Legal Question in Consumer Law in Florida
I have a home warranty with a national company for the past three years. We currently have tenants in the home and the A/C is not working. The Warranty company told us to get someone to take a look at the unit. This company stated that the unit is old (it is 18 years old), and it needs to be replaced due to age, and normal wear and tear. They reported this to the warranty. The warranty company then stated that they wanted a second opinion and sent out one of there regular company out there. There diagnosis is that the unit is dirty and that is what caused the unit to malfunction. Suffice to say, they have declined the claim. I have done research on this company American Home Shield and have found out that this is there normal practice, to always find something non mechanical to deny the claim. We have paid them ontime every month to avoid a large expenditure like this. We now have to come out of pocket almost $4,000.00 to replace the unit. I would like to pursue this matter as I feel that the claim should have been approved. I offered to pay for a third independent company to go out there and they have refused. I need advice on how to procede. They also have had several class action suit filed against them.
2 Answers from Attorneys
You need to take all of your documentation to a general practice attorney. If you have all of your opinions and the warranty company's denial, in writing, you may have a case. If your claim boils down to a "he said, she said" contest, you will probably not get very far. You must have documented and dated phone calls, notes, letters, written diagnosis of the problem, a copy of the warranty, and most of all, the warranty company's written reason for refusing your claim. Otherwise, you are trying to nail down jello. In order to force an insurance provider to pay, you must first prove that you had current and valid coverage in effect for the loss of item or event, at the time of the loss/event. Then you must prove that the loss or event happened in a manner that was covered. Then you must prove that the insurance company was properly notified and was given an adequate opportunity to inspect or determine the extent of the loss or event. Then you must prove that the insurance company had the obligation to pay for the loss or event. Then you must prove that the insurance company wrongfully refused to pay for the loss or event. From your question, it is apparent that you have reason to suspect that this insurance company may have a "policy" of denying valid claims. To protect yourself against bad faith insurance companies, consumers should always research the company for their "track records" of denying claims. Go to http://www.badfaithinsurance.org/ for more information.
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