Automobile Claims

Q. What if the amount I owe to pay off my financed vehicle is more than the amount the company is willing to pay for its total loss?

A. The amount to replace a vehicle is based upon its Actual Cash Value (ACV) at the time of loss. This is the price you would expect to pay for a vehicle in similar condition and mileage at wholesale price. If you finance your car, especially for a longer period of time, the depreciation could be more than the amount of equity you have built up in the finance contract. Some insurance carriers offer “total replacement cost” and some auto finance contracts provide a “gap” coverage option. In absence of either of these options, you would have to pay your lender the difference.

Q. I have submitted a claim to my insurance company; however, the accident was not my fault. Will this claim affect my rates or claim experience? Who will pay my deductible?

A. If the liable party has sufficient property damage liability coverage, payment for your vehicle will be afforded from their carrier. If this is the case, you would not be responsible for your deductible. If you had your vehicle repaired and paid for by your insurance company and the other insurance company is denying liability, you will have to pay your deductible. Your insurance company will subrogate from the other carrier in an attempt to recover full payment of the claim and your deductible. Each time a claim is reported to an insurance company, it will show on your claim history, even if no payment was made under your policy. Although you are not at-fault for the accident, insurance companies evaluate all claim activity. If there is a claim pattern which is unacceptable to their underwriting standards or guidelines, your rates and eligibility for new or renewal coverage may be affected.

Q. I am confused about the different deductibles that apply to my claim or policy. Can you explain when and how these apply?

A. There are separate deductibles for collision and comprehensive losses. Collision is damage to your vehicle as a result of hitting or being hit by another object or vehicle (except contact with animals or “missiles and falling” objects). If you submit a collision claim to repair damage to your vehicle, even if it was caused by another party, your collision deductible will apply. Comprehensive is for all other damage such as wind, hail, fire, vandalism, or theft. If your vehicle is insured in Florida and you carry comprehensive coverage, damage to a windshield is repaired or replaced with no deductible applied.

Q. My vehicle was towed to a body shop affiliated with the towing company. Can I have my car repaired at my dealership or other body shop?

A. Most insurance companies will allow you to have your car repaired at a shop of your choice. Your insurance company will prepare an estimate to determine the cost to repair your vehicle. If the dealership or body shop you choose does not agree with the company estimate, you may be responsible for the difference between the amount paid by the insurance company and the amount charged by your repair facility. Please request your body shop or dealership prepare a written estimate prior to any repairs being made. Promptly forward the written estimate to the adjuster for review. If the estimate is approved and you wish to have the vehicle repaired at the body shop or dealership of your choice, notify the insurance company adjuster immediately to avoid accruing additional storage fees from the shop where your vehicle was towed. Oftentimes insurance companies will pay for “reasonable” towing and storage.

Q. Am I entitled to a rental car while my car is being repaired?

A. Many standard auto policies include some rental reimbursement coverage, i.e. $20 per day, up to $600. Coverage begins 24 hours after your vehicle is out of service due to a covered loss. If the cost exceeds the amount on your policy, you would be responsible for the difference. If the at fault driver’s insurance company is paying for your repair, they should agree to provide you a rental car. In the event your vehicle is stolen, transportation coverage would take affect 48 hours after the loss.

Q. When I rent a car, should I purchase the “Collision Damage Waiver” option? It seems quite expensive. Is it worth the cost?

A. There are several factors to consider when you evaluate the cost-benefit of this option. The easy answer is, yes; purchase it for peace of mind. Would you have other coverage for damage to the rental car if you don’t purchase it? In many cases you might have coverage from the credit card company who issued the card used to pay for the rental. Your automobile insurance policy may provide coverage for borrowed or rented vehicles. If you have comprehensive and collision on at least one of your insured vehicles, you would most likely have the same coverage for the rental vehicle. The problem occurs when the rental agreement obligates you for things that may not be covered on your insurance policy, such as, “total replacement value” of the rental car instead of its “actual cash value”. The rental contract may require immediate reimbursement for the damage, which would cause a large debit to your credit card. This is subject to your insurance policy deductible.

Q. I was involved in an automobile accident, however, I was not at-fault. I do not have collision coverage on my car. Will I be paid for the damage to my automobile?

A. You should contact the other driver’s insurance company. If they accept full liability for the accident and the driver has sufficient property damage coverage to pay for the damage to your vehicle, you will be paid for your loss. If the other carrier does not accept liability for the accident or is unresponsive to your attempts to have them accept liability, you may have to take civil action against the vehicle owner to recover payment for damage to your vehicle.

Commercial Auto Claims

Q. I allow my employee to drive our company vehicle home at night. What if he is in an accident on the way home or driving the vehicle to the store at night or on the weekend?

A. Your company, as well as its owners and officers, are covered for liability for a claim in this case as well as the damage to your vehicle as long as you maintain comprehensive and or collision coverage. Your employee driver is also covered by your policy if they are named in lawsuit as a result of that accident regardless of when they are operating the vehicle as long as it is with your permission.

Be certain though, that your employee understands that if they do not own and insure another vehicle in their household on a family auto policy or through a named non-owner policy, they have no coverage when driving any other vehicle whether it is a friend’s or non-household family member’s car. They are only covered while driving the business vehicle and only covered on your policy for that specific vehicle operation. This un-insured situation would also apply to an owner if they did not insure any personal vehicles on a personal auto policy. On your business auto policy, the coverage “follows” the vehicle unlike on a personal policy where the coverage “follows” the driver.

Q. What if the amount I owe to pay off my financed vehicle is more than the amount the Adjuster is willing to pay for its total loss?

A. The amount to replace a vehicle is based upon its Actual Cash Value (ACV) at the time of loss. This is the price that you could expect to pay for a vehicle in similar condition and mileage at wholesale price. If you finance your car, especially for a longer period of time, the depreciation could be more than the amount of equity you have built up in the finance contract. Some insurance carriers offer “total replacement cost” and some auto finance contracts provide a “gap” coverage option. In absence of either of these options, you would have to pay your lender the difference.

Q. One of my employees was in an accident while driving one of our company vehicles while on the job. He has some minor injuries. Who will pay for the medical costs for those injuries? What if he loses wages from work? What if he was not at fault?

A. For all work related injuries regardless if they are a result of a motor vehicle accident, (even if the employee is driving their own car for work) workers’ compensation benefits are primary and exclusive. The employee cannot sue the employer for any other benefits or compensation. Both medical expenses and lost wages would be covered under workers’ compensation on a primary basis. Personal Injury Protection under the auto policy would not apply.

If the employee was not at fault, they may at their option take a third part action (file suit) against the at-fault other driver as long as it is not an employee of the your company. Your workers’ compensation carrier would have a lien or subrogation right to any money awarded to the employee by that third party, but usually this amounts to less than 25 % due to allocating legal expenses, and other negotiated terms of the settlements.

Commercial Property Claims

Q. If I have materials that I have brought to a jobsite where we are the subcontractor and they have not been installed or utilized in our subcontract project and they are destroyed by a covered peril on my commercial property policy, am I covered for the loss? What if the materials have been installed, but the project is not yet completed and the materials or partially completed job is damaged by a covered peril?

A. In order for these materials to be covered by your insurance in either example, you must have a separate coverage called an “Installation Floater” If the materials were installed and in some cases are on the jobsite waiting to be installed, they could be covered by the Builder’s Risk policy usually secured by the Owner or General Contractor. Prior to the start of a contract, you should clarify in writing with the general contractor what material or work will be covered by the builder’s risk policy BEFORE you have a claim or start the work.

Q. My main office and warehouse buildings were just destroyed in a fire. I understand that the insurance will replace the building, but it is going to take at least 6 months to rebuild the building. I will have to take on a temporary operation center at a significant expense and will have many other expenses to get that new location up and running for the next 6 months. Also, I will not be able to serve any of my customers for at least 2 months while we get the new location going. I will lose significant revenue during this delay period. Am I covered for any of these expenses and lost revenue?

A. Many small business owners’ package policies (BOP) include coverage for actual loss of business INCOME (profit) and extra expense as a result of a shut-down caused by a covered peril such as fire. The coverage usually does not have a specific limit of coverage but usually only provide coverage for 12 months. Standard commercial property policies require the addition of a Business Interruption coverage form for a specific limit that you purchase. It is essential that you carefully evaluate your potential loss from a major catastrophe and choose your coverage accordingly based upon this calculated amount.

Q. I have an equipment floater policy for my larger equipment that I use in my business. I acquired a new backhoe over 8 months ago but forgot to add it to my schedule. It was stolen from the fenced in yard next to my building. Is it covered? What if it was stolen from a jobsite several miles away?

A. In many cases newly acquired property or equipment is covered for a limited period of time after acquisition automatically. However, this period is rarely more than 90 days. But, since the tractor was within 1000 feet of your building premises, it may be covered under your business personal property. However, the loss may be subject to deduction for depreciation and co-insurance clauses may apply. If it was stolen from a job-site and not on the “floater” then it is likely not covered.

Q. One of my employees, who is our vehicle maintenance mechanic, has brought all of his tools to our place of business to use in his work repairing our equipment. Does my insurance provide coverage for his tools?

A. There may be a limited amount of coverage for property of others (up to $2,500) including property of employees that is in your care, custody or control. It may be possible to increase this coverage if needed.

Personal Property Claims

Q. The claim I reported was for water damage (fire or smoke) in my home. What do I do?

A. You should take immediate action to minimize any further damage such as having the water removed from the premises, installing temporary coverings to any openings in the roof or walls. If you or the insurance adjuster have not contacted a restoration contractor, you should do so now. There are several companies that specialize in cleaning up and repairing this type of damage. Fireservice Disaster Kleenup is highly reputable in Southwest Florida.

Q. I am confused by the different deductibles which apply to my homeowner policy such as the wind or hurricane deductible. How are these deductibles applied to a claim or loss I have?

A. A “wind” deductible would apply to any wind damage loss during the year. This would include a hurricane, tornado, or any other damage caused by “wind.” A “hurricane” deductible is more specific and requires that a named storm be the cause of the property damage. Most wind and hurricane deductibles are stated as a percentage, generally 2% or 5%. The percentage applies to the value of the dwelling, not the amount of the damage. For example, if your dwelling is insured for $500,000 and you have a wind or hurricane deductible of 2%, your deductible for any hurricane or wind loss is $10,000.

Q. My jewelry valued at $15,000 was stolen from my home, but the insurance adjuster said I may only be covered for up to $1,000. Why isn’t my loss totally covered?

A. Most homeowner policies have a basic limit of $1,000 to $5,000 for theft of jewelry, watches, furs, silverware, guns, coins, stamps and other valuable articles. The best way to insure these special items is to “schedule” them on your policy for their full appraised value for an additional premium.

Q. If my minor child is playing baseball in the neighborhood and hits a ball through an expensive art glass window of the house next door, am I covered for this damage?

A. Yes. Property damage or bodily injury caused accidentally by any “insured” person (which includes your resident children and relatives) would be covered.

Q. My dependent daughter is attending college and is living in a dormitory on campus. She has taken many of her clothes and some furniture with her to use in her dormitory. Are they covered under my homeowner policy? What if she is living in an apartment instead of a dorm?

A. A “temporary residence” is covered as an insured location, which would include a dormitory that was not permanently occupied. An apartment would also be an insured location, as long as it was considered temporary. (If she comes home for the summer, this would imply a temporary residence.) If she lives there year round, this would be a permanent residence and she would need to obtain a tenant insurance policy. There is an extension of coverage that applies to this scenario or when property is put in storage. Coverage is typically limited to 10% of the personal property limit on the policy or $1,000, whichever is greater.

Q. If a visitor to my home slips and falls and injures themselves, what coverage do I have available on my policy?

A. There are two coverage parts that may provide coverage under your policy. The important issue is whether there was any negligence on your part which caused the incident to occur. Many times, people will fall and get hurt for no apparent reason other than their own carelessness. In this case, where there is no negligence on your part, medical payments to others, could provide a limited benefit for their medical costs. If it is determined an injury occurred as a result of your negligence, personal liability coverage would apply.

Q. If my house is damaged by an insured peril such as fire and I am unable to live in the home while it is being repaired what is the coverage for my expenses to live somewhere else?

A. Coverage for additional living expense incurred or fair rental value lost due to a covered loss is limited to the amount shown on your policy declarations. Normal expenses such as food are not considered additional living expenses. The cost of meals out may be considered if you were staying in a hotel or other temporary housing. These additional living expenses should be at moderately priced accommodations.

Q. My home had water damage that was covered and repaired by my insurance company. Several months later, I noticed that my family was feeling ill and an inspection of our home revealed we have mold. What coverage do we have for our illness and the removal and remediation of this mold problem?

A. More and more insurance policies are limiting or excluding coverage for mold damage to the home. Bodily injury liability resulting from mold exposure is almost always excluded from the policy.

Workers Compensation Claims

Q. How do I report an injury of my employee to my insurance carrier?

A. Most carriers have a toll free 24 hour claim reporting number for phoning in the details of the claim, or they may provide you with a FAX number if you wish to FAX a First Report of Injury form (DWC-1) to them instead. If you need the phone or FAX number call one of our Claims Professionals at 239-261-3646

Q. Does my company have to report minor claims even if we pay the medical provider directly?

A. Yes, any claim that is not considered “First Aid” must be reported for two reasons: First, the law says that you could be committing premium fraud if you under report your payroll or LOSS experience to obtain a lower premium. Second, if that minor claim should become more serious, especially unbeknownst to you such as when an employee leaves employment, your claim could be denied by the carrier from future reporting for failure to report it from the beginning.

Q. What is the definition of a “First Aid” claim?

A. A “First Aid” claim is defined as a claim that is treated at the place of injury and does not generate a bill or charges for treatment. Therefore, any injury that is treated off premises that generates a bill for that treatment is reportable.

Q. How many employees must I have before I am required to purchase workers’ compensation insurance?

A. If you are in an industry, other than construction, and have four or more employees, full-time or part-time, you are required to carry workers’ compensation coverage (an exempted corporate officer does not count as an employee). If you are in the construction industry, and have one or more employees (including yourself), you are required to carry workers’ compensation coverage (an exempted corporate officer or member of a limited liability company does not count as an employee).

Q. My employee claims to have been injured on the job and is seeking treatment, but no one witnessed the accident. Is this injury covered and do I need to report it?

A. Yes. If a medical doctor confirms the need for treatment is at least 51% as a result of the “injury” claimed by the employee, it must be reported and would be covered. An employee need not “prove” their accident took place, but an employer can and would have to “prove” that injury did not occur in order for the claim to be denied on that basis.

Q. Our company was told that we could reduce our “Mod Factor” and save money on our premium. How does that work?

A. Every company that generates a minimum of at least $5,000 of premium for two years or $10,000 in a recent year has an Experience Modification Rate (EMR) calculated and assigned to the company regardless of the insurance carrier. That factor can be less than “1.00” (a credit) or more than “1.00” (a debit). This factor is based upon your loss experience compared to an expected loss experience for similar businesses in the same industry class. By reducing the number of claims and their payment amount, you can reduce the EMR and reduce your premium. Assisting you with managing this factor and your claims is one of the value added services provided directly to your company by Gulfshore Insurance.

Q. Avoid Injuries to Truck Drivers

A. We know that workplace injuries are costing your business money in a many ways; increased insurance premiums, cost of hiring and replacement, lost efficiency, additional training, increased paperwork and administrative costs, and more.

According to the Bureau of Labor Statistics, professional truck drivers suffer more injuries than any other industry.

Why are these injuries happening?

A recent 10 year study out of Washington state gives us the statistics behind the leading Truck Driver injuries…

  • 40% are due to Musculoskeletal Injury (strains, sprains, pulls, overexertion, etc.)
  • 19% are due to Falls from Elevation or Same Level (mostly getting in or out of the vehicle)
  • 12% are due to being Struck By or Against an Object (falling object, swinging door, etc.)
  • 9% are due to Vehicle Crashes

Most of these injuries are preventable with the proper training, planning and awareness.  Keep your employees safe and your premiums and other injury costs down by taking a proactive approach.


Scenario: Moving containers or equipment (boxes, crates, bins etc.)Solution: Provide proper lift training and “strategy”.  Employees should first evaluate, then lift.  Use mechanical aids when necessary.

Falls from Elevation or Same Level

Scenario: Falling while entering/exiting the vehicle and trailer/loading area.

Solution:  Use the “3-Point Contact” rule when entering or exiting – no jumping.  Provide proper step conditions (step ladder to cab/trailer).  Provide training and reminders that employees cannot jump from trailer or cab.

Struck by or Against an Object

Scenario: Struck by container or loose cargo.

Solution:  Provide ample equipment to secure/store cargo properly.  Replace binders/straps if they are worn.  Train employees on proper stacking and loading techniques.


Scenario: 29% of all crashes are Rear-End Collisions.  Most of these are due to following too closely.

Solution:  Use a “4-second rule” when following another vehicle.  Reduce speed increase following distance in poor/wet conditions.  Constantly discuss and remind drivers of the importance of keeping proper following distance.  Provide trainings and information about proper following techniques.

Investing in safety and training for your employees will pay dividends by keeping insurance premiums and injury related costs down over the long haul.

At Gulfshore Insurance, we specialize in insurance and risk management in the trucking and transportation industry. We work with more than 10,000 clients throughout Florida and we are happy to assist you with training materials, safety programs, and insurance for your business.

Q. 2022 Midyear Market Outlook – Workers’ Compensation Insurance

A. Unlike other forms of coverage, the workers’ compensation insurance market has stayed resilient in recent years. Accord­ing to the National Council on Compensation Insurance (NCCI), the segment’s private carrier combined ratio in 2021 was 87, matching 2020’s results and marking the eighth con­secutive year of underwriting profit.

Additionally, industry data confirmed workers’ compensation coverage was the only major commercial line of business to generate a negative average rate change in the first quarter of 2022 at -1.23%. Although the COVID-19 pandemic contrib­uted to some fluctuations in the number of workers’ compen­sation claims and associated costs, insurance experts predict claim frequency will continually decline while claim severity will see moderate changes—thus maintaining the market’s robust reserves. Looking ahead, the segment should remain stable, with most policyholders experiencing rate decreases and others seeing minimal rate increases.

Developments and Trends to Watch

  • Labor shifts—Over the past year, many employees have begun leaving their jobs in search of positions that offer greater work-life balance, flexibility and benefits, coining a new employment trend known as the “Great Reshuffle.” This trend has led to a rise in short-tenured employees and increased labor shifts between industries. Such changes present several workers’ compensation implications. Accord­ing to the NCCI, short-tenured employees have significantly higher injury frequency rates than their long-tenured coun­terparts, potentially contributing to additional workers’ compensation claims—especially in the construction, manu­facturing and wholesale trade sectors.
  • Wage inflation issues—In efforts to attract and retain employ­ees amid the Great Reshuffle, many businesses have increased their workers’ pay. Although this trend is happen­ing across industry lines, it has been most prevalent in sec­tors with a large proportion of lower-wage positions (e.g., leisure and hospitality), according to the NCCI. Because pay­roll is leveraged as an exposure base to calculate workers’ compensation premiums, wage inflation could prompt increased rates. After all, higher wages are tied to greater benefits, and it’s important for benefits and premiums to remain in balance. The NCCI also reported that the surge in employees receiving raises and moving from lower-wage positions to higher-paying roles could create short-term dis­connects between wages, benefits and workers’ compensa­tion premiums.
  • Gig economy challenges—Gig workers are individuals who work on demand and at will by performing short-term jobs or tasks for multiple clients. As the gig economy expands, busi­nesses that utilize such workers have encountered various challenges. In particular, some states have developed legisla­tion regarding whether gig workers should be classified as employees or independent contractors. Making this distinc­tion is critical, as it determines the workers’ compensation benefits each type of worker is entitled to. Generally, an employee would be protected by a business’s workers’ com­pensation program and receive certain benefits following a job-related illness or injury (e.g., covered treatment costs, reimbursement for lost wages and return-to-work resources), whereas an independent contractor would not.

Tips for Insurance Buyers

  • Implement occupational safety and health programs to address common risks in the workplace. Ensure all employees receive proper safety training.
  • Develop an effective return-to-work program that adequately supports employees in the processes of healing from work-related illnesses or injuries and resuming job duties.
  • Establish workplace wellness initiatives aimed at prevent­ing or treating chronic health conditions and improving the overall well-being of staff.

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