Frequently Asked Questions and Glossary of Terms

  • If an attorney is willing to take my case on a contingency fee basis what does that mean?  It generally means that you only have to pay the attorney after there is a settlement, after a judgment is paid, or some other monetary resolution. The attorney’s fee is usually based on an agreed to percentage of the settlement, judgment or other proceeds from a resolution.
  • What are litigation costs in Florida?  Litigation costs refer to the costs necessary to litigate a case through trial and appeal, if necessary. These costs do not include attorney fees, which are separate. Litigation costs include such costs as: complaint filing fees, the costs for court reporters for depositions, expert fees, copying costs, witness fees, costs for subpoenaing documents, etc. These costs can be significant, especially if a case goes through a jury trial.
  • Who is ultimately responsible for litigation costs?  Each person who files a lawsuit is ultimately responsible for litigation costs. However, generally when an attorney takes a case on a contingency fee basis, the attorney also agrees to pay for litigation costs until there is a resolution. After resolution, the attorney has the right to get reimbursed for the litigation costs paid for and on behalf of the client in addition to the contingency fee pursuant to prior agreement.
  • What should I look for if I need a Florida lawyer in a bad faith case against my insurance company? It can be difficult to find an insurance lawyer in these types of cases who will handle your case with the attention and skill that everyone who has a valid case deserves. You need insurance lawyers who are experienced, tough, and resilient, who know their stuff, work hard, and care about your interests. You will want to find insurance lawyers who know what they are doing and with whom you are comfortable. You also have to be able to trust their judgment.If you are interested in talking to an insurance lawyer after you have looked at their website or gotten their name by a referral or other means, call them by telephone to discuss your insurance case. Does the insurance lawyer seem knowledgeable about insurance law? Does he or she ask important questions in an attempt to get a handle on your problem right away?If the lawyer is interested in your insurance case, he or she should ask you to send a complete copy of your insurance policy, copies of all correspondence between you and your insurance company, cost estimates to repair your property if it is a property damage claim, and any other documentation relevant to your type of claim. Most qualified insurance lawyers want to study your case a little further by reviewing such documentation.
  • How do I secure the counsel of a qualified attorney?  You may be asked to sign a legal services agreement. Before you sign, be sure you want to hire this lawyer or law firm. Find out about their experience. Are they capable of taking a case to trial? What kinds of cases have they handled, and what kind of results have they achieved?If you are interested in hiring a law firm, ask lots of questions about the legal services agreement. Take it home and read it, and then call the lawyer with your questions. Make sure you understand all aspects of the legal agreement, including the financial terms of the agreement and your and the law firm’s obligations under the agreement before you sign.
  • Why did you turn down my case?  At Chavin Mitchell Shmuely, we wish we could help everyone who comes to us with an insurance, personal injury or consumer protection matter, but we cannot for a number of reasons. We have to be convinced that, after some initial investigation, we can help. In other words, we have to be as sure as we can that your case has merit under the applicable law in Florida. In addition, we only take a select number of cases so we can devote our full attention to each case that we take. This means we only take cases that are serious enough to justify the time and resources that will be necessary to litigate the case aggressively, in order to increase the odds of obtaining a satisfactory result.

 

Glossary of Common Legal Terms

Please be aware that these are general definitions to help increase your awareness of common terms. Please check your own policies for definitions specific to your circumstance.

Actual Cash Value: Often called just “ACV”. This is one way of calculating a value of lost or damaged property that is determined by the insurance company. This number is often calculated by determining replacement cost value minus depreciation and known to be rather subjective as it is the insurance company who is putting a value to the policyholder’s property. Be very inquisitive into how depreciation is being calculated.

Aggregate/Aggregate policy: This can be taken to mean a certain limit within an insurance policy stating the maximum it will pay for all covered losses within a specified period of time.

Any Occupation Disability Insurance: Under this type of policy, benefits are payable so long as the insured is prevented from engaging in work for which he is suited and the type of work is not limited to a certain specific occupation.

Application Misrepresentation: Fraudulent, negligent, or innocent misstatement of information on an insurance policy, or a lack of complete information on the policy, can be considered an application misrepresentation. This can be grounds for a denial from the insurance company when filing a claim, however, some inaccurate information may not bar your claim and you should have your legal rights reviewed.

Appraisal: An alternative dispute resolution process available under some insurance policies where there is an disagreement on the amount of the loss. Specific policies have controlling language and different jurisdictions allow for different processes.

Bad Faith: Bad Faith can be described as insurance companies delaying, withholding, or denying policyholder benefits that are based upon legitimate claims filed under valid insurance policies. In terms of insurance this can be non-fulfillment of contractual obligations to the policyholder. This can be an unfair or deceptive action by the insurance company and can also be present when the adjusters are not properly trained.

Beneficiary: An individual who could receive payment under a will, life insurance policy, retirement plan, annuity, trust, or other contract.

Benefits (Medical and Hospital Expenses): The costs for health care services covered by an insurance company.

Business Owners Policy: A policy of insurance specific for business typically for property, liability and business interruption coverage.

Catastrophe Loss: A loss of large magnitude such as a hurricane.

Claim: A formal request from a policyholder to their insurance company for payment due to loss and damage incurred and covered under the policy.

Company Insurance Adjuster: An adjuster sent by an insurance company to assess the amount of compensation necessary for a person who has made a claim on their insurance policy.

Conditions: Check your insurance policy of the listed conditions; these are requirements that must be upheld or followed by the insured when seeking coverage.

Declarations: Often called the “dec pages”. The declarations are insurance forms within an insurance policy that give details of insurable interest, demographic information of the insured, and some of the specifics of the property covered.

Direct Loss: Property loss or damage that is a direct result of an event or unbroken chain of events that is covered under the insurance policy.

Examination Under Oath (EUO): A formal proceeding during which an insured, under oath and in the presence of a court reporter, is questioned by an attorney for the insurance company, or in some cases an insurance representative. You should retain an attorney to attend any Examinations Under Oath with you because this is formal testimony specific for your loss and claim. The attorney for the insurance company does not represent you.

Exposure: As a policyholder or a property; being subject to loss or damage because of a contingency or hazard.

Hazard: A circumstance that has the potential to increase the probability or severity of a loss.

Independent Adjuster: This adjuster has the ability to be a freelance representative adjuster who is paid to adjust losses on behalf of insurance companies. This adjuster can work for many different insurance companies on different claims and is not the adjuster for a certain designated company. This adjuster is not a policyholder adjuster or a public adjuster.

Insured: The person or entity covered by an insurance policy (Policyholder).

Insurer: A person or company authorized to write property and/or casualty insurance under the laws of the particular state (Insurance Company).

Irrevocable Beneficiary: A life insurance policy beneficiary whose compensation cannot be changed without his or her consent.

Loss payment clause: A Loss Payment Clause is a fairly standard provision that can be found within commercial and residential insurance policies. The “loss payment” provision is one of the few provisions favoring the policyholder and should be followed when funds are tendered.

Negligence: Failure to exercise reasonable care, resulting in loss or damage to oneself or others.

Nursing Home: A private institution providing residential accommodations with health care, especially for the elderly.

Own Occupation Disability Insurance: Insures the person and gives insurance benefits in the event the person is unable to pursue his usual line of work. Applies specifically to the policyholders own career or job, not just employment in general.

Policy: A written contract containing the terms and conditions of an insurance agreement.

Premium: The amount paid monthly, quarterly, or yearly for insurance coverage that reflects the expectation of loss.

Primary Insurance: The coverage that holds superiority when more than one policy covers the same loss.

Proof of Loss: A formal written statement made by the insured to the insurer regarding a claim, especially in property insurance, so the insurer can determine its liability under the policy. Requests for proofs of loss should be handled timely and policyholders need to be familiar with the time requirements of these forms because strict adherence is often required as a requirement to payment.

Provisions: Terms, conditions, limitations, or exclusions detailed in the various sections of an insurance policy.

Proximate Cause: An event well related to a legally recognized injury and is named the cause of the injury, which is covered under the insured’s policy.

Public Adjuster: A Public Adjuster is a licensed and trained specialist that adjusts insurance claims for homeowners, commercial property owners, and businesses. Public adjusters are insurance adjusters who work solely for the policyholder and not the insurance company on a particular claim.

Replacement Cost Value: The cost of replacing the property loss or damage without a reduction for depreciation due to normal wear and tear or age.

Salvage: Value that remains after loss or damage.

Term: Stated period of time for which an insured’s policy is in effect.

Third Party: Someone other than the policyholder or insurer who has experienced loss or is entitled to be compensated due to acts of the insured

Umpire: The appraisal process of an insurance claim is made up of a two appraisers and, if needed, an umpire chosen by mutual agreement or appointment by the court. Any agreement by two of the three is binding. An umpire is typically an expert in the field of the repairs needed, such as an engineer or an architect.