Mediation gives you the opportunity to settle claim disputes with your insurance company by allowing you to meet with them in an informal setting (conference) with a certified, neutral mediator or (Sinkhole) Neutral Evaluator to assist in resolving your claim.
Mediation is non-binding, which means none of the parties are required to accept the outcome.
The following programs are currently available:
Residential property mediation allows you to settle disputes regarding all residential property claims resulting from damage to your house, dwelling, mobile home or condominium. Mediation is a pre-appraisal and pre-suit process that allows you to meet with your insurance company in an informal setting (conference) with a certified, neutral mediator to assist in resolving your claim.
If a settlement is reached, you have three business days to rescind the agreement as long as you have not cashed the check and you inform the company of your decision.
Who can request Mediation?
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.
If the policyholder or third-party assignee is represented by an attorney or public adjuster, the Department will need a copy the public adjuster contract and/or the attorney's Letter of Representation to ensure they are included in mediation notifications.
What is an Assignment of Benefits?
An AOB is an agreement, that once signed, transfers the insurance claims rights or benefits of the policy to a third-party. An AOB gives the third-party authority to file a claim, make repair decisions, and collect insurance payments without the involvement of the policyholder(s). Depending on the language in the AOB, the insurance company may only be permitted to communicate directly with the third-party and you may lose all rights to the insurance claim, including the right to mediate the claim, or to make any decisions regarding the claim, including repairs.
Is my dispute eligible?
A dispute must be $500 or more after the deductible is applied. The dispute must be a disagreement over what caused the damage or if you do not agree with the amount the company offered to repair the damages. If the dispute does not meet the eligibility requirements, yet the parties agree to participate in mediation, written documentation is required for the Department to proceed.
What happens next?
Upon receipt of an eligible request for mediation, a mediator will be assigned to conduct the conference. The conference is to occur within 21 (calendar) days of the mediator's assignment.
When applicable, good cause continuances can be requested by the parties. Good cause includes severe illness, injury, or other emergency which could not be controlled by the party and could not reasonably be remedied by the party prior to the conference by providing a replacement representative or otherwise. Good cause includes the necessity of obtaining additional information, securing the attendance of a necessary professional, or the avoidance of significant financial hardship.
Who can attend?
Review your policy carefully to confirm who is listed as "named insured". All policyholders listed on the claim's effective policy must attend the conference.
It is not necessary to have an attorney present. However, if you choose to retain and attorney, please notify the mediator and the Department at least 14 (calendar) days prior to the conference date.
The conference may also be attended by person who can assist a party in presenting the claim or defense in the conference, such as contractors, adjusters, engineers and interpreters.
What if there is an Assignment of Benefit (AOB) contract signed?
If the policyholder(s) and AOB both retain rights to the claim, all with rights must attend the conference. If only the AOB retains right to the claim, the policyholder(s) do not need to be in attendance (as they no longer have settlement authority).
What should I bring?
Be sure to bring any supporting documents including your policy, photographs, estimates, bills, reports, letters, etc. It is important to bring specific dollar estimates or quotes for all items that are in dispute.
Cost of Mediation:
The insurance company pays the entire cost ($350) of the mediation unless you fail to appear at the conference and want to reschedule the mediation. You must pay the rescheduled mediation costs ($350) prior to the conference being rescheduled.
Additional Information:
Reference: Florida Statute 627.7015 and Rule 69J-166.031
Automobile mediation allows you to settle insurance claim disputes caused by the ownership, operation, and use or maintenance of a motor vehicle. Mediation is a pre-suit process that allows you to meet with the insurance company in an informal setting (conference) with a certified, neutral mediator to assist in resolving your claim.
Claims against your insurance company and claims against the other party's insurance company are both eligible for mediation. Automobile mediation is voluntary. Neither you nor the insurance company are required to participate. However, if you or the insurance company choose not to participate in mediation, that party must notify the Department of Financial Services in writing, of the specific reasons for not participating.
Who can request Mediation?
Mediation may be requested by first-party claimants (for a claim dispute against your own insurance company) and third-party claimants (for a claim dispute against someone else's insurance company). First-party claims will be governed by the terms and conditions for mediation specified in your insurance policy.
The insurance company may also request mediation.
If the claimant is represented by an attorney or public adjuster, the Department will need a copy of the public adjuster's contract and/or the attorney's Letter of Representation to ensure they are included in mediation notifications.
Is my dispute eligible?
Automobile mediation allows you to settle disputes for property damage claims in any amount or for bodily injury claims up to $10,000.
What happens next?
Upon receipt of an eligible request for mediation, the Department will notify the respondent and provide them 21 (calendar) days to decline in writing.
If notice of decline, notice of settlement, notice of withdraw from the requester or any information to support in-eligibility is not provided to the Department before the 21-day resolution period expires, a mediator will be assigned to conduct the conference. The conference is to occur within 21 (calendar) days of the mediator’s assignment. When applicable, a mediator can grant a continuance if good cause is shown or if neither party objects. All parties shall be notified of the date and place of the rescheduled conference.
Who can attend?
For first-party claims, all policyholders listed on the claim's effective policy must attend the conference. Review your policy carefully to confirm who is listed as "named insured." For third-party claims, all third-party claimants must attend the conference.
All corporate parties who are complainants or respondents must provide a corporate representative who has full knowledge of the facts of the dispute and is fully authorized to make an agreement to completely resolve the dispute.
What should I bring?
Be sure to bring any supporting documents including your policy, photographs, estimates, bills, reports, letters, etc. It is important to bring specific dollar estimates or quotes for all items that are in dispute.
Cost of Mediation:
The insurance company pays the entire cost ($200) of the mediation conference unless you fail to appear at the conference and want to reschedule the mediation. You must pay the rescheduled mediation costs ($200) prior to the conference being rescheduled.
Additional Information:
Reference: Florida Statute 627.745 and Rule 69J-176.022
Upon receipt of a claim for a sinkhole loss to a covered building, Florida law requires insurance companies to inspect the premises to determine if there has been structural damage that may be the result of sinkhole activity.
If the insurer discovers structural damage which is consistent with a sinkhole loss, or if the insurer is unable to identify a valid cause of such damage, the insurer must engage a professional engineer or geologist to conduct testing to determine the cause of loss within a reasonable professional probability. The professional engineer or geologist will provide a report of their findings to the insurer.
Following the receipt of the report or the denial of a claim for a sinkhole loss, the insurer is required to notify the policyholder of their right to participate in the neutral evaluation program.
If your insurance company denied a claim for loss or damage based on the results of the testing, or you cannot agree on the method of repair and remediation, you have the option to request a Neutral Evaluation.
What if my insurance company denies my claim without conducting testing and a sinkhole report?
Within 60 days of the claim denial, you must send a demand for geological testing, in writing, to your insurance company. You will have to pay 50% of the actual costs of the testing or $2,500, whichever is less. If a sinkhole loss is confirmed, your insurance company will reimburse you for the costs of the testing.
How does the Neutral Evaluation Program work?
The Neutral Evaluation program provides a professional engineer or a professional geologist to serve as an objective third party to determine the existence of a sinkhole loss and the method of repair and remediation. The Neutral Evaluator will schedule a conference with you and your insurance company to gather information to help him or her reach a decision.
Your insurance company is required to pay the reasonable costs associated with the Neutral Evaluation program. You will be required to pay for a court reporter or stenographer if you choose to have one at the Neutral Evaluation conference.
Neutral Evaluation is mandatory if requested by you or your insurance company. The Neutral Evaluation is non-binding, and both parties retain their right to pursue legal action. The Neutral Evaluator's written recommendation, oral testimony, and full report shall be admitted in any subsequent legal action.
Then what?
The Department will provide a list of certified Neutral Evaluators to you and your insurance company. You have 14 business days to mutually select a Neutral Evaluator. If you and your insurance company cannot agree on a Neutral Evaluator, the Department will appoint one from the list.
Each party can submit requests to disqualify any Neutral Evaluator on the list "for cause."
Additionally, each party can disqualify up to two Neutral Evaluators "without cause."
Once assigned, the Neutral Evaluator has 14 business days to notify you and your insurance company of the date, time and place of the conference. The Neutral Evaluator will make a reasonable effort to hold the conference within 90 days after the receipt of the request. If the Neutral Evaluator does not hold the conference within 90 days, it does not invalidate either party's right to neutral evaluation or to a neutral evaluation conference held outside this timeframe.
You must allow the Neutral Evaluator reasonable access to the interior and exterior of your home and provide him or her with any report you or your representative initiated.
Both parties retain their right to pursue legal action. However, filing a request for neutral evaluation tolls the applicable time requirements for filing suit for 60 days following the conclusion of the neutral evaluation process or the time prescribed in Florida Statute 95.11, whichever is later.
Additional Information:
Reference: Florida Statute 627.7074 and Rule 69J-8
Residential property mediation allows you to settle disputes regarding all residential property claims resulting from policies in which a Condominium Association, Cooperative Association or Homeowners' Association are the policyholder. Mediation is a pre-appraisal and pre-suit process that allows you to meet with your insurance company in an informal setting (conference) with a certified, neutral mediator to assist in resolving your claim.
If a settlement is reached, you have three business days to rescind the agreement as long as you have not cashed the check and you inform the company of your decision.
Mediation is an informal way to resolve claims between the policyholder and the insurance.
Who can request Mediation?
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.
If the policyholder or third-party assignee is represented by an attorney or public adjuster, the Department will need a copy the public adjuster contract and/or the attorney's Letter of Representation to ensure they are included in mediation notifications.
What is an Assignment of Benefits?
An AOB is an agreement, that once signed, transfers the insurance claims rights or benefits of the policy to a third-party. An AOB gives the third-party authority to file a claim, make repair decisions, and collect insurance payments without the involvement of the policyholder(s). Depending on the language in the AOB, the insurance company may only be permitted to communicate directly with the third-party and you may lose all rights to the insurance claim, including the right to mediate the claim, or to make any decisions regarding the claim, including repairs.
Is my dispute eligible?
A dispute must be $500 or more after the deductible is applied. The dispute must be a disagreement over what caused the damage or if you do not agree with the amount the company offered to repair the damages. If the dispute does not meet the eligibility requirements, yet the parties agree to participate in mediation, written documentation is required for the Department to proceed.
What happens next?
Upon receipt of an eligible request for mediation, the Department will notify the parties that they have 21 (calendar) days to otherwise resolve the dispute before a mediator is assigned. If notice of settlement, the notice of withdrawal from the requester or any information to support in-eligibility is not provided to the Department before the 21-day resolution period expires, a mediator will be assigned to conduct the conference. The conference is to occur within 21 (calendar) days of the mediator's assignment.
Who can attend?
Review your policy carefully to confirm who is listed as "named insured". All policyholders listed on the claim's effective policy must attend the conference.
All corporate parties who are complainants or respondents shall be represented at the conference by a corporate representative who has full knowledge of the facts of the dispute and is fully authorized to make an agreement to completely resolve the dispute.
It is not necessary to have an attorney present. However, if you choose to retain and attorney, please notify the mediator and the Department at least 7 (calendar) days prior to the conference date.
The conference may also be attended by person who can assist a party in presenting the claim or defense in the conference, such as contractors, adjusters, engineers and interpreters.
What if there is an Assignment of Benefit (AOB) contract signed?
If the policyholder(s) and AOB both retain rights to the claim, all with rights must attend the conference. If only the AOB retains right to the claim, the policyholder(s) do not need to be in attendance (as they no longer have settlement authority).
What should I bring?
Be sure to bring any supporting documents including your policy, photographs, estimates, bills, reports, letters, etc. It is important to bring specific dollar estimates or quotes for all items that are in dispute.
If the policyholder is a condominium, cooperative, or homeowners' association, the governing board of those properties and entities created by the provisions of chapters 718, 719 and 720, F.S., shall cause to be prepared the following documentation for review at the mediation conference:
a. A document by which the governing board for the property or entity designates an authorized representative. The document shall provide the name of the condominium or cooperative, the name of the association, the date of the meeting at which the designation was made, the name of the designated individual(s), and the authority granted to said individual(s).
b. A copy of those provisions in the governing documents for the property and entity which relate to (i) the insurance responsibilities of the entity and (ii) the responsibilities of the entity and the unit owners of the property for maintaining and repairing the property.
c. For claims where there is damage to the structure of the building or foundation, a written, expert analysis of the damage to the property consistent with the standards required in subsections 607.0830(2) and 617.0830(2), F.S.
d. A written analysis of the damage to the property that allocates the estimated damages between the individually owned parcels or units, the common elements or common areas, and the entity's property in a manner consistent with the governing documents.
Cost of Mediation:
The insurance company pays the entire cost of the mediation, which shall not exceed $5,000, unless you fail to appear at the conference and want to reschedule the mediation. You must pay the rescheduled mediation costs (a sum equal to the fees paid by the company for the first scheduled mediation) prior to the conference being rescheduled.
This sum shall be applied towards the second mediation with the insurer paying the balance of the cost of that second mediation.
Additional Information:
Reference: Florida Statute 627.7015 and Rule 69J-166.002
If you are having difficulty with your claim and are interested in one of our mediation programs, you may contact the Department of Financial Services (DFS) using the information listed below.
