Insurance Coverage

Our firm represents individuals and business entities that have responsibly secured insurance coverage, regularly paid premiums, and then submitted valid claims only to have them improperly denied by their insurance companies.

After a claim is filed, the insurance company will first scour the application to determine whether any information the insured had previously filed can be characterized as a misrepresentation. Then they look to invoke any exclusion, no matter how broad the interpretation, so as to deny the claim. We handle cases involve a variety of insurance policies: business, commercial, marine, windstorm, health, disability, and many others. We aggressively represent our clients to insure coverage.

For example, in the commercial context we successfully represented a the owner of multiple warehouses whose hurricane damage claim was improperly denied when the insurance company tried to characterize the insured’s intermediate roofs as “awnings”. Our representation resulted in a multi-million dollar settlement. In another case, we represented the owner of a high rise who learned that the structural engineer had negligently designed the building so that it was at great risk of imploding. The insurance company argued that the policy did not cover the claim because the building had not yet experienced a “collapse”. We persuaded the trial court that this limiting language in the insurance policy should be read liberally to include the risk of collapse so as to avoid a catastrophe. Last year we obtained a judgment in excess of a million dollars on behalf of a business that sought reimbursement for money paid it out in settlement following a government investigation. The trial court rejected the insurance company’s argument that “mistakes” it made in drafting the language of the policy were immaterial, and the decision was affirmed on appeal.

Health insurance policies are also frequent a source of litigation as insurance companies look for ways to avoid paying catastrophic medical bills. Similarly, in the disability context, insurance companies will continuously monitor their insureds looking for any reason, valid or not, to deny the insured’s benefits. Our firm has had great success in insuring or restoring health coverage for many individuals in need. For one particularly poignant example, click and read below.

Case Result: When You Can’t Afford To Lose

Some years ago, we were contacted by a young woman (who I will refer to as Karen) who suffered from a medical condition that required continuous ventilator support for her to survive. In spite of her predicament, she was still fortunate – so she thought – to have a comprehensive health insurance policy in place to pay for her extraordinary medical bills. Her insurance policy benefits allowed her, along with the constant and devoted assistance of her parents, to live at home. All she had to do to keep her benefits in place was to timely pay her renewal premium as it became due, which for obvious reasons she did religiously.

Karen’s insurance company, however, was not pleased about having to pay a lifetime of Karen’s medical bills, particularly given her young age and life expectancy, so it devised a plan to remove her from her insurance coverage. The company crafted a letter to her that began with the phrase: “BAD NEWS!!!!/GOOD NEWS!!!!”. The bad news, so the letter said, was that the insurance company would not be renewing her policy; it failed to inform her, however, that based on the policy language, this non-renewal would not affect her ongoing medical claim. The so-called “good news” that followed encouraged her to exchange her policy for another policy offered by the same insurance company, which she did immediately to ensure she would not be bankrupted by her medical condition.

Until it was too late, Karen didn’t realize that she had been the victim of a devious scheme. The new insurance policy Karen shortly found out, included policy language that allowed the insurance company to cancel her policy in one year, after which no benefits would be payable. This it did without hesitation. Facing economic ruin and life as a public charge in a county hospital or nursing home, Karen frantically asked us for help. We filed a Complaint on her behalf for breach of contract. The insurance company argued that the language of each policy was clear: as a young adult of sound mind, Karen should not be excused for having not carefully read the terms of her policies. As the case hung in the balance, here at the firm we felt enormous stress - it was a case we simply could not afford to lose. Ultimately the trial court ruled in Karen’s favor against the insurance company, including an award attorney’s fees, and the decision was affirmed on appeal.

There are very few movies about the law that appeal to me, but one scene in particular from the movie Philadelphia rings true about Karen’s case. The main character, an attorney played by Tom Hanks, describes what he loves most about the law: "Every now and again, not often, but occasionally, you get to be a part of justice being done. It really is quite a thrill when that happens".

A few years later Karen died from health complications relating to her ongoing ventilator dependency. She passed away at home, with her parents, at peace, and in a loving environment.