Let me talk a little more about fuzzy language and connect that to what the courts actually are saying about it, what they will do, what they are being directed to do by the appellate courts in our state, which is this fuzzy language concept in these insurance policies. That is to me the most important focus that a lawyer should place on this whole insurance thing.
The appellate court in the case that I talked about which I brought, made it clear to all the courts in Florida how the courts are supposed to view these long-term care insurance policies. Basically what the court said and I’m going to read directly from the decision that we received: “An insurer is required to make clear precisely what is excluded from coverage.” And then the appellate court stated from another case as follows, “As the supreme court observed long ago, so long as an insurance contract is drawn in a manner that it requires the proverbial lawyer to comprehend the terms embodied in it, the courts should and will construe them liberally in favor of the insured and strictly against the insurer to protect the buying public who rely upon the companies and agencies in such transactions.” That’s very strong language and that’s a directive by the courts on how to deal with policies that are drawn with fuzzy language. But even more so in long term care insurance the court said, “The failure to adhere to this principle,” (this principle being the clarity in the drawing up or writing of an insurance contract), “The failure to adhere to this principle is especially pernicious, which means especially harmful, in this particular field of long term care insurance because a person an elderly person making plans for the possible consequences of the infirmities of old age is entitled to believe that he or she is buying protection against the common expenses of care such as vital services of a home health aide and homemaker and so forth.”
What I’m trying to convey here is that the courts not only are very serious in their directive to the insurance companies. They have to write contracts that are clear, and they’re going to be even more scrutinizing of insurance policies dealing with elderly people, specifically long term care policies so that if a person who is insured under long term care policy read their policy and it seems as though it should be covering something and they’re being told by the insurance company no it doesn’t mean that, the insured person must know that the courts are going to look at that policy in a light most favorable to the insured person and if the contract is not clear the insured person is going to get the benefits.
That is the public policy in the state of Florida and the public policy that the court in this case laid down specifically in reference to long-term care insurance policies. So people have to know and understand that the courts are going to protect them, especially when it involves a long-term care insurance issue.
So now how does an individual perfect their rights? How does a person pursue their rights when they have a controversy like that? They have to get a lawyer. They can’t do it by themselves. They have to get a lawyer, have to file an action against the insurance company. The lawyer will file the action, take that insurance policy to the court and lay out why that policy is not written with clarity and why the individual should be getting the benefits that they require.
The way that we work is called a contingency basis. That simply means that our getting paid is contingent upon us getting a favorable recovery on behalf of our clients. If we don’t get a favorable result, our clients are not responsible to pay any fee. Furthermore, in Florida, if we have to sue an insurance company on behalf of an insured person and we prevail, the Florida statute says that the insurer is going to have to pay a substantial if not all of the fees associated with bringing the action.
It’s a great policy that our state has because without it, insurers could deny all the time without any recourse. But with the attorney fee provision in the law, they have to think twice before they deny because if they’re going to have to pay not only their own lawyers to defend these bad policies but also have to pay the lawyers for the individuals who brought the action, so people don’t have to be afraid that they’re going to get wrapped up in a lawsuit that costs them money, or afraid they’re going to get caught up in the legal system. The law is in their favor as it should be and if there’s a bad policy the court is going to rule in their favor. They should not be afraid to pursue their rights, in fact they must pursue their rights. If they need care under the policy that they bought that’s supposed to provide them with care and the insurer is refusing to provide it, they should pursue their rights. They should not be without the care they need. And that’s how it works. And that’s how we work, on a contingency basis.