Florida First-Party Insurance Claims

First-party insurance claims are between you and your own insurance company, so it might seem as if these claims should be straightforward. However, you can encounter problems with first-party claims just like any other insurance claim. If you do, an attorney may be able to help.

Here’s what you need to know about first-party insurance claims in Florida.

What Is a First-Party Insurance Claim?

In the world of insurance, first-party claims are those in which you request that your own insurance company pay out what you believe it owes you. Insurance claims can involve three different parties:

First Party: The policyholder
Second Party: The policyholder’s insurance company
Third Party: Another person who files a claim against the policyholder’s insurance

There are two broad categories of claims in insurance: first-party claims and third-party claims.

First-Party Insurance Claims

In a first-party claim, no third party is involved. For example, if a tree falls on your house and you file a claim with your homeowners insurance, you’ve filed a first-party insurance claim.

Third-Party Insurance Claims

In a third-party claim, another person or business files a claim against your insurance company. Liability insurance claims are a common example of this. For instance, if you cause a car accident and the other driver files a claim with your car insurance, they’ve filed a third-party insurance claim.

Types of First-Party Insurance Coverage

There are many different types of first-party insurance claims spanning virtually every variety of insurance policy. Here are some common examples:

Health Insurance

You pay your health insurance company a certain premium each month. In return, your insurer agrees to pay some or all of the cost of your medical care. Many healthcare providers automate these claims, so filing a claim against your health insurance isn’t always as time-consuming as filing other kinds of insurance claims.

Collision and Comprehensive Auto Insurance

Collision insurance will pay for repairs to your car regardless of who causes the damage. Comprehensive insurance, meanwhile, covers various types of damage not related to accidents, including theft, storm damage, vandalism, and collisions with wild animals.

For either type of coverage, you must file a first-party insurance claim to receive payment.

Uninsured/Underinsured Motorist Coverage

Most drivers have uninsured/underinsured motorist coverage. Ordinarily, if you’re in a car accident caused by another driver, you would file a third-party claim against that person’s liability insurance. However, if the other driver is uninsured or their policy limit is too low to cover your losses, you might file a first-party claim with your own insurance.

Personal Injury Protection (PIP)

Florida is a no-fault state for auto insurance. This means that in many cases, you would need to file a first-party insurance claim with your personal injury protection provider regardless of who caused the accident.

Homeowners Insurance

With the exception of liability claims, most homeowners insurance claims are first-party claims. Notable examples include:

Wind and hail damage claims
Fire and lightning damage claims
Vandalism claims
Water damage claims

Some homeowners insurance companies will pay out claims with no issue. Others might try to underpay your claim or even deny it altogether. When that happens, a bad-faith insurance lawyer may be able to advocate for you and file a lawsuit if needed.

Flood Insurance

Many homeowners must have a separate policy to cover flood damage. If you have flood insurance and your home sustains damage, you would need to file a flood insurance claim to receive payment.

Renters Insurance

Renters insurance typically covers the belongings a renter has within an apartment or rented home. If you’re renting your residence and your property is damaged by a fire, natural disaster, or another event, you would need to file a first-party claim to be reimbursed.

The Claims Process: What to Expect

Here’s a closer look at the general process of filing a first-party insurance claim and what you can expect as you seek reimbursement for your losses:

Thoroughly Document the Damage

Your claim is more likely to be approved if you submit ample proof of the damage. For example, if parts of your home have been destroyed in a storm, you would want to include photos that show the home as a whole, as well as close-ups of the wreckage.

File Your Claim

You should contact your insurance company to file a claim as soon as possible. This is especially important following a natural disaster or other event that causes widespread damage. The sooner you can get your claim started, the faster it’s likely to be resolved.

Make Temporary Repairs if Needed

You should never make permanent repairs before an insurance adjuster comes to view the damage. However, it’s a good idea to make temporary repairs to protect your home from further damage. For example, if there’s a large hole in your roof, you should cover it with a tarp.

Communicate With the Insurance Adjuster

Your insurance company will send out an adjuster to inspect the damage and determine whether to pay out your claim. Make it a point to be polite when communicating with the adjuster, but consider hiring an independent adjuster to assess the damage if you think the insurance company’s valuation of the damage is unfairly low.

Consult a Lawyer if Needed

Don’t be afraid to reach out for legal assistance. If the insurance company is undervaluing your claim or simply refusing to pay it, a lawyer experienced with first-party insurance claims may be able to help you gain access to the resources you need.

Common Challenges in First-Party Insurance Claims

Insurance coverage isn’t always as simple as it sounds. Here are some of the challenges you might run into when filing a first-party claim:

Disputes Over Coverage

Insurance policies should be written clearly enough that there won’t be any disputes over what they cover. Even so, disputes may sometimes arise between policyholders and their insurance companies.

If you believe a particular loss is covered under your insurance contract and your insurer doesn’t, you may need to turn to an attorney for advice.

Refusal of Valid Claims

In some cases, you may have a valid claim that the insurer refuses to pay. Often, the insurer will send a denial letter full of complex legal jargon. If you receive a letter like this, it’s worth talking to an insurance lawyer.

Attorneys are familiar with the tactics insurers use to avoid paying claims, and they can easily see through manipulations like this.

Unreasonable Delays

It’s not uncommon for insurance companies to refuse to adjudicate claims in a timely manner. Insurers frequently use delaying tactics to try to wear down the policyholder. They reason that you may be more willing to accept a lower settlement if you’ve been waiting months for some kind of compensation for your losses.

Insurance companies also earn more money in interest each day they refuse to pay a claim. Sometimes, their delays are nothing more than an attempt to generate greater profit.

Undervaluing Your Claim

Insurance companies don’t always outright deny claims they don’t want to pay. Sometimes, an insurer will insist on paying less than a claim is worth in hopes that the policyholder will accept the lesser amount.

For example, imagine that your home has been severely damaged in a storm. You talk to several local contractors, and each one estimates that it will cost at least $20,000 to make the necessary repairs. If your insurer refuses to pay more than $10,000, it may be undervaluing your claim.

How an Attorney Can Help With Insurance Claims

Insurance companies have a vested interest in spending as little money as possible. They also have teams of high-powered lawyers to defend them in disputes with policyholders.

Going up against an insurance company on your own may seem intimidating. However, if your insurer has unfairly denied your claim or is refusing to pay what it’s worth, a Florida first-party insurance claims lawyer may be able to defend your rights. Here’s how the right attorney can help you:

Identifying Weaknesses in the Insurance Company’s Position

Policyholders can often tell that something isn’t right with a claim denial but don’t know which laws the insurer is breaking. An attorney can quickly identify problems with the insurance company’s refusal to pay.

Gathering Evidence to Strengthen Your Claim

In some instances, presenting more evidence to support a claim may be enough to convince the insurer to pay. For example, if your insurance company isn’t convinced of the total value of the damage to your property, your lawyer may be able to secure expert witness testimony to strengthen your claim.

Negotiating With the Insurer

Insurance claim lawyers are skilled negotiators, and they know how to deal with insurers. Insurance companies are also far more likely to negotiate with attorneys than with policyholders. They know that if they don’t offer to pay a reasonable amount toward your claim, your attorney won’t hesitate to take them to court.

Going to Court if Needed

It’s usually much easier for both sides if they can agree on a reasonable settlement amount. In some cases, however, an insurance company might simply refuse to settle. If this happens, your lawyer can file a bad-faith insurance lawsuit and represent you in court, where a judge or jury will decide the outcome of the case.

Deadlines and Time Limits for Filing a Claim

Generally speaking, you have one year from the incident or date the damage occurred to file a property claim. However, certain insurance policies may have their own deadlines for filing claims. To reduce your risk of running into issues with claim approval, always read your insurance policy closely and follow all required deadlines.

If you file a claim and your insurer denies it in bad faith, you have the right to file a bad-faith insurance lawsuit.

You’ll typically have five years from the date of the bad-faith action to file suit. However, because deadlines may vary based on the circumstances of your case, you should consult a qualified attorney to ensure that you don’t miss your opportunity to take legal action.

The Right First-Party Insurance Claims Lawyer Can Make All the Difference

Most of the time, insurance providers pay out claims without incident. However, if your insurer is acting in bad faith by unfairly denying coverage, you have options for getting the compensation you need.

At Kennon Law, we have a long history of representing Florida families and businesses against insurance companies that try to shirk their contractual obligations. Whether you’re having issues with property insurance, life insurance, car insurance, or something else, we’re ready to stand up for your rights.

Frequently Asked Questions

What Is the Difference Between Third-Party Claims and First-Party Claims?

A first-party insurance claim is between you and your own insurance company — you file a claim to be repaid for your losses. By contrast, a third-party claim is when another person or entity files a claim against your insurance. For example, if your dog attacks a neighbor, they may file a third-party liability claim against your homeowners insurance.

What Is the Statute of Limitations on First-Party Property in Florida?

Your insurance policy should tell you how long you have to file first-party claims. However, if you need to file a lawsuit against your insurer for breach of contract or acting in bad faith, you generally have five years to do so.

If you decide to file a lawsuit against your insurance company, don’t wait until you’re close to the end of the statute of limitations. It will take your lawyer some time to build a strong case, so the sooner you get in touch with them, the better.

How Long Does an Insurance Company Have to Settle a Claim in Florida?

Generally, home insurance companies have 90 days to investigate a claim, make a decision, and pay the policyholder if the claim is covered.

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