wrongful denials of otherwise valid and payable claims will go unchallenged because people cannot afford to hire attorneys and engineers to fight for coverage,’ Merlin said.
A response to a comment by an insurance agent to the article correctly stated:
The premium you pay is based on the materials at your property. If you have a tile roof, the carrier has ran the algos to see what the likelihood of you having a claim is and how much they may have to pay in that instance.
That means that, if you have a tile roof damage by a covered cause of loss, the carrier would have to pay you to replace that tile roof they insured.
What you’re suggesting is akin to driving a Ferrari, paying insurance for it, it gets totaled, & your insurance company pays you for a Kia. Doesn’t make any logical sense.
By the way, carriers are also pulling out of California. Not anywhere near as much litigation there as here based on the statistics, so what gives? Natural disasters affect their bottom line. Well, don’t be in the business of insurance then if you don’t want your bottom line affected when you’ve contracted with your clients to pay out.
Every consumer in the state is losing rights and getting nothing in return but increased premiums for significantly less coverage. Oh, and the carriers still aren’t paying. Just check the stats on how many open, denied, and underpaid Hurricane Ian claims remain. Actually, why don’t you check to see how many Hurricane Michael victims are still living in trailers on their properties because their houses were total losses and the carriers still haven’t paid them. It’s a joke.
Maybe our insurance regulators analyzing the proposed wording of insurance forms should study Bill Wilson’s book, When Words Collide: Resolving Insurance Coverage and Claims Disputes, and remember this case quote from it:
‘It seems that insurers generally are attempting to convince the customer when selling the policy that everything is covered and convince the court when a claim is made that nothing is covered. The miracle of it all is that the English language can be subjected to such abuse and still remain an instrument of communication.
But, until such time as courts generally grow weary of the task we have just experienced and strike down the entire practice, we feel that we must run with the pack and attempt to construe that which may well be impossible of construction.’ Universal Underwriters Insurance Company v. Travelers Insurance Co., 451 S.W. 2d 616, 622-23 (Ky. Ct. App. 1970)
We need better efforts from our Florida insurance regulators. Let’s hope they get the message.
Thought For The Day
Strength and growth come only through continuous effort and struggle.
—Napoleon Hill
