Years ago your insurance policy would include something called an appraisal clause, but unless you read your policy cover to cover its unlikely it would have stood out to you in any particular way.  The appraisal process was a quick and efficient way to have appraisers simply review the matters at hand and come to a conclusion which usually meant a quick resolution.

You get home from work or wake up in the morning and find that your home has suffered an insurance loss.  This could be anything from a busted water pipe, a sewer line back up, fire, or any other number of losses.  After any immediate “emergency,” measures should be taken in an effort tosafeguard your home, so the first thing you do is call your insurance company.  You imagine that you’ll be required to fill out some paperwork and wait for the check to come in the mail.  Although many claims are handled, processed, and paid quickly, the claims procedure can be complicated.  Perhaps you read your policy, every single last word of it, and discovered you don’t have an “appraisal clause,” but you think “no worries, I see a mediation clause.”  Personally, its not something that would have caught my eye.  Both clauses sound okay, don’t they?

In reality, these clauses aren’t equal, they aren’t the same, and they don’t provide YOU with the same amount of protection.  The difference is important.

An appraisal clause is part of the insurance policy and in simple terms it states that if you and the insurance company disagree on the value of your loss, then you and the insurance company each choose separate appraisers.  These appraisers then get together and choose a neutral third party appraiser who will determine the value of your loss (which is binding) and payment follows.  An appraisal clause is binding and, although not perfect, usually results in quick resolution.  In other cases, your claim is denied entirely.  The consequences and time limits that may follow the denial of a claim should be dealt with by an experienced attorney who can help you navigate the complex process to come.

Mediation is when both parties, you and your insurer, get together and choose a mediator to help both sides reach an amicable agreement.  The mediator, however, doesn’t have final say in the outcome.  This person’s role is merely to guide the parties to a resolution.  In this case, if no final resolution can be reached, the next step is to hire an attorney to file a lawsuit to recover damages from the insurance company.  The bad news is that a large percentage of these mediations result in no real effort made on the behalf of the insurance company so you’ll ultimately need a lawyer-Florida Statute 627.428.

Having practiced the law for over 25 years, I am strongly of the opinion the modern trend toward mediation over appraisal is skewed in favor of the insurance company.  Assuming no favorable resolution is reached in pre-suit mediation, a law suit typically follows which may take as long as a few years to reach a courtroom.  The mediation clause puts time on the side of the insurance company and puts all of the responsibility of recovering from your incident on you.  I don’t pay my monthly premiums with the assumption in mind that if and when I need to file a claim I also need to file a lawsuit.  Mediation is a procedural hoop that the insurance company hopes you don’t jump through; hiring an attorney sounds expensive, scary, and complicated.  They are counting on that and hoping you don’t bother.

Here is the goods news.  Florida statute 627.428 allows you to hire an attorney and to file suit against your insurance company to collect benefits due.  Our firm and most insurance litigation attorneys will not require an upfront fee from you, but rather review the case and determine the likelihood of prevailing and if so the attorney’s fees would be contingent upon the success of your claim.  Hold on because it gets better… should you prevail at trial or during the litigation process, the insurance company is obligated by law to pay your attorney for you!  If you were hesitant to spend money pursuing your claim, you have nothing to fear.  Gimenez & Carrillo, LLC has been specializing in this area of law for over 20 years.  If you need information or a FREE consultation to discuss your case, please feel free to call Gimenez & Carrillo, LLC at your convenience (305) 444- 3000.  We are here to secure what is rightfully yours and are happy to do so.


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