Insurance Claim Mediation and Neutral Evaluation Services

Florida law provides informal alternative dispute resolution programs for certain types of insurance claims. If you have a claim dispute with your insurer, our programs may help you to resolve it prior to taking legal action. If your insurer maintains a position regarding your claim which you find unsatisfactory, mediation will allow you to sit down face to face with the company and a neutral third party mediator certified by the Department of Financial Services (DFS) to try and resolve your differences. The mediator acts to encourage and assist in the resolution of the dispute without dictating the outcome. If you have a sinkhole claim dispute, our sinkhole Neutral Evaluation program will provide a neutral third party professional to review the findings of the insurer.

Both mediation and sinkhole neutral evaluation are non-binding. Neither the insured nor the insurance company is legally obligated to accept the outcome of the mediation conference.

The following programs are currently available:

Mediation is available to anyone filing a claim with an insurance company for property damage for any dollar amount, or for bodily injuries up to $10,000, which includes injuries covered under PIP. Either party (consumer or insurance company) may request mediation of the claim prior to the institution of litigation or the appraisal process. The insured may have an attorney present but must notify the company in advance.

RESIDENTIAL PROPERTY MEDIATION

Mediation is an informal way to resolve a claims dispute between the policyholder and the insurance company. It is a process where a neutral third-party acts to encourage and assist in the resolution of a dispute without dictating the outcome. The insurer must provide a representative with full authority to settle the claim at the mediation conference.  The conference should be held at a location near the policyholder residence.

The policyholder and the insurer shall attend the mediation conference, have full knowledge of the facts of the dispute, and be fully authorized to make an agreement to completely resolve the claim. An insurer will be deemed to have failed to appear if the insurer’s representative lacks authority to settle the full value of the claim. The authority to settle the claim includes the ability to disburse the full settlement amount within ten days of the conclusion of the conference.

Mediation is non-binding. Neither the policyholder nor the insurance company is legally obligated to accept the outcome of the mediation conference. Settlements reached at the conference can be rescinded within three days of the agreement as long as the check has not been cashed.

Eligibility:

Effective March 30, 2018, mediation may be requested only by the policyholder, as a first-party claimant, a third-party, as an assignee of the policy benefits, or the insurer.  However, an insurer is not required to participate in any mediation requested by a third-party assignee of the policy benefits. Disputes or denials of residential property claims (flood claims not included as they fall under rules of FEMA) in excess of $500 are eligible. Mediation is not binding on either party. The insurance company pays the entire cost of mediation.  Eligibility: All property insurance claims (hurricane and non-hurricane) are eligible for mediation unless either of the following issues is present – 1) if fraud complaint has been filed, or 2) if the policyholder and insurer agreed as to what has caused the loss and that cause is not covered under the policy. If there is a dispute concerning the cause of loss, and it could be covered, then it is eligible for mediation.

Cost of Mediation:

Property mediation is free for the policyholder. The insurance company pays the entire cost of the conference. However, if the conference, has to be rescheduled, there are associated fees. If the policyholder fails to appear for the conference, it can be rescheduled after the policyholder pays the mediator’s fee. Generally, the cost of mediation is $350. If the insurance company fails to appear, without good cause, they must pay the mediator’s fee for the rescheduled conference.

Legal Representation:

The policyholder can bring their attorney to the mediation conference. However, the insurer must be notified of the attorney’s attendance prior to the conference.

Additional Information:

Reference: Florida Statute 627.7015 and Rule 69J-166.031

COMMERCIAL RESIDENTIAL MEDIATION

Mediation is an informal way to resolve claims between the policyholder and the insurance company. It is a process where a neutral third-party acts to encourage and assist in the resolution of a dispute without dictating the outcome. Mediation is non-binding. Neither the policyholder nor the insurance company is legally obligated to accept the outcome of the mediation conference.

Note: Effective March 30, 2018, mediation may be requested only by the policyholder, as a first party claimant, a third-party, as an assignee of the policy benefits, or the insurer. However, an insurer is not required to participate in any mediation requested by a third-party assignee of the policy benefits.

Disputes or denial of personal property claims in excess of $500, not including deductibles, are eligible. To have attorney present is optional; however if the policyholder chooses to have an attorney present, the company must be notified in advance.

The policyholder and the insurer must attend the mediation conference, have full knowledge of the facts of the dispute, and be fully authorized to make an agreement to completely resolve the claim. The authority to settle the claim includes the ability to disburse the full settlement amount within 10 days of the conclusion of the conference. The conference will be held within a reasonable proximity of the insured property.

To request mediation, the Commercial Residential Mediation Request Form must be completed by the policyholder and sent to the Mediation Section of the Department of Financial Services (DFS). Once they are contacted, the insurance company has 21 days in which to resolve the dispute. If the dispute is not resolved, the issue is assigned to a mediator. The process should be completed within 45 days of the request. The mediator is randomly selected by DFS.

Commercial Residential Property Mediation is free for the policyholder. The insurance company pays the entire cost of the conference. However if the conference has to be rescheduled, there are associated fees. If the policyholder fails to appear for the conference, it can be rescheduled after the policyholder pays the mediator’s fee. If the insurance company fails to appear, without good cause, they must pay actual cash expenses of the policyholder in attending the rescheduled conference and they must pay the mediator’s fee for the rescheduled conference.

Mediation settlements can be rescinded within three days of the agreement as long as the check has not been cashed.

Additional Information:

Reference: Florida Statute 627.7015 and Rule 69J-166.002

Insurance Assurance Inc. is an experienced and knowledgeable insurance professional adjuster that can act as independent insurance mediator for homeowners and business owners. With our help, we can reach an equitable, mutually acceptable agreement with your insurance company.  We offer insurance claim help throughout the entire state of Florida.

Call Us: 321-735-6428

CONTACT INFORMATION

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Florida License No. D032331

Contact Us: 866-432-7093/(321) 735-6428

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