Frequently Asked Questions
Why Avila Public Adjusting Group?
At Avila Public Adjusting Group, we are a dedicated, client-focused public adjusting firm that helps policyholders and assignees resolve disputes against insurance companies.
We take an aggressive, proactive approach to the claims process that maximizes efficiency and exceeeds client expectations. Our unique expertise and deep understanding of Florida insurance law helps to achieve rapid and favorable settlements.
How much does it cost to retain Avila Public Adjusting Group?
At Avila Public Adjusting Group, we work on a contingency fee basis, so there is no cost to you unless we settle your claim. We are dedicated to obtaining the maximum settlement for our clients.
What does Avila Public Adjusting Group need in order to review your potential claim?
Avila Public Adjusting Group asks you to please provide the following documents if applicable and available.
For Residential and Commercial Property Claims:
- Insurance policy or copy of declaration page of insurance policy
- Denial letter
- Any and all correspondence to and from the insurance company
- Any estimates of items to be replaced/repaired
What are the rules the insurance company must follow on my insurance claim?
- The insurance company must treat its policyholderÃ¢Â€Â™s interests with equal regard as it does for its own interestsÃ¢Â€Â”this is not an adversarial process.
- Should assist the policyholder with the claim.
- Must disclose to its insured all benefits, coverages, and time limits that may apply to the claim and must conduct a full, fair, and prompt investigation of the claim at its own expense.
- May not deny a claim or any part of a claim based uponÃ‚Â insufficient information, speculation, or biased information. In the case of a full or partial denial, the insurance carrier must give written explanation, pointing toÃ‚Â the facts and policy provisions.
- Must not misrepresent facts or policy provisions.
- May not make unreasonably low settlement offers.
- An insurer must adopt and implement reasonable standards for the promptÃ‚Â evaluation of claims. In evaluating a claim under a replacement cost policy, it is not proper for anÃ‚Â insurer to deduct deprecation from the value of the claim.
- Failure to fairly and reasonably investigate a claim does not permit the insuranceÃ‚Â company to deny the claim due to lack of information or one-sided information.
- An insurance company may not ignore evidence which supports coverage and if a claim is denied, the insurance company must promptly give the policyholder a reasonable explanation of the basis in the insurance policy in relation to the facts, policy provisions, or applicable law upon which it relies for denial of the claim.
- Cannot discriminate in the claim settlement practices based on theÃ‚Â claimantÃ¢Â€Â™s race, gender, income, religion, sexual orientation, national origin, disability, or the territory of the property or person insured.
- An insurer must communicate with its insured to keep it appraised of theÃ‚Â status of its claim and the insurer has a duty to disclose all significant facts to its insured while not misrepresent facts or policy provisionsÃ‚Â relating to coverage of an insurance policy.
- An insurance company must not fail to acknowledge and act promptly upon communications regarding a claim arising under an insurance policy shouldÃ‚Â adopt and implement reasonable standards for prompt investigation of claims.
- WhenÃ‚Â insureds donÃ¢Â€Â™t recognize they are entitled to benefits in a policy, an insurance companyÃ¢Â€Â™s obligation is to point out those policy benefits to them.
- An insurance company may not use the claims department as a profit center and must keep a total claims file that reflects all activity on a file.
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What are my insurer’s responsibilities after a loss?
The insurance company should send out a licensed insurance adjuster following the claim. Insurance companies should ensure that the insuredÃ¢Â€Â™s property can be put back to its pre-damage condition. As a policyholder it is important to review the policy and look for provisions of elections of the right to repair, managed repair programs, and to read through the policies to know what their requirements and obligations are when a loss occurs.
Insurance Provider Responsibilities:
- Investigate the policyholderÃ¢Â€Â™s claim thoroughly, sufficiently and in a timely manner.
- Treat the policyholder fairly and without bias.
- Compensate policyholder for any covered damages promptly.
- Clearly and thoroughly explain in writing to the policyholder why their insurance claim or part of their insurance claim was denied.
How do I know if my “loss” or “damage” is covered?
When evaluating damages and losses to your property, there are several things to be evaluated. One key note to investigate: was there damage before the loss? Does your insurance policy only cover loss and not damage? Can there be loss without damage? Was the damage pre-existing (resulting from wear and tear)?