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Insurance Company Accused of Conspiring with Adjuster Firms to Deny Roof Damage Claims

Insurance policies can be very difficult to understand. They are full of legal jargon and can be intimidating. If you have ever felt unsure about a policy, do not worry because you are not alone. When talking to an insurance agent, you may hear several different phrases thrown around that are normal terms for the agent, but they might be new to you. In these moments, you should stop the agent and ask for clarification on the term until you are confident in your understanding. For an unbiased explanation, hire a legal professional to proofread your policies. By including a third-party’s take on the information, you give yourself an extra layer of protection in the event that an insurance company ever denies your claim. This can prove to be even more helpful in the event that your insurance company is conspiring with an insurance adjuster against your claim, as is the case in a recent lawsuit filed against United Property & Casualty Insurance Co. (UPC) in Florida.

UPC Accused of Violating RICO Act

Southern Florida Restoration (SFR) Services has filed a lawsuit against United Property & Casualty Insurance Company (UPC) and FKS Insurance Services and Property Loss Specialists, an adjuster firm, regarding their reactions to roof damage claims by policyholders. The lawsuit charges them with “violating the federal Racketeer Influenced and Corrupt Organizations Act, known as the RICO Act, along with fraud, breach of contract and unfair trade practices.”

The complaint states:

“Instead of ensuring that field adjusters created honest, accurate reports to confirm that UPC’s insureds received an assessment that reflected their loss, defendants specifically instructed desk adjusters to modify the estimates created by field adjusters to decrease estimates in order to ultimately decrease the amount of money UPC pays to its insureds when claims are made under the insurance policies…As this scheme has come to light, some field adjusters have stated under oath that UPC commanded them to add language to their reports which was inaccurate and outright false…Insurance companies like UPC know that, when a severe weather event occurs, not every policyholder will submit a claim for coverage, even if the insured is entitled to coverage under the terms of the policy.”

SFR charges UPC with denying coverage and downplaying the extent of real claims in an attempt to make more of a profit.

Can I Sue My Insurance Company for Denial of Benefits?

Yes, you do have the ability to sue your insurance company if the denial of a claim is unreasonable. There are many reasons why an insurance company may deny a claim, but it becomes an issue of bad faith if the denial is unreasonable, incredibly delayed, or based on faulty investigation. If you believe your claim denial falls under at least one of these categories, contact Keller, Melchiorre & Walsh PLLC today to speak to an attorney well-versed in the issue of bad faith.

Florida State Statute 624.155 states, “bad faith is when the insurer does not attempt in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests; making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made; or except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.”

What Red Flags Should I Look Out For When Filing a Claim?

The lawsuit mentioned above is just one of many ways an insurance company can take advantage of you. Insurance companies are businesses first. While they are meant to provide you with help during your time of need, that is unfortunately not always the case. Here are a few red flags to keep an eye out for when you think your insurance company might not have your best interest at heart:

  • They try to convince you to not hire an attorney.
  • Their arguments against your claim are based on loopholes in the policy.
  • Their responses are confusing or unclear when you ask for clarification.
  • They undervalue your estimate.
  • They pressure you to accept a smaller settlement by threatening to deny your claim.

Your Next Steps in Closing Roof Damage Claims

On a larger scale, Florida lawmakers are on the move to improve the roof claims process. If you believe your insurance company is purposely avoiding your open claim due to roof damage, contact us today at Keller, Melchiorre & Walsh PLLC. You need a trusted lawyer to gather inventory of your damage, document expenses, and negotiate with the insurance company on your behalf. Our experienced team is ready to fight for you and get you back on the road to recovery.

CONTACT OUR FIRM

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