Florida Statute 627.70131 | Lawyer Caselaw & Research

The 2024 Florida Statutes

Title XXXVII
INSURANCE

Chapter 627
INSURANCE RATES AND CONTRACTS

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F.S. 627.70131

627.70131 Insurer’s duty to acknowledge communications regarding claims; investigation.—

(1)(a) Upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 7 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer. If the acknowledgment is not in writing, a notification indicating acknowledgment shall be made in the insurer’s claim file and dated. A communication made to or by a representative of an insurer with respect to a claim shall constitute communication to or by the insurer.

(b) As used in this subsection, the term “representative” means any person to whom an insurer has granted authority or responsibility to receive or make such communications with respect to claims on behalf of the insurer.

(c) This subsection does not apply to claimants represented by counsel beyond those communications necessary to provide forms and instructions.

(2) Such acknowledgment must be responsive to the communication. If the communication constitutes a notification of a claim, unless the acknowledgment reasonably advises the claimant that the claim appears not to be covered by the insurer, the acknowledgment must provide necessary claim forms, and instructions, including an appropriate telephone number.

(3)(a) Unless otherwise provided by the policy of insurance or by law, within 7 days after an insurer receives proof-of-loss statements, the insurer shall begin such investigation as is reasonably necessary unless the failure to begin such investigation is caused by factors beyond the control of the insurer.

(b) If such investigation involves a physical inspection of the property, the licensed adjuster assigned by the insurer must provide the policyholder with a printed or electronic document containing his or her name and state adjuster license number. An insurer must conduct any such physical inspection within 30 days after its receipt of the proof-of-loss statements.

(c) Any subsequent communication with the policyholder regarding the claim must also include the name and license number of the adjuster communicating about the claim. Communication of the adjuster’s name and license number may be included with other information provided to the policyholder.

(d) An insurer may use electronic methods to investigate the loss. Such electronic methods may include any method that provides the insurer with clear, color pictures or video documenting the loss, including, but not limited to, electronic photographs or video recordings of the loss; video conferencing between the adjuster and the policyholder which includes video recording of the loss; and video recordings or photographs of the loss using a drone, driverless vehicle, or other machine that can move independently or through remote control. The insurer also may allow the policyholder to use such methods to assist in the investigation of the loss. An insurer may void the insurance policy if the policyholder or any other person at the direction of the policyholder, with intent to injure, defraud, or deceive any insurer, commits insurance fraud by providing false, incomplete, or misleading information concerning any fact or thing material to a claim using electronic methods. The use of electronic methods to investigate the loss does not prohibit an insurer from assigning a licensed adjuster to physically inspect the property.

(e) The insurer must send the policyholder a copy of any detailed estimate of the amount of the loss within 7 days after the estimate is generated by an insurer’s adjuster. This paragraph does not require that an insurer create a detailed estimate of the amount of the loss if such estimate is not reasonably necessary as part of the claim investigation.

(4) An insurer shall maintain:

(a) A record or log of each adjuster who communicates with the policyholder as provided in paragraphs (3)(b) and (c) and provide a list of such adjusters to the insured, office, or department upon request.

(b) Claim records, including dates, of:

1. Any claim-related communication made between the insurer and the policyholder or the policyholder’s representative;

2. The insurer’s receipt of the policyholder’s proof-of-loss statement;

3. Any claim-related request for information made by the insurer to the policyholder or the policyholder’s representative;

4. Any claim-related inspections of the property made by the insurer, including physical inspections and inspections made by electronic means;

5. Any detailed estimate of the amount of the loss generated by the insurer’s adjuster;

6. The beginning and end of any tolling period provided for in subsection (8); and

7. The insurer’s payment or denial of the claim.

(5) For purposes of this section, the term:

(a) “Factors beyond the control of the insurer” means:

1. Any of the following events that is the basis for the office issuing an order finding that such event renders all or specified residential property insurers reasonably unable to meet the requirements of this section in specified locations and ordering that such insurer or insurers may have additional time as specified by the office to comply with the requirements of this section: a state of emergency declared by the Governor under s. 252.36, a breach of security that must be reported under s. 501.171(3), or an information technology issue. The office may not extend the period for payment or denial of a claim for more than 30 additional days.

2. Actions by the policyholder or the policyholder’s representative which constitute fraud, lack of cooperation, or intentional misrepresentation regarding the claim for which benefits are owed when such actions reasonably prevent the insurer from complying with any requirement of this section.

(b) “Insurer” means any residential property insurer.

(6)(a) When providing a preliminary or partial estimate of damage regarding a claim, an insurer shall include with the estimate the following statement printed in at least 12-point bold, uppercase type: THIS ESTIMATE REPRESENTS OUR CURRENT EVALUATION OF THE COVERED DAMAGES TO YOUR INSURED PROPERTY AND MAY BE REVISED AS WE CONTINUE TO EVALUATE YOUR CLAIM. IF YOU HAVE QUESTIONS, CONCERNS, OR ADDITIONAL INFORMATION REGARDING YOUR CLAIM, WE ENCOURAGE YOU TO CONTACT US.

(b) When providing a payment on a claim which is not the full and final payment for the claim, an insurer shall include with the payment the following statement printed in at least 12-point bold, uppercase type: WE ARE CONTINUING TO EVALUATE YOUR CLAIM INVOLVING YOUR INSURED PROPERTY AND MAY ISSUE ADDITIONAL PAYMENTS. IF YOU HAVE QUESTIONS, CONCERNS, OR ADDITIONAL INFORMATION REGARDING YOUR CLAIM, WE ENCOURAGE YOU TO CONTACT US.

(7)(a) Within 60 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer. The insurer shall provide a reasonable explanation in writing to the policyholder of the basis in the insurance policy, in relation to the facts or applicable law, for the payment, denial, or partial denial of a claim. If the insurer’s claim payment is less than specified in any insurer’s detailed estimate of the amount of the loss, the insurer must provide a reasonable explanation in writing of the difference to the policyholder. Any payment of an initial or supplemental claim or portion of such claim made 60 days after the insurer receives notice of the claim, or made after the expiration of any additional timeframe provided to pay or deny a claim or a portion of a claim made pursuant to an order of the office finding factors beyond the control of the insurer, whichever is later, bears interest at the rate set forth in s. 55.03. Interest begins to accrue from the date the insurer receives notice of the claim. The provisions of this subsection may not be waived, voided, or nullified by the terms of the insurance policy. If there is a right to prejudgment interest, the insured must select whether to receive prejudgment interest or interest under this subsection. Interest is payable when the claim or portion of the claim is paid. Failure to comply with this subsection constitutes a violation of this code. However, failure to comply with this subsection does not form the sole basis for a private cause of action.

(b) Notwithstanding subsection (5), for purposes of this subsection, the term “claim” means any of the following:

1. A claim under an insurance policy providing residential coverage as defined in s. 627.4025(1);

2. A claim for structural or contents coverage under a commercial property insurance policy if the insured structure is 10,000 square feet or less; or

3. A claim for contents coverage under a commercial tenant policy if the insured premises is 10,000 square feet or less.

(c) This subsection does not apply to claims under an insurance policy covering nonresidential commercial structures or contents in more than one state.

(8) The requirements of this section are tolled:

(a) During the pendency of any mediation proceeding under s. 627.7015 or any alternative dispute resolution proceeding provided for in the insurance contract. The tolling period ends upon the end of the mediation or alternative dispute resolution proceeding.

(b) Upon the failure of a policyholder or a representative of the policyholder to provide material claims information requested by the insurer within 10 days after the request was received. The tolling period ends upon the insurer’s receipt of the requested information. Tolling under this paragraph applies only to requests sent by the insurer to the policyholder or a representative of the policyholder at least 15 days before the insurer is required to pay or deny the claim or a portion of the claim under subsection (7).

(9) This section also applies to surplus lines insurers and surplus lines insurance authorized under ss. 626.913-626.937 providing residential coverage.

History.—s. 23, ch. 2005-111; s. 27, ch. 2007-1; s. 18, ch. 2007-90; s. 20, ch. 2011-39; s. 18, ch. 2021-104; s. 15, ch. 2022-268; s. 15, ch. 2022-271.

Note.—Former s. 627.4261.

F.S. 627.70131 on Google Scholar

F.S. 627.70131 on Casetext

Amendments to 627.70131

Arrestable Offenses / Crimes under Fla. Stat. 627.70131

Level: Degree
Misdemeanor/Felony: First/Second/Third

Current data shows no reason an arrest or criminal charge should have occurred directly under Florida Statute 627.70131.

Annotations, Discussions, Cases:

Cases Citing Statute 627.70131

Total Results: 19

AYMEE TAYLOR, INDIVIDUALLY AND ON BEHALF OF THOSE SIMILARLY SITUATED v. STATE FARM FLORIDA INSURANCE COMPANY, A FLORIDA INSURANCE CORPORATION

Court: Fla. Dist. Ct. App. | Date Filed: 2024-04-12T00:00:00-07:00

Snippet: private causes of action contained in section 627.70131(5), Florida Statutes (2020). Taylor now argues… at the language of the Policy and of section 627.70131(5)(a) (“section 5(a)”). Pertinent to this appeal…will be paid in accordance with Section 627.70131(5) of the Florida Insurance Code. …this subsection constitutes a 1 Section 627.70131 was amended in 2021 and subsection (5)(a) was …basis for a private cause of action. § 627.70131(5)(a), Fla. Stat. (2020) (emphasis added).

Fernando Cantens and Ana Marie Cantens v. Certain Underwriters at Lloyd's London, etc.

Court: Fla. Dist. Ct. App. | Date Filed: 2024-02-14T00:00:00-08:00

Snippet: made a determination of coverage under s. 627.70131. § 627.70152(3)(a), Fla. Stat. (2021). The trial…has made a determination of coverage under s. 627.70131.”), with § 627.736(10)(a), Fla. Stat. (“Such

AYMEE TAYLOR, INDIVIDUALLY AND ON BEHALF OF THOSE SIMILARLY SITUATED v. STATE FARM FLORIDA INSURANCE COMPANY, A FLORIDA INSURANCE CORPORATION

Court: Fla. Dist. Ct. App. | Date Filed: 2024-02-02T00:00:00-08:00

Snippet: action. § 627.70131(5)(a), Fla. Stat. (2020) (emphasis added). 1 Section 627.70131 was amended…private causes of action contained in section 627.70131(5), Florida Statutes (2020). Taylor now argues… at the language of the Policy and of section 627.70131(5)(a) (“section 5(a)”). Pertinent to this appeal…will be paid in accordance with Section 627.70131(5) of the Florida Insurance Code. … the time the Policy was in effect, 1 section 627.70131(5) provided: (a) Within 90 days

REBECCA HUGHES v. UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY

Court: Fla. Dist. Ct. App. | Date Filed: 2023-11-22T00:00:00-08:00

Snippet: 3 determination of coverage under s. 627.70131. . . . The notice must state with specificity

HERMAN COLE v. UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY

Court: Fla. Dist. Ct. App. | Date Filed: 2023-05-03T00:53:00-07:00

Snippet: made a determination of coverage under s. 627.70131. . . . § 627.70152(3)(a), Fla. Stat. (2021).

THE KIDWELL GROUP, LLC, D/ B/ A AIR QUALITY ASSESSORS OF FLORIDA , A/ A/ O ROBERT AND MAUREEN MUCCIACCIO v. AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA

Court: Fla. Dist. Ct. App. | Date Filed: 2022-09-16T00:53:00-07:00

Snippet: made a determination of coverage under s. 627.70131. The notice must specify the damages in dispute

HOMEOWNERS CHOICE PROPERTY & CASUALTY INSURANCE COMPANY v. PATRICK FRASER AND ALICE JACOBS

Court: Fla. Dist. Ct. App. | Date Filed: 2022-09-07T00:53:00-07:00

Snippet: received notice of the claim pursuant to section 627.70131, Florida

THE DENTAL LAW FIRM, P.A. d/b/a SHOCHET LAW GROUP v. PAUL KINCER, SCOTT MOORE, and THE PEOPLE'S CHOICE PUBLIC ADJUSTERS, LLC

Court: Fla. Dist. Ct. App. | Date Filed: 2022-08-17T00:53:00-07:00

Snippet: insurer’s request was untimely pursuant to section 627.70131(5)(a), Florida Statutes (2017): Within …which reasonably prevent such payment. … § 627.70131(5)(a), Fla. Stat. (2017) (emphases added). Based… the property had been untimely under section 627.70131(5)(a). Without any opposition having been filed…out the insurance claim before [section 627.70131(5)(a)’s] [ninety-]day deadline …. (paragraph… the insurer’s failure to comply with section 627.70131(5)(a)’s ninety-day deadline to inspect the property

TOTAL CARE RESTORATION, LLC a/a/o ANNIE GRIFFITHS v. CITIZENS PROPERTY INSURANCE CORPORATION

Court: Fla. Dist. Ct. App. | Date Filed: 2022-04-20T00:53:00-07:00

Snippet: made a determination of coverage under s. 627.70131. The notice must specify the damages in

EXPERT INSPECTIONS, LLC v. UNITED PROPERTY & CASUALTY INSURANCE COMPANY

Court: Fla. Dist. Ct. App. | Date Filed: 2022-01-04T23:53:00-08:00

Snippet: the next 14 days in compliance with Fla. Stat. 627.70131.” The insurer admitted it received the claim. … to receive payment. Under section 627.70131(1)(a), Florida Statutes (2018), the insurer was…the 90 days within which, pursuant to section 627.70131(5)(a), Florida Statutes (2018), the insurer was

WINSTON DIAS and KATHLEEN DIAS v. UNIVERSAL PROPERTY AND CASUALTY INSURANCE COMPANY

Court: Fla. Dist. Ct. App. | Date Filed: 2021-11-03T00:53:00-07:00

Snippet: of the statutory period contained in section 627.70131(5)(a), Florida Statutes (2020), which provides

PEOPLE'S TRUST INSURANCE COMPANY v. PEDRO R. RAMOS SANTOS

Court: Fla. Dist. Ct. App. | Date Filed: 2021-05-12T00:53:00-07:00

Snippet: People’s Trust had violated sections 627.7011, 627.70131, and 627.7142 of the Florida Statutes. Because…s purported violations of sections 627.7011, 627.70131 and 627.7142 of the Florida Statutes. Namely,…with the Homeowner Claims Bill of Rights) and 627.70131(1)(a) (insurer’s duty to acknowledge communications…Insureds’ complaint neither cited to sections 627.70131 and 627.7142 nor contained any allegations with…627.7142 and that any alleged violation of section 627.70131 was not a breach of the policy and, therefore

THOMAS BARBATO AND YVONNE BARBATO v. STATE FARM FLORIDA INSURANCE COMPANY

Court: Fla. Dist. Ct. App. | Date Filed: 2021-03-17T00:53:00-07:00

Snippet: neither Tracey nor its progeny violate section 627.70131(5)(a), Florida Statutes (2019), we decline to

STATE FARM FLORIDA INSURANCE COMPANY v. DAVID HILL AND BETTY HILL

Court: Fla. Dist. Ct. App. | Date Filed: 2020-11-24T23:53:00-08:00

Snippet: State Farm had “wholly denied coverage under § 627.70131(5)(a), Florida Statute[s].” 1,2 1 The statute… sole basis for a private cause of action. § 627.70131(5)(a), Fla. Stat. (2019). 2 On June 24, 2020…knowledge of State Farm’s “compliance” with section 627.70131(5)(a) of the Florida Statutes; and (ii) requested…policy and guidelines” for complying with section 627.70131(5)(a). State Farm then moved for a protective … requested discovery with respect to section 627.70131(5)(a) is nevertheless impermissible. See Gov’

Castro v. Homeowners Choice Property & Casualty Insurance Company

Court: Fla. Dist. Ct. App. | Date Filed: 2017-08-23T00:00:00-07:00

Citation: 228 So. 3d 596, 2017 WL 3614102

Snippet: claim” in section 627.70131(5)(a),. Florida Statutes (2014), is misplaced. Section 627.70131(5)(a) authorizes

Citizens Property Insurance Corporation v. Nunez

Court: Fla. Dist. Ct. App. | Date Filed: 2016-06-24T00:00:00-07:00

Citation: 194 So. 3d 1064, 2016 Fla. App. LEXIS 9693, 2016 WL 3450426

Snippet: that reasonably prevented ⅛ payment. Section 627.70131(5)(a)‘ Florida Statutes (2013), authorizes an …alteration in original). Interestingly, section 627.70131(5)(a) also provides that “[i]f there is a right…subsection.” This provision clarifies that section 627.70131(5)(a) is not necessarily a statutory source for

Tower Hill Select Insurance Company v. McKee

Court: Fla. Dist. Ct. App. | Date Filed: 2014-08-20T00:00:00-07:00

Citation: 151 So. 3d 2, 2014 WL 4086807, 2014 Fla. App. LEXIS 12784

Snippet: control that reasonably prevented payment. Section 627.70131(5)(a), Florida Statutes (2013), authorizes an

Great Lakes Reinsurance (U.K.) PLC v. Branam

Court: Fla. Dist. Ct. App. | Date Filed: 2013-03-06T00:00:00-08:00

Citation: 126 So. 3d 297, 2013 WL 811677, 2013 Fla. App. LEXIS 3504

Snippet: the policy claims. Further, relying on section 627.70131(5)(a), Florida Statutes (2009), which sets forth…on by the trial court was derived from section 627.70131(5)(a), Florida Statutes, which states: *303Within…prevent such payment.... On its surface, section 627.70131(5)(a) would seem to govern the instant set of …reasons. First, the plain language of section 627.70131(4) specifies that “[f|or purposes of this section

State Farm Florida Insurance Co. v. Silber

Court: Fla. Dist. Ct. App. | Date Filed: 2011-10-19T00:00:00-07:00

Citation: 72 So. 3d 286, 2011 Fla. App. LEXIS 16362

Snippet: of prejudgment interest, pursuant to section 627.70131(5)(a), Florida Statutes (2009), and a subsequent…award of interest was not permitted under section 627.70131(5)(a), which provides that “this subsection shall… sole basis for a private cause of action.” § 627.70131(5)(a), Fla. Stat. (2009). At a subsequent hearing…statutory interest. 2. Pursuant to Fla. Stat. § [] 627.70131(5)(a), State Farm owes interest, because it did…of action for statutory interest under section 627.70131(5)(a); and *289(2) to establish a basis for attorney