MEDIATION

What is 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 10 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 Settlements reached at the conference can be rescinded within three days of the agreement as long as the check has not been cashed.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 03/30/2018, 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 a 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 actual cash expenses of the policyholder in attending the rescheduled conference and 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