Insurance Settlements

Florida’s Road to Recovery – What You Need to Know About Hurricane Insurance Claims 

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Hurricane Ian recently caused an estimated $25 billion – $40 billion in damages across the State of Florida, much of which is not fully protected by insurance. If your property has been damaged or destroyed as the result of this ferocious storm, the difficult and uncertain work of rebuilding now begins.

What do you do first? And how do you make sure you’re receiving every dime you deserve from your insurance company? 

It’s going to be a long road ahead but you’ll want these basics to start the process.

Immediately After the Storm:

Report the Damage

Instead of jumping straight into clean up and repair mode, it’s best to contact your insurance company before doing anything else. This allows your agent to advise you on a repair plan that adheres to the terms of your policy. Gather as much information as you can about your policy, including how much time you have to file a claim. It’s going to be a busy time!  Most insurers will advise that once you file a claim, you’ll likely wait a few days or even weeks before an adjuster contacts you to schedule an inspection. The earlier your claim is in, the better, as claims are prioritized by first-filed and most severe.

Make Temporary Repairs

After contacting your insurer, you should begin making temporary repairs to secure your property. This might include boarding up broken windows, placing tarps over holes in the roof, and/or drying out wet items to prevent mold. Take photos and video of all damage both inside and outside of your home or property before any clean-up or repair efforts are made. Keep receipts for materials used and keep a record of all repairs made. It is important to know that payments for temporary repairs come out of the total settlement amount of your claim, so now is not the time to make extensive or permanent repairs. Property insurance policies typically require that you make repairs to mitigate further loss.  BUT, you will not want to start those renovations before the insurer can conduct an inspection of the property.  It is critical that you wait until after meeting with your claims adjuster to begin final repairs.

If You Need to Relocate/Evacuate

If you are unable to live in your home due to the storm damage, your insurance policy may cover reasonable additional living expenses. These expenses can include hotel rooms, gas, meals and even clothing and other necessities. Be sure to keep records and receipts from all expenses you pay out-of-pocket while you are displaced. Sometimes insurance companies will advance the money to you but regardless, you will be required to provide proof of how the money was spent.

Filing a Claim

Once you’ve notified your insurance company of your claim, the insurer will assign and send out an adjuster to inspect your property.  Generally, an adjuster will inspect your property within 2-4 weeks. In the meantime, you will need to thoroughly document your losses and get ready for their visit.  And don’t forget, make emergency repairs and mitigate any further damages, if necessary, but do not complete unnecessary repairs before the insurer’s inspection takes place!

You will want to begin making a list of damaged items, along with specific product description information and estimated value, immediately. The more detailed the information you can provide, the smoother the process is likely to go. Again, take photos and/or video of all damage and do not throw anything away until the adjuster has seen it. During their visit, the adjuster will inspect the damage, take photos and measurements, and provide instructions on submitting receipts for emergency repairs and reimbursements. They should also go over the claims process and an itemized claim estimate with you. Be sure to ask any and all questions you have, and do not be afraid to contact them to follow-up.  

Obtain written estimates from licensed contractors on repair costs. You ALWAYS want at least one (preferably two or three) independent estimates, as insurance companies make their profits by delaying, denying, and/or low-balling claims.  Ensure the bids are detailed and include information such as materials to be used and prices on a line-by-line basis. Once you find a contractor and a bid you like, your adjuster will need to approve the cost. Never pay in advance of work being performed, and never sign your insurance check over to a contractor. 

Get Help from a Legal Professional

If you need help navigating the difficult maze of delayed or denied property insurance claims after Hurricane Ian, the Law Offices of Heather D. Lee may be able to assist you.  

Often, when a property insurance claim is denied, people turn to a public adjuster for help. However, most public adjusters charge contingent-fees similar to an attorney’s fees. And when your public adjuster cannot get a fair settlement of your claim? Well, they’ll leave you looking for an attorney to file a lawsuit. Don’t waste your time and valuable funds. Go directly to the assistance you need now.

The Life & Property Insurance Law Offices of Heather D. Lee provide free consultations on all potential cases.  As a Florida native, Attorney Lee knows how devastating the aftermath of hurricanes and other major storms can be. You don’t have to go through this nightmare alone.  We are here for you, Florida. 

#floridastrong

Attorney Heather D. Lee Admitted to U.S. District Court for the Eastern District of New York

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It is an honor and a privilege to announce the admission of Attorney Heather D. Lee to the U.S. District Court for the Eastern District of New York. Attorney Lee represents insureds and beneficiaries in pursuit of wrongfully delayed and denied life insurance claims, as well as homeowners, renters and other property insurance claims, life insurance beneficiary disputes and interpleader actions.

The Law Offices of Heather D. Lee serve clients in the States of New York, Florida, Pennsylvania, and Colorado. Attorney Lee looks forward to representing the firm and her clients in the Eastern District of New York. She is also admitted to practice in federal court in the Northern District of Florida and the Eastern District of Pennsylvania.

State Probes Into Wrongful Life Insurance Practices May Lead To Your Lost Policy

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The nation’s largest life insurance companies are feeling the heat as some states investigate wrongful insurance practices, particularly with respect to locating beneficiaries after an insured has died. In fact, it is estimated that tens of thousands of life insurance beneficiaries have been deprived of approximately $1 billion (or more) in unclaimed proceeds. Many of the life insurance companies currently under fire continue to claim that it is the sole responsibility of the beneficiary to notify the company of an insured’s death.

Life insurance beneficiaries often do not know a policy exists, however, and may not be in the best position to find out. Sometimes beneficiaries know about a loved one’s policy but do not know which life insurance company to contact and are unable to locate the policy documents.  Even worse, life insurance companies may mislead a beneficiary who does not have a copy of the policy and deter them from filing of a claim.  When thousands of policies go unclaimed every year, insurance companies just sit on the money.

But a life insurance company does not know when an insured has died, right? Wrong. State probes revealed that these companies have routinely checked the Social Security Administration’s ‘Death Master File’ for decades to discontinue annuity payments.  Until recently, life insurance companies never used the same source to notify beneficiaries of unclaimed policies.

In the past several months, multi-state settlement agreements have been reached with leading life insurance companies, including Prudential, John Hancock, and Metropolitan Life. The States of Pennsylvania, New Jersey, Colorado, New York, California, and Florida are among the leaders of these probes. As a condition of the agreements, participating life insurance companies will be required to improve their practices and make better attempts to locate the beneficiaries of unclaimed policies. The problem with locating past unpaid beneficiaries, though, remains.

The issue that state regulators are not addressing is the inability to locate older records of unpaid policies. Life insurance companies are only required to keep records of “terminated” policies for a certain period of years. Consider that when an insured dies and a life insurance company no longer receives premium payments, the policy will be treated as “terminated.”  Years later, because these policies are not properly held as unclaimed property, the records are destroyed, leaving the beneficiary responsible for proving the life insurance company’s liability. Of course, if the beneficiary had such proof, the claim would not have been delayed.

If you believe that an insurance company owes you money, speak to a life insurance attorney about your options right away.  The Life & Property Insurance Law Offices of Heather D. Lee can assist you in filing your life insurance claim, demanding that the company pay you immediately and with all applicable interest accrued as a result of the delay.  We work aggressively to collect wrongfully delayed and denied life insurance claims and do not charge any fees whatsoever unless we are successful.

Common Reasons For Delaying & Denying Life Insurance Claims

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At least 5,000 life insurance claims are denied in the United States every year, and even more policies go unclaimed.  People are usually surprised to discover that life insurance companies can delay or deny claims for many different reasons.  In fact, most people believe that when an insured passes away, the beneficiary receives a payout immediately.  Unfortunately, this is too often not the case.  Like most businesses, life insurance companies are motivated by profit, having a strong financial incentive to collect premiums but later deny as many life insurance claims as possible, or to delay claims as long as possible.

DELAYED LIFE INSURANCE CLAIMS

If a life insurance company has failed to promptly issue payment of your life insurance proceeds, you may have a claim for breach of contract and bad faith insurance practices.  Life insurance companies must investigate your claim within a reasonable period of time, usually within sixty (60) days of the claim being filed or in accordance with the life insurance policy terms.  An insurance company may attempt to discourage you from hiring a life insurance lawyer by wrongfully delaying your life insurance claim, offering a reduced settlement amount, or making other efforts to avoid paying the full claim.

Some common tactics that life insurance companies will use to wrongfully delay your claim include but are not limited to the following:

Insured’s Death Occurring Within Contestable Period
Hospital Records/Medical Documentation Not Yet Received
Hospital or Medical Provider Refuses to Release Records
Failure to Provide Income Tax Returns
Failure to Provide Non-existent Medical Documentation
Independent Investigation Based on Suspicious Cause of Death
Independent Medical Review to Dispute Evidence
Beneficiary Dispute Based On Divorce
Beneficiary Dispute Based On Suspicious Cause of Death

No matter how badly you need the insurance proceeds, you should never accept a settlement offer without the advice of an experienced life insurance attorney.  An offer to settle your claim for a reduced amount may indicate that the insurance company’s reason for delaying or denying your claim is illegitimate.

To discourage beneficiaries from pursuing a wrongfully denied life insurance claim, life insurance companies will mail complex denial letters designed to confuse you.  Life insurance companies know that you are likely unfamiliar with the life insurance contract itself, or with your rights as the beneficiary.
Some common tactics that insurance companies will use to wrongfully deny your claim include but are not limited to the following:
Policy Lapse Due to Nonpayment
Misrepresentations Regarding Age, Employment and/or Income
Failure to Disclose Immaterial Pre-Existing Medical Condition
Failure to Disclose Medical Appointments/Regular Check-Ups
Failure to Disclose Unknown/Unofficial Medical Diagnosis
Failure to Disclose Condition Requiring Future Treatment
Failure to Disclose Prior Alcohol, Drug, or Tobacco Use
Failure to Disclose Criminal History on Application for Insurance
Accidental Death Related to Independent Medical Condition
Accidental Death Actually Self-Inflicted
Accidental Death Caused by Alcohol/Drug Use or Crime
Accidental Death Not Occurring Within Specific Time/Date
Accidental Overdose Caused by Misuse of Medication
Policy Not Active Due to Death Occurring Prior to Effective Date
Policy Not Active Based on Period of Limited Activity Exclusion
Independent Investigation Based on Suspicious Cause of Death
Insufficient Evidence to Show Heart Attack
Independent Medical Examiner Disputes Evidence
Change In Health After Policy Lapse Due to Nonpayment
Change In Health Condition Prior to Effective Date of Insurance
Handwriting Expert Claims False Application Signature
Failure to Elect and/or Qualify for Employment Coverage
Failure to Convert Employment Coverage to Individual Policy
Insurance Company Not Responsible for Agency Errors
Insured Not Resident of United States on Date of Death
Failure to Properly Change Beneficiary
Policy Lapse Due to Depleted Cash Value
Many insurance companies have large legal departments prepared to defend denied life insurance claims, which can discourage a beneficiary from hiring a life insurance attorney, appealing a denied life insurance claim, or filing a law suit.
The Life & Property Insurance Law Offices of Heather D. Lee, Esquire are familiar with the various tactics used by life insurance companies to delay and deny claims, and we are experienced in pressuring insurance companies to quickly complete the claims process and pay all proceeds due under their life insurance policies.  If your insurance claim is being wrongfully delayed or denied, Contact Us for your free case evaluation today.

Don Cornelius’ Ex-Wife May Collect $300,000 In Life Insurance Benefits Despite Suicide

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The recent suicide of Don Cornelius and subsequent reports that his ex-wife, Viktoria Chapman Cornelius, is entitled to collect approximately $300,000 in life insurance benefits has caused a great deal of confusion.  Many of us wrongly assume that an act of suicide automatically precludes recovery against any life insurance policy.  In fact, no such “blanket” exclusion exists in life insurance law, and whether a beneficiary will collect life insurance proceeds following a suicide ultimately depends upon the terms of each policy.

On February 1, 2012, TMZ made a misleading report that Viktoria Chapman Cornelius has “score[d] huge life insurance payout” based on California law.  According to the TMZ Article, the ex-couple’s divorce decree provides that Viktoria was to remain beneficiary of two life insurance policies, and “[u]nder California law, if a policyholder commits suicide within [two] years of the time the policy is issued, the company can deny payment.”  TMZ prematurely concluded that because Don Cornelius took out the policy more than two years ago, Viktoria would undoubtedly collect the life insurance proceeds.  However, her right to the subject benefits cannot be confirmed without a thorough legal review of the life insurance contracts, and any reports based solely on “California law” are unfounded.

Typically, life insurance policies do expressly deny coverage for death by suicide, and such policies contain an exclusionary clause and often a definition of suicide.  For example, life insurance contracts may include a provision similar to the following: “If the insured, whether sane or insane, dies by suicide within two years from the date of the policy, no benefits are payable.”  These exclusions are generally recognized as valid.

An issue surrounding death by suicide arises, with or without an exclusionary clause, under Accidental Death & Dismemberment policies.  The concept of denying AD&D coverage for suicide is easier to understand because an intentional taking of one’s life can hardly be considered an accident.  In most cases, though, the life insurance company has the burden to prove that an insured’s death was committed with the requisite suicidal intent, and a mere intent to inflict pain which results in death will not be sufficient.  Indeed, numerous life insurance cases have involved an insured’s death caused by “erotic asphyxiation,” or the act of intentionally choking oneself or otherwise restricting oxygen to the brain for sexual gratification.  Under these circumstances, a self-inflicted death will not be considered an intentional suicide for the purposes of life insurance coverage.  Thus, while Viktoria Chapman Cornelius may collect the full $300,000 in benefits, additional information about the specific terms of Don Cornelius’ life insurance contracts is required to make a proper determination.

Don Cornelius was a pioneer whose enormous contribution to music, television, and popular culture will always be remembered and appreciated.  He is best known for his creation of “Soul Train” and its national exposure and tribute to decades of black artists and icons.  Don – wishing you eternal love, peace, and soul…

Feds Immune from Federal Employees’ Group Life Insurance Act (FEGLIA) Lawsuit for Loss of Beneficiary Designations

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In Graber v. Metropolitan Life Insurance Company, a lawsuit against the United States and Metropolitan Life Insurance Company to obtain the life insurance benefits of a deceased federal employee, a U.S. District Court in Ohio ruled yesterday that the federal government has sovereign immunity for the improper maintenance of life insurance beneficiary designation forms.  The dispute arose when Metropolitan Life Insurance Company denied a life insurance claim filed by the insured’s surviving spouse and subsequently issued payment of the benefits to the insured’s brother.  Met Life based its decision on the insured’s incomplete personnel file, which contained a form designating the brother as sole beneficiary in 1996 but lacked any record of the insured’s request in 2008 to change the beneficiary to her husband.

Under the Federal Employees’ Group Life Insurance Act, the United States has waived sovereign immunity for any “breach of legal duty owed.”  Although the federal government was responsible for maintaining the insured’s personnel file, the District Court’s holding that no duty exists to properly maintain FEGLI records precludes recovery, as the federal government has not unequivocally consented to be sued for the loss, misfiling, or misplacing of beneficiary designation forms.

Sound like a bunch of nonsensical legal mumbo jumbo?  Well, that’s debatable… even federal courts are somewhat split on the issue.  Prior to the Graber decision, the Fifth Circuit concluded in Metropolitan Life v. Atkins that the federal government does have the duty to properly maintain beneficiary designation forms in the care of its FEGLI personnel clerks.  Yet, other federal courts limit the United States’ duty under the Act to only negotiating and issuing the correct FEGLI life insurance policy.

The lesson to be taken away from this discussion is two-fold.  First, if you are a federal employee with group life insurance benefits, follow-up on any beneficiary designations to ensure that your personnel file accurately reflects your intentions.  And most importantly, always consult with a life insurance lawyer about your denied life insurance claim or beneficiary dispute.  Until the Supreme Court picks a side, every “designated” beneficiary deserves to make their case.

The full court opinions referenced in this post can be found here —–> Graber v. Metropolitan Life ; Metropolitan Life v. Atkins .

For additional information on how a life insurance lawyer can help you, visit www.life-insurancelawyer.com or Contact Us at (800)403-5710 to speak with an attorney about your case now.

Interim Coverage Granted For Insured Who Died Prior To Policy’s Effective Date

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If an insured passes away prior to a life insurance policy’s effective date but after the first premium payment, the insurance company will likely deny the beneficiary’s life insurance claim.  This makes sense to many of us, and to many state legislators, as the application for life insurance must generally be approved before an insurance company accepts the insurance risk.

In some states, though, temporary or interim coverage is recognized when insurance companies collect premiums on the application date but fail to clearly explain the delay in life insurance coverage.  In Pennsylvania, Heather D. Lee, Esquire recently won an administrative appeal after a major life insurance company denied a claim based on the alleged “inactive” status of a policy.  The insured, who suffered an unexpected heart attack less than one week before the policy’s “effective date,” was never properly notified of any delay in coverage even though the life insurance company eagerly accepted the first premium payment.  With the assistance of an experienced life insurance lawyer, the insured’s policy was reinstated and the claim properly reviewed and paid.

Under these circumstances, an insurance company is still entitled to conduct a standard review of the application upon reinstatement because the insured’s death will have occurred within two (2) years of the policy’s effective date.  For more information on how a life insurance attorney can help you with a similar or other life insurance denial, visit www.life-insurancelawyer.com or Contact Us at (800)403-5710 for a free claim evaluation.

Protecting Your Rights & Your Family

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At the Life & Property Insurance Law Offices of Heather D. Lee, PLLC, we assist insureds and their beneficiaries on delayed and denied life insurance claims, homeowners and renters insurance disputes, and other contract and consumer protection matters.  Our mission is to protect your rights and your family by ensuring that powerful insurance companies fulfill their legal and contractual obligations to you.

While the Life Insurance Law Bloggers are primarily focused on life and property insurance matters, it is our priority to provide helpful information regarding many areas of civil claims and consumer law.  The information on this site may not apply to your state, as insurance laws vary from state-to-state.  The Life & Property Insurance Law Offices of Heather D. Lee are located in Florida, New York, Pennsylvania, and Colorado.  The information on the Life & Property Insurance Lawyer Blog is NOT and should NOT be construed as legal advice.  The information contained in this website does not create an attorney-client relationship between any person who reads such information and Heather D. Lee, Esquire and/or the Life & Property Insurance Law Bloggers.

For your free case evaluation, Contact Us to speak with an experienced life and property insurance attorney about the details of your claim today.