Volume 2 Issue 2  ●  2nd Quarter 2010

Dear Floridian:

Welcome to the fifth issue of The Advocate’s Advice newsletter. The Office of the Insurance Consumer Advocate continues to publish informational articles and advisories on our website (http://www.myfloridacfo.com/ica/ recently redesigned. The CFO’s website http://www.myfloridacfo.com/ was also redesigned which makes it easier to navigate. The Advocate’s Advice continues to be a great way for us to communicate directly with the insurance consumers of this state.

In May, the Office of the Insurance Consumer Advocate petitioned the Office of Insurance Regulation (OIR) to launch an investigation into The Hartford’s practices when revoking disability benefits. You can find a description of the allegations in this quarter’s newsletter. These practices were also featured on Good Morning America on April 7, 2010. In addition to the petition, Sean Shaw sought to protect consumers by forming the Florida Insurance Consumer Coalition. The coalition and its members pooled resources to better represent consumers on all insurance issues before the Legislature during the most recent legislative session. Sean Shaw and several coalition members supported Senator Ronda Storms’ amendment (267518) to Senate Bill 2044. Consumers can read why the amendment is advantageous to Floridians inside this edition of the newsletter.

Since the last edition of the newsletter, automobile issues have become very prominent in the news. Specifically, as one of the largest global manufacturers of automobiles, the Toyota recalls had a wide ranging effect on citizens in every state including Florida. To help consumers who were affected by these recalls, the ICA Office issued an advisory on the effects of an auto recall on consumers’ auto insurance. Appreciating that a faulty part may often lead to accidents, the ICA Office also released an advisory to help consumers navigate the process of filing an auto insurance claim.

As summer approaches, many citizens will experience a major change in their lives. Some citizens may get married, others will be graduating. In response to these issues, our office published a three part series on insurance issues to consider when getting married. The first installment of the series focused on health and life insurance issues, the second installment addressed protecting assets, and the third installment aided consumers in planning for their "later life" insurance needs. Those citizens who are not getting married are likely to know someone who is graduating. This year’s graduating class is facing a tough economic environment and many may be forced to move in with their parents again. These citizens have been referred to as “boomerangers” and were the subject of another educational piece from our office. Having an adult child move in with you presents certain insurance issues; consumers can find what these issues are and how to address them in this quarter’s newsletter.

Another summer tradition for Floridians is preparing for hurricane season. When this newsletter reaches you, Florida will have officially entered hurricane season. To ensure that Floridians are prepared in the event of a major hurricane making landfall, the ICA Office prepared two educational articles which can be found in this newsletter. The first article explains to Floridians how to navigate the claims process if they experience a loss as a result of a natural disaster. The second article explains who public adjusters are and how to work with them, should any consumers choose to hire one.

Lastly, we recognized National Kidney Awareness Month. In addition, to making the public aware of End Stage Renal Disease (ERSD), we also provided consumers living with ERSD with the legislation that assists them in receiving care.

I encourage you to subscribe to The Advocate’s Advice newsletter (it's free!) by clicking on the button on the left. Just put the word “subscribe” in the subject line. Once you subscribe, you will continue to receive future newsletter issues. You will be able to unsubscribe at any time in the future, if you wish, by clicking on the “unsubscribe” button on the left.

Sincerely,

Sean Signature

Sean M. Shaw, Esq.
Insurance Consumer Advocate

ICA Shaw Recommends Investigation of The Hartford Business Practices

Office of the Insurance Consumer Advocate

By: ICA Staff
May 26, 2010

TALLAHASSEE—Citing specific circumstances of questionable claims denials, Florida’s Insurance Consumer Advocate Sean Shaw today sent a petition to the Office of Insurance Regulation requesting an investigation into The Hartford’s use of video surveillance when denying disability benefits.

“We have been informed of multiple cases in which consumers felt their benefits were unfairly denied by The Hartford, and I believe we need to specifically address the use of video surveillance as it is the common thread in these complaints,” said ICA Shaw. “The Office of Insurance Regulation is the agency charged with investigating insurance companies, and I am asking that they use their authority to investigate any potential wrongdoing on behalf of Florida’s insurance consumers.”

After the Department of Financial Services received several complaints from citizens regarding the termination of disability benefits by The Hartford Life & Accident Insurance Company, the Office of the Insurance Consumer Advocate began an analysis of The Hartford’s denial procedures. In several cases, The Hartford hired a private investigator to film consumers performing daily tasks.

Based on the video surveillance, The Hartford terminated each of the consumers’ disability insurance benefits despite medical testimony that each of the consumers was disabled. ICA Shaw filed the petition due to his belief that the circumstances in each complaint may constitute a violation of Florida law. The Insurance Consumer Advocate’s petition asks the Office of Insurance Regulation to investigate The Hartford for violating Florida’s unfair claim settlement practice laws.

If OIR takes action, Florida would join several other states, including Texas, California and Arkansas, in investigating inappropriate denial of benefits in similar circumstances to determine whether The Hartford’s business practices violated state insurance laws.

The Insurance Consumer Advocate has filed this petition pursuant to section 627.0613 Florida Statutes which states: “The Chief Financial Officer must appoint a consumer advocate who must represent the general public of the state before the department [Department of Financial Services] and the Office [Office of Insurance Regulation]…The consumer advocate has such powers as are necessary to carry out the duties of the office of consumer advocate including but not limited to: (1) Recommend to the department of office, by petition, the commencement of any proceeding or action….”

ICA Supports Property Insurance Bill Amendment


property amendment billBy: ICA Staff
April 23, 2010

TALLAHASSEE — Florida’s Insurance Consumer Advocate Sean Shaw applauds Senator Ronda Storms’ amendment to Senate Bill 2044. Amendment 267518 would ensure that Florida’s insurance consumers, who have experienced a loss, are not further victimized by undue hardship in the replacement of their personal property. The amendment would further ensure prompt payment for the repaired property.

Senate Bill 2044, before the amendments, would change a law adopted by the Legislature in 2007. This legislation corrected unfair insurance practices that prevented Florida’s families from being able to recover insurance proceeds to replace their personal property. Current law simply requires insurers to pay full replacement cost for repairing and replacing damaged property that is insured under a policy that provides replacement cost coverage.

Consumers found themselves with the financial burden of assuming the replacement costs for personal property, especially if they did not have pictures or receipts and could not prove the loss of basic furnishings and clothing. Senator Storm’s amendment provides for replacement costs upfront to allow consumers to replace their lost personal property on a schedule that works for them, relieving consumers concerns about replacing seasonal items such as clothing, decorations, etc.

When homeowners purchase insurance, they have the option to purchase actual cash value coverage or replacement cost coverage for their personal property. If the consumer chooses replacement cost for their personal property, they pay an additional premium. They should have the right to have claims paid in accordance with the contract they have purchased. If insurers do not think the premium they are charging is sufficient, this issue should be addressed in the insurers’ rate filings. Senator Storms’ amendment offers the protection that Florida’s insurance consumers deserve.

Insurance Consumer Advocate Sean Shaw Forms Coalition to Fight for Florida Consumers


Sean M. Shaw, Insurance Consumer AdvocateBy: ICA Staff
March 3, 2010

TALLAHASSEE — Florida Insurance Consumer Advocate Sean Shaw today announced the formation of the Florida Insurance Consumer Coalition, a group of insurance consumer organizations that will work together to weigh-in and advocate for issues impacting Florida’s insurance consumers.

“This new coalition will benefit Florida’s consumers by speaking with a united voice to stand up for consumers’ interests and fight on their behalf,” said Insurance Consumer Advocate Sean Shaw. “It’s important that Florida's consumers have people looking out for their best interests and the Florida Insurance Consumer Coalition will be able to do that.”

Members of the Office of the Florida Insurance Consumer Coalition include the Florida Insurance Consumer Advocate, Consumer Federation of America, Center for Economic Justice, Consumer Federation of the Southeast, Florida Consumer Action Network, Florida Public Interest Research Group, Fair Insurance Rates in Monroe (FIRM), Cyber Citizens for Justice Florida, and Florida Community Health Action Information Network (CHAIN).

ICA Shaw Offers Consumers Tips on Navigating the Claims Process in Preparation for Hurricane Season


hurricane seasonBy: ICA Staff
May 20, 2010

June 1st will usher in another hurricane season, and consumers should begin preparing for the potential of a storm making landfall in Florida. Hurricane preparedness also entails understanding the claims process in the event of storm damage. Many consumers choose to work with a public adjuster, however, consumers should remember that public adjusters are not required in order to receive a settlement from an insurance company. The Office of the Insurance Consumer Advocate would like to share information with consumers on navigating the claims process.

In Florida, the threat of a storm is prevalent, but being prepared can reduce the cost of repairs and help ensure that consumers have their claims paid as quickly as possible. Navigating the claims process can be difficult if consumers are ill prepared; there are some recommended steps consumers should consider prior to filing a claim.

During the aftermath of a storm, homeowners should make necessary efforts to ensure that all property is accounted for and restored. Consumers should consider the importance of being detailed and organized while navigating the claims process.

Most claims disputes involve the difference in the amount offered by the insurance company to make repairs and the contractor’s estimate. Should consumers find themselves in the midst of a claims dispute they should consider the following in regards to a claims dispute resolution:

Consumers that have any further questions regarding navigating the claims process should contact the Division of Consumer Services within the Department of Financial Services online at http://www.myfloridacfo.com/Consumers/ or by phone at 1-877-MY-FL-CFO (1-877-693-5236), toll-free in Florida, and (850) 413-3089 from out of state.

ICA Sean Shaw Discusses the Effect of Automobile Recalls on Consumers’ Insurance Coverage


auto recallsBy: ICA Staff
March 12, 2010

The recent congressional hearings regarding the Toyota recall have led many consumers to have questions regarding their automobile coverage in the event of a recall.

Automobile recalls happen quite frequently, but not all recalls receive the notoriety and media attention the current Toyota recall is experiencing. Other companies that have issued recalls include Infiniti, Nissan, BMW, Honda, and Acura. Recalls often involve vehicles ranging from older models to current year models.

Consumers should remain alert for an announcement of any recalls affecting their model. There are many internet sites where consumers can check if a recall has been issued for their vehicle. The Office of the Insurance Consumer Advocate recommends visiting the National Highway Traffic Safety Administration in the U.S. Department of Transportation website at http://www-odi.nhtsa.dot.gov/recalls/recallsearch.cfm. There, consumers can enter their vehicle make, model, and identification number and receive up-to-date recall information.

Consumers who own cars that have been recalled should keep the following facts in mind:

In response to questions regarding whether or not a recall will result in premium increases for recalled cars, a spokesperson for Property Casualty Insurers Association (PCIA) stated that many factors determine premium rates and a recall may not be sufficient to trigger a premium increase.

In addition to other woes brought on by the recall, auto insurance companies that experience recalls may be charged higher premiums from warranty insurers; in turn, these costs may be passed on to consumers.

If consumers have questions regarding their auto coverage, they should first contact their agent or automobile insurer.

Consumers who have further questions regarding auto insurance coverage should contact the Division of Consumer Services within the Department of Financial Services online at http://www.myfloridacfo.com/Consumers/ or by phone at 1-877-MY-FL-CFO (1-877-693-5236), toll-free in Florida, and (850) 413-3089 from out of state.

ICA Sean Shaw Consumer Tips about Auto Accidents and Filing a Claim


auto accidentsBy: ICA Staff
March 19, 2010

Just about everyone can agree that accidents happen, but what should consumers do when they find themselves in an automobile accident? The Office of the Insurance Consumer Advocate would like to share some information regarding automobile insurance and accident protocol.

When on the road, drivers should always have their insurance cards and the phone numbers of their insurance company and agent on hand. The Office of the Insurance Consumer Advocate has a few tips that motorists should keep in mind if they find themselves in an accident:

In most instances, consumers will file an insurance claim for damages sustained to their vehicle. There are also some important issues for consumers to note when preparing to get their vehicle repaired:

Consumers that have any further questions regarding auto insurance and auto insurance protocol should contact the Division of Consumer Services within the Department of Financial Services on-line at http://www.myfloridacfo.com/Consumers/ or by phone at 1-877-MY-FL-CFO (1-877-693-5236), toll-free in Florida, and (850) 413-3089 from out of state.

ICA Sean Shaw Provides Advice for Consumers When Disputing Claims


disputing claimsBy: ICA Staff
March 26, 2010

When claim disputes between policyholders and insurance companies occur; it is important for consumers to know what to do in the event that they are unhappy with the settlement offer. Many issues arise that may compel consumers to contest a settlement offer. As a result, the Office of the Insurance Consumer Advocate would like to share some information with consumers about how to resolve a disputed claim.

Disputes usually arise when consumers and insurance companies disagree on the cost of repairs. For instance, a consumer may believe their roof needs to be replaced, while the insurance company will only pay for repairs. Disagreements such as these can be resolved if a few steps are taken.

The Division of Consumer Services can be contacted within the Department of Financial Services on-line at http://www.myfloridacfo.com/Consumers/ or by phone at 1-877-MY-FL-CFO (1-877-693-5236), toll-free in Florida, and (850) 413-3089 from out of state.

ICA Sean Shaw Recognizes National Kidney Awareness Month and Supports End-Stage Renal Disease Access Legislation


National Kidney FoundationBy: ICA Staff
April 2, 2010

In recognition of National Kidney Awareness Month, the Office of the Insurance Consumer Advocate would like to provide consumers with information about End Stage Renal Disease (ESRD) and dialysis treatment coverage.

ESRD requires an extensive amount of time and care and usually includes dialysis treatment in order to sustain life. According to The National Kidney Foundation, 26 million American adults have chronic kidney disease and millions of others are at increased risk. ESRD can be caused by various factors such as diabetes, hypertension and genetic history. In addition, African Americans and Hispanics are disproportionately affected by the disease.

Though kidney failure can be fatal, dialysis treatment helps patients sustain a better quality of life. There are two types of dialysis available, hemodialysis and peritoneal dialysis. Hemodialysis requires that the individual with ESRD attend a facility three times a week for several hours of dialysis treatment. Peritoneal dialysis can be performed in an individual’s home, but may place greater responsibility on the patient.

In 1972, Congress passed legislation making people with permanent kidney failure, or ESRD eligible for Medicare. Medicare will pay for 80% of the associated costs of dialysis treatments after the part B deductible has been satisfied. However, many people with ESRD need assistance in paying the 20% coinsurance required under the Medicare End Stage Renal Disease Program. Prior to last year in Florida, as in many states, the only way to get assistance in paying the 20% coinsurance was to qualify for Medicaid. This caused many consumers suffering from ERSD to dispose of assets in order to qualify for Medicaid.

In 2009, the Florida Legislature passed House Bill 675, also known as the Alonzo Mourning Access to Care Act, requiring that Medigap policy issuers include people with ESRD who are under the age of 65 in their supplemental coverage plan.

Florida is now among 22 other states who require that Medigap issuers also include those under 65 with ESRD. The combination of these measures provides those consumers who are afflicted with ERSD the ability to receive the treatment that can extend and improve the quality of their lives.

Consumers who have further questions regarding renal insurance coverage should contact the Division of Consumer Services within the Department of Financial Services on-line at http://www.myfloridacfo.com/Consumers/ or by phone at 1-877-MY-FL-CFO (1-877-693-5236), toll-free in Florida, and (850) 413-3089 from out of state.

ICA Shaw Discusses the Effects of Boomerangers on Family Insurance Coverage


boomerangersBy: ICA Staff
April 30, 2010

As the United States economy continues to recover, many recent graduates find themselves without employment and forced to move in with their parents. “Boomerangers” are young adults who are unable to financially support themselves, because layoffs and hiring freezes in this difficult economy are making it tough for young professionals to achieve financial stability.

With many young people returning home, boomerangers and their parents face important decisions about how to most cost effectively obtain insurance until they are on firm financial ground once again. The Office of the Insurance Consumer Advocate offers the following information for parents and boomerangers about the potential insurance implications this new living situation may present.

A recent survey by the Pew Research Center found that most boomerangers are between the ages of 18 and 34, and 13 percent of parents with grown children have had at least one grown child return home within the last year. College loans and unexpected job losses have led to the increase of young people living with their parents to help gain financial stability.

Living at home can pose many insurance coverage issues for parents and young people alike. Consumers should begin by reviewing their insurance policies to determine what their new coverage needs may be. There are some important coverage issues to consider to ensure that your insurance coverage adequately reflects any new living arrangements:

Any consumer, who has any questions regarding their insurance needs as a result of a new living situation, should contact the Division of Consumer Services within the Department of Financial Services on-line at http://www.myfloridacfo.com/Consumers/ or by phone at 1-877-MY-FL-CFO (1-877-693-5236), toll-free in Florida, and (850) 413-3089 from out of state.

ICA Sean Shaw’s Insurance Advice for Newlyweds Part I - Insuring Your Life Together


newlyweds part oneBy: ICA Staff
May 7, 2010

As summer approaches, many couples will make one of the most important decisions of their lives, marriage. However, each year many couples forget that there are crucial decisions to make regarding their post-nuptial insurance needs. The Office of the Florida Insurance Consumer Advocate has prepared a three part series to aid newlyweds with their post-nuptial insurance decisions.

While all lines of insurance should be reviewed, this portion of the series will concentrate on health and life insurance.

Health Insurance

Health insurance is a critical component to maintaining a healthy family. Because each spouse brings their own unique medical history to the marriage consumers should review each individual’s policy to determine which plan provides the most suitable benefits for both spouses. Newlyweds should be cognizant of any restrictions or time limited qualifying events which may affect their ability to change policies. Additionally, many employers may limit adding a new spouse if that spouse has access to coverage through their employer.

For many newlyweds, marriage may also mean welcoming children from a previous relationship into their new family. When children or dependents are involved, there are many issues to consider. Couples with children should coordinate with any previous spouses to determine which insurance will cover the children, who has the authority to make medical decisions, and any issues relating to court ordered support. Should couples need any guidance regarding these issues, they should consult their employers’ human resource advisor or a trusted financial planner. The Department of Financial Services (DFS), Division of Consumer Services has health insurance booklets and representatives who can assist, but ultimately it is up to the consumer to make the decisions. Consumer Services can be contacted at 1-877-693-5236, or through the web at www.myfloridacfo.com. Find a health guide at http://www.myfloridacfo.com/Consumers/Guides/Health/docs/health_2008.pdf.

Life Insurance

Life insurance is an essential financial planning tool for providing for the family in the event of the death of either spouse. Many employers offer some type of life insurance coverage, usually term insurance coverage at a factor of salary; (i.e. one or two times an employee’s salary). Beneficiary designation is a significant issue to consider following the purchase of life insurance. If either spouse has a previous policy, it is wise to discuss changing the designation. Consumers with children should consider that a minor designee (under 18) cannot be paid directly from an insurance company in the event of a death. Many families avert this issue by establishing a trust, but a trusted adult guardian should be named as the executor.

Many consumers or their spouse have extended family members who reside in a foreign country. These consumers should ensure that any beneficiaries or contingent beneficiaries are not living in a country that is under sanctions by the United States (e.g. Iran, Cuba, etc.). These sanctions may affect the ability of these designees to receive funds.

Finally, consumers should consider the amount of life insurance that is needed for the family to maintain their lifestyle. It is highly recommended that consumers seek guidance from a trusted financial advisor when making this decision. Consumers who have further questions regarding life insurance should consult the DFS Consumer Services Division brochure on life insurance at this link:  http://www.myfloridacfo.com/Consumers/Guides/Life/docs/life_annuities_2008.pdf

ICA Sean Shaw’s Insurance Advice for Newlyweds Part II—Protecting Your Joint Assets


newlyweds part twoBy: ICA Staff
May 14, 2010

As many couples seek to unify their lives this summer; some will forget that the joys of marriage often bring unforeseen issues regarding post-nuptial insurance needs. The Office of the Insurance Consumer Advocate would like to offer consumers advice that addresses insurance coverage issues for newlyweds. The Office has prepared a three-part series which discusses the various insurance issues honeymooners should consider.

In the first part of this series life and health insurance issues were discussed. In the second installment of this series, insurance issues relating to personal assets will be discussed. Marriage means not only increasing the size of your family, but also increasing the amount of possessions in your home. As consumers join all aspects of their lives in marriage, the following are some issues that should be considered.

Renters or Homeowners Insurance

Renters or homeowners insurance provides consumers with protection for their belongings or their home. Once newlyweds have determined where they will reside, they should meet with a qualified property and casualty insurance agent to assist in obtaining coverage. A couple who has decided to own their home should consider flood insurance, especially if the home is near a body of water. After marriage many couples may have doubled their possessions. As a result, they should update their homeowner’s insurance by taking an inventory of all assets and storing this information in a safe place. Newlyweds should research the coverage needed and select a company and agent together. Couples who would like to understand many of the property insurance issues they will face can review the consumer guide provided by the Division of Consumer Services in the Department of Financial Services at: http://www.myfloridacfo.com/Consumers/Guides/Property/docs/InsuringYourHomeEnglish.pdf.

Automobile Insurance

Automobile insurance is required by Florida law and serves to protect individuals in the event of automobile loss. Because spouses often drive each others cars, couples should be sure to add each other to their respective policies in order to avoid any coverage issues in the event of an accident. Families who have driving-age children should also ensure that the children are identified on their policies. As some companies give a multi-policy discount to consumers who have multiple lines with a single carrier (e.g. auto, home, life, etc.), couples should evaluate the benefits of consolidating their insurance coverage. Couples who have questions regarding auto insurance should consult the Department of Consumer Services in the Department of Financial Services, which has a brochure on automobile coverage that will help answer many questions. It can be reviewed at: http://www.myfloridacfo.com/Consumers/Guides/Auto/docs/autoGuide2008.pdf.

ICA Sean Shaw’s Insurance Advice for Newlyweds Part III—Later in Life Insurance Needs


newlyweds part threeBy: ICA Staff
June 1, 2010

When couples pledge to remain with each other for better or worse, very few of them actually plan for the worse. Although it is an unpleasant thought, couples should have a plan should a serious, non-lethal injury befall either of the spouses during their lives. In the final installment of this series we will discuss two types of insurance that are useful for protecting income, or assisting in paying assisted living expenses.

Disability Income Insurance – is designed to pay a weekly or monthly income for a specific period of time if a consumer suffers a disability and cannot continue or obtain work. The disability may involve sickness, injury or a combination of the two. The chances of a disability occurring are even greater than death and can affect the income of a married couple for an extended period of time. Disabilities occur every second of every day – over 85,000 disabilities occur each day.

When buying a disability policy, consumers should research the company’s definition of disability and the requirements that must be met, especially whether the company requires “own occupation” (the inability to perform the material and substantial duties of your regular occupation) or any occupation (because of sickness or injury you are unable to perform the material and substantial duties of your occupation, and are not engaged in any other occupation). This affects the circumstances under which benefits will be paid. Individual and group disability income policies must provide coverage for a policyholder or eligible dependent who becomes disabled. Disability income information is discussed in the Department of Financial Services’ Division of Consumer Services Health Insurance brochure, http://www.myfloridacfo.com/Consumers/Guides/Health/docs/health_2008.pdf.

Disability income insurance generally consists of two types; short term (a year or less) and long term (usually to age 65 or life). Most plans have an exclusion or waiting period. The longer the exclusion period, the lower the premiums can be. Most plans coordinate with Social Security in the event Social Security Disability is applied for and approved. If a consumer is applying for Social Security Disability, the consumer may wish to have the estimated amount withheld from the monthly benefit. If Social Security is approved and no deductions were withheld, the consumer may have to repay a substantial sum to the disability carrier.

Additionally, consumers should research the company from which they are considering purchasing coverage to make sure that they have a strong record of paying disability claims.

Long Term Care Insurance (LTC) – is a type of insurance developed specifically to cover the costs of long-term care services, most of which are not covered by traditional health insurance or Medicare. These include services in the home such as assistance with activities of daily living as well as care in a variety of facility and community settings.

There is a great deal of choice and flexibility in long-term care insurance policies. Long-term care insurance policies have a specific benefit period or benefit amount such as a daily benefit amount, as well as a lifetime benefit maximum, which is the total amount of time or total amount of dollars up to which benefits will be paid. Common benefit periods for long-term care policies are two, three, four, and five years, and lifetime or unlimited coverage. Most policies translate these time periods into dollar amounts and do not actually limit the number of days for which they will pay for care – just the overall dollar amount that the policy will pay.

Consumers who choose a daily benefit amounts (generally from $50 to $500/day) receive that daily amount for LTC expenses. Often you can choose whether you want the policy to pay the same daily benefit amount for care in all settings, or whether you want the policy to pay less for care in less costly settings, such as home care. Consumers who select a Maximum Lifetime Benefit, (i.e. $100,000 or $300,000) which is the total amount of money that may be paid for allowed charges for covered services and may correspond to a period of time such as 2, 3, 5 years, or an unlimited period of time, will receive a lump sum amount. DFS Division of Consumer Services has a brochure on their website at http://www.myfloridacfo.com/Consumers/Guides/Health/docs/LongTermCare2009.pdf. It may be worthwhile to note that Long Term Care Insurance is not appropriate for everyone and that a new Federal option may also be in the future.

Public Adjusters: An Alternative to Handling a Claim on Your Own


Office of the Insurance Consumer AdvocateBy: ICA Staff
May 28, 2010

In a continuing effort to make sure that consumers are prepared for this hurricane season, the Office of the Insurance Consumer Advocate believes it is necessary for consumers to understand what public adjusters do and what services they provide.

Immediately after experiencing a loss, there are certain steps that all consumers should take whether they hire a public adjuster or not. Most claims are resolved quickly and repairs can be done expeditiously, but the claims process can be stressful, especially for homeowners or business owners dealing with the emotional experience of a major loss.

When there is a dispute between the policyholder and the insurance company, there are options available to resolve those differences. Consumers should obtain a copy of the insurance company’s estimate and the contractor’s estimate and may attempt to discuss the differences with their insurance company. If the consumer is still not satisfied with the settlement offered by their insurance company and have disputed a claim amount in excess of $500.00, they have the statutory right to request mediation. The mediation process is an informal and non-binding way to resolve claims through a neutral third party. The mediation program is administrated by the Department of Financial Services, Division of Consumer Services and the insurance company pays the entire cost.

For consumers who want assistance with navigating the claims process or with disputes over settlement offers, they may wish to hire a public adjuster. Among other things, public adjusters can help to manage the mediation process, analyze coverage from the policyholder’s perspective, identify, record and quantify all damages associated with a claim’s event, help the policyholder to understand the quality of all settlement offers advanced by the insurance carrier and assist the policyholder in preparation, presentation and the adjustment of the claim.

Public adjusters are licensed by the State of Florida specifically to represent insured policyholders. They do not work for insurance companies or independent adjusting firms. They are different from company adjusters who are employed by the consumer’s insurance company. Public adjusters contract directly with a policyholder to provide adjusting services and negotiate a claim settlement on the policyholder’s behalf with the insurance company.

Consumers need to be aware that a public adjuster is usually entitled under their contract to a percentage of the total claim settlement. A consumer should review a contract with a public adjuster carefully to be sure they understand the terms and conditions of the contract.

Consumers who retain the services of a public adjuster should also be aware of standards that Florida law provides when dealing with a public adjuster:

Consumers who have further questions regarding public adjusters should contact the Division of Consumer Services within the Department of Financial Services on-line at http://www.myfloridacfo.com/Consumers/ or by phone at 1-877-MY-FL-CFO (1-877-693-5236), toll-free in Florida, and (850) 413-3089 from out of state.

The Insurance Consumer Advocate is appointed by Florida Chief Financial Officer Alex Sink and is committed to finding solutions to insurance issues facing Floridians, calling attention to questionable insurance practices, promoting a viable insurance market responsive to the needs of Florida’s diverse population and assuring that rates are fair and justified.