My client was injured at work.  Her employer totally controverted the claim.  Because the claim was denied, she sought medical care under her employer sponsored HMO policy. 

Eventually, she and her workers compensation lawyer settled the work comp case as a totally controverted claim.  The HMO sought reimbursement of its alleged lien out of the work comp settlement.  Her work comp lawyer asked the carrier to waive its lien, and the HMO carrier refused.

I filed a declaratory judgment action seeking a declaration that there is no lien based on two grounds: 1) work comp proceeds are statutorily exempt from all claims of creditors; and 2) HMO reimbursements are a creature of statute, and the applicable statute only allows HMO's to be reimbursed out of recoveries from "tortfeasors."

Even though this was an employer sponsored plan, this is not controlled by ERISA. Even if it were controlled by ERISA, the HMO reimbursement statute is "saved" from ERISA preemption.
 

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Our client bought car insurance from Nationwide.  A few years later, Nationwide transferred the insurance to Allied insurance, a subsidiary of Nationwide.  Later, our client was injured in an automobile accident caused by an underinsured motorist.  Allied has stated that there is only $10,000 in UM available under the Allied policy.  Our client has $100,000 in bodily injury liability limits.  The law provides that an insurer can offer UM limits at a level lower than the bodily injury limits, if the insurer obtains a written request for the lower UM limits. 

Allied states that our client's husband signed a request for lower UM limits when he bought the Nationwide policy.  However, Florida Statute Section 627.727 says that the "insurer" must obtain a written request for the lower limits.  Nationwide is not the "insurer" for this accident, and Allied does not possess a written request that it provide lower UM limits.  Allied steadfastly relies on the Nationwide UM selection form.

I filed suit today seeking a judicial declaration that Allied is required to provide our client with $100,000 in uninsured motorists limits.  If I am successful, Allied will have to pay our fees and costs, and if I lose, I'll work for free. 

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During these tough economic times, government has set in place many spending cuts. Now, due to federal spending cuts, the air squadron which performs hurricane research may have its operations budget cut by 40%. This air squadron has helped hurricane forecasters more accurately track storms over the last decade

While the budget cut proposal is many months away from becoming a reality, a red flag has been raised with top forecasters. They worry that reduced flights or hours for the planes they used to track hurricanes will stall their efforts to better computer forecast models.

Apart from the short-term effect of lowering operating costs, those cuts may lead to high long-term costs. Improved forecasts can help save lives and money. The money would be saved because improved forecasts would help communities more effectively conduct evacuations. Luckily, these proposed cuts would not affect the daily flights into active tropical storms. However, these planes are not equipped to conduct the research done by the Hurricane Hunters.

These researchers are rightfully concerned about the potential long term costs of the loss of this valuable research. This research is vital because it helps us all better understand the nature of hurricanes. In turn, the public is better able to prepare for the impending landfall of these storm systems.

At this point in the hurricane season, forecasters predict that tropical activity is going to increase. Accordingly, make sure you have plans in place for your property and family as we will begin to see more tropical storms and hurricanes in the coming months.

On this blog we have posted several articles discussing useful tips on preparing for hurricane season. Our Miami Hurricane Dispute Lawyers are also prepared to assist you with any hurricane damage claim you may have against your insurance company.

About the Author - Gabriel de las Salas is an attorney with the law firm of Alvarez & Barbara, LLP. His practice is focused on general civil and commercial litigation, including personal injury, insurance claims and real estate disputes. Mr. de las Salas received his B.A., cum laude, from the University of Florida, and his J.D., from Stetson University College of Law.

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Channel 10 News in Tampa is the latest to report on the ongoing saga involving the federal flood insurance program.

As our Miami insurance dispute attorneys reported on our Florida Insurance Claim Blog, Congress has extended the program in fits and starts, often just a few months at a time. When the program is unavailable, it causes huge headaches for homebuyers, who cannot qualify for a mortgage without flood insurance.

Further complicating the matter, are new FEMA maps that have been decried as inaccurate and frequently require flood insurance of homeowners in areas with no history and little real threat of flooding.

While South Florida Congresswoman Ileana Ros-Letinen is among the supporters of the program, it has come under heavy fire for questionable payouts. Additionally, about 1 million policies are riskier than their premiums would suggest, leaving taxpayers to foot the remainder of the bill.

FEMA records show about 20,000 properties have collected on claims in excess of their value -- sometimes far in excess of their value. Channel 10 reports on a $153,000 Alabama home that has received more than $2 million in claims.

Others are receiving discounts for rental or vacation properties. In Longboat Key, a wealthy resort area near Sarasota, a direct hit from a hurricane could cause an estimated $13 billion in damages, yet nearly half (48 percent) of homeowners receive discounts because the homes are not their primary residences.

In other cases, homeowners file claims storm after storm for recurring damage to the same poorly situated and vulnerable property. Pinellas County has reported $72 million in repetitive claims; Pasco County has had $32 million. Statewide, more than $1.3 trillion in repetitive claims have been paid out.

Currently the flood insurance program is $19 billion in the red.

From a practical standpoint, the issues with the flood insurance program can make it more difficult for a homeowner to file a legitimate claim; may increase the risk of a denial; and can subject legitimate claims to excessive wait times. Consulting a storm damage attorney in South Florida is often your best bet when dealing with a substantial insurance claim.

If you are facing a dispute over an insurance claim in Florida, contact Alvarez & Barbara, LLP toll free at 866-518-2913 for a free and confidential consultation to discuss your rights.

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Spent the day yesterday in beautiful Bartow taking the deposition of the Geotechnical Engineer who performed sinkhole testing on my client's home on behalf of her homeowners insurance company. 

Often homeowners will find cracking in the walls of their home, and/or the foundation. Or, they will find the foundation separating from the walls. Contrary to what your homeowners insurance company may tell you, your homeowners insurer is responsible for all this damage unless your insurance company can exclude sinkhole as a potential cause. The burden of proof is on your insurance company (not you) to prove that sinkhole is not a potential cause of the damage. If your insurance company can't exclude sinkhole as a cause then your insurer is responsible for the damage.

In order to exclude sinkhole, the insurance company will frequently hire a geotechnical engineering firm to perform testing at your home. The insurance company's engineers may then write a report that there is no evidence of sinkhole activity although the test findings actually show that there is sinkhole activity. If you know what to look for, there are simple things to look at to determine if the testing actually revealed sinkhole activity.

If your insurance company has denied your sinkhole claim, do not give up. I will look at any sinkhole denial for free. In order to determine if you have sustained sinkhole damage I will often retain a geotechnical engineer to inspect your home to determine if there is indeed sinkhole damage.

I handle sinkhole cases throughout the State of Florida. In these types of cases my client owes me nothing out-of-pocket. In most of my insurance cases, if I win, the insurance company must typically pay my fees and costs, and if I lose, I'll work for free.
 

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My client suffers from a couple of different debilitating medical conditions.  He purchased an AFLAC policy at work, which was supposed to pay him when he was off work as a result of illness or injury.  The maximum benefit was for 6 months, at which point AFLAC would not pay anymore for that particular medical problem until he had returned to work for a certain time.  My client was off work for 6 months, and then went back to work.  Shortly thereafter, before the "return to work period" had expired, he had to go back off work for another medical problem. 

AFLAC refused to pay, claiming that this was the same medical problem that they had previously paid for and that my client had not been back at work long enough to qualify for additional benefits for that medical problem.  The medical evidence shows that although the new medical condition was to the same area of the body, it was a different medical condition.  Accordingly, my client would be entitled to recover up to another 6 months of disability insurance benefits. 

On Monday, I filed a lawsuit against AFLAC for breach of contract.  As with most of my insurance cases, if I win this lawsuit, the insurance company will be required to pay all of my fees and costs, and if I lose, I will work for free. 

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My book Claim Denied is now available.   You can download or order a free copy by clicking here.
 

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According to the Colorado State University's Tropical Meteorlogy Project, we should get ready for a less hectic hurricane season this year due as opposed to years past.

They predict that the 2012 hurricane season will be less active than normal. They also predict that this hurricane season will be close to half as active as last year. Last year we saw 19 named storms. Of those storms, 7 of them turned into hurricanes, and 3 of them turned in major hurricanes measured at Cat 3 or stronger.

However, forecasters Philip Klotzbach and William Gray predict the 2012 season, which begins June 1, will have 4 hurricanes, compared with an average of 6.5 hurricanes between 1981 and 2010, and 10 named storms, compared with an average of 12.

The forecasting duo credit a combination of cooler than normal sea surface temperatures in the tropical Atlantic Ocean and an expected return to El Nino warmer than normal surface water conditions in the eastern and central Pacific Ocean for the reduced tropical storm activity.

Although Florida was again spared in the busy 2012 season, one should not their guard down.

Forecasters don't like to make landfall predictions, but they are able to say that certain areas may be more prone to being hit by a hurricane this year. South Florida, Texas, and the Carolinas are being pinpointed as areas where chances of landfall are greater.

It's certainly frightening to hear that South Florida is at great risk year to be struck by a hurricane, even if there are potentially less hurricanes in total this year. We've been spared over the last few years, but hurricanes are a fact of life in South Florida.

Although this often leads us to brush off hurricanes, it's important to be prepared.

One way of ensuring that you're prepared is to make sure to having everything in place to contact your insurance company in the event of a windstorm because all insureds have a duty to immediately notify an insurers of a loss. Whatever you do, and no matter how slight the damage, call your insurer if your home has been damaged by a windstorm.

However, there are times when immediate notice is still not enough because an insurer will treat their policyholder unfairly by wholly denying a valid claim or by not fully covering their insured's loss. Realizing that most people are unaware of their rights, insurers may take advantage of their policyholders.

If you ever find yourself in a situation where you believe that your insurance company is treating you unfairly, don't hesitate to contact Alvarez & Barbara, LLP. We have considerable experience dealing with insurance companies and working to make sure our clients get what they are owed.

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An annual insurance company gathering at Monte Carlo is funded by Florida's extensive spending on insurance and reinsurance. This expensive gathering is paid by the two thirds of property insurance premiums that now leave Florida as unregulated payments to largely offshore companies that sell hurricane protection to insurers and that operate without rate control or consumer oversight.

These unregulated companies determine how much Floridians must pay for property insurance, and whether property insurance is available at all in Florida.

Florida's increased reliance on this unregulated market is eroding the industry's ability to withstand the inevitable disaster that a major hurricane will inflict on Florida.

Meanwhile, Florida's insurance companies are pleading poverty today despite the fact that Florida has not been hit by a major hurricane in 5 years. This costly dependence on reinsurers will only hurt Florida especially since the reinsurers only play by the rules established on Wall Street and fail to play any role in insuring the risk here in Florida.

Indeed, former Gov. Jeb Bush set aside his free market ideology to conclude that Florida could not "be at the mercy of people who hope for catastrophes to keep their rates high" purely for profit and to the detriment of all Floridians.

This problem is highlighted by the fact that from 2004 to 2009, Florida carriers' reinsurance bill nearly tripled, from $1.4 billion a year to more than $4 billion.

The portion of homeowners' premium devoted to reinsurance in that time increased from 37 percent to 64 percent, according to an analysis conducted of 70 Florida-only property insurers. The national average is only 19 percent.

That in turn drove up the cost of coverage for all of Florida's homeowners. Quarterly premium reports show the average Florida homeowner pays 72 percent more today than in 2003. The average premium has nearly doubled or more in nine coastal counties.

And despite all of this, the State of Florida is nonetheless poised to aid these insurance companies to the detriment of Floridians across our great state.

Consider Your Options. Contact Us Today.

Before opening our law firm in 2006, our attorneys worked for some of the state's, and nation's, largest law firms, and worked representing the insurance companies for years. Our attorneys are now uniquely positioned to use that experience to assist individuals and businesses alike throughout Florida with their insurance claims. As a result, our attorneys are well versed in the impact insurance has on businesses, condominiums, and individuals alike. Our insurance litigation practice group is prepared to tackle your insurance claim.

Given our extensive experience litigating for, and against, insurance companies, our insurance litigation practice group is prepared to provide aggressive, efficient and effective representation on a broad spectrum of insurance claims in Florida for local, national, and international clients. We are prepared to advocate insurance claims at the pre-suit stage, trial, appellate and arbitration levels.

If you are facing a dispute over an insurance claim in Florida, contact Alvarez & Barbara, LLP for a free and confidential consultation to discuss your rights.

Call us today toll free at 1-866-518-2913 or at 305-263-7700.

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As of this morning, Tropical Storm Emily has maximum sustained winds at near 40 miles per hour. It is anticipated that its center will move across the northeastern Caribbean Sea today and approach the island of Hispaniola as early as tonight.

Emily is projected to head towards Cuba, the Bahamas, and possibly Florida.

Current conditions suggest that Tropical Storm Emily could intensify and strengthened over the course of the next 48 hours. It is not anticipated to approach Florida until the weekend, but by the time does it could be as strong as a hurricane.

Emily Could Strengthen to a Category 1 Hurricane

Forecasters are predicting that Tropical Storm Emily could grow into a Category 1 hurricane, with winds of at least 74 miles per hour according to the Saffir-Simpson Hurricane Wind Scale.

A category 1 hurricane is defined as having sustained winds between 74-95 mph. It is a dangerous storm and its winds will produce damage.

Time to Prepare

Our Miami Insurance Dispute Lawyers would like to remind you that now is the time to prepare for Emily's potential arrival later in South Florida later this week.

On this blog we have posted several articles discussing useful tips on preparing for hurricane season. We encourage you to read them, and, more importantly, we encourage you to prepare for the storm's potential arrival.

Consider Your Options. Contact Us Today.

Before opening our law firm in 2006, our attorneys worked for some of the state's, and nation's, largest law firms, and worked representing the insurance companies for years. Our attorneys are now uniquely positioned to use that experience to assist individuals and businesses alike throughout Florida with their insurance claims. As a result, our attorneys are well versed in the impact insurance has on businesses, condominiums, and individuals alike. Our insurance litigation practice group is prepared to tackle your insurance claim.

Given our extensive experience litigating for, and against, insurance companies, our insurance litigation practice group is prepared to provide aggressive, efficient and effective representation on a broad spectrum of insurance claims in Florida for local, national, and international clients. We are prepared to advocate insurance claims at the pre-suit stage, trial, appellate and arbitration levels.

If you are facing a dispute over an insurance claim in Florida, contact Alvarez & Barbara, LLP, for a free and confidential consultation to discuss your rights.

Call us today toll free at 1-866-518-2913 or at 305-263-7700.

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The...

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