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Ocean Point Claims Company
Ocean Point Claims:using exclusions inconsistently
Insurer Tactic

Using Exclusions Inconsistently

Exclusions get invoked when convenient and ignored when not. That inconsistency, across claims, across carriers, even within the same claim, creates arguments against pretextual exclusion use.

How inconsistency manifests

  • Same exclusion applied to your claim but waived on prior claims at same property
  • Similar damage at neighbor's property paid; yours excluded
  • Different adjusters on same carrier applying exclusion differently
  • Internal guidance differs from the stated denial basis

Why it matters legally

  • Florida case law on consistent exclusion application
  • Pattern evidence supports bad-faith arguments
  • "Reasonable interpretation" doctrine applied when ambiguity exists
  • Regulatory interest in consistent claim handling

Ocean Point Claims:engineering report shopping

Documenting inconsistency

Prior claims at the property

  • Request prior claim history from the carrier
  • Compare claim handling across events
  • Note inconsistent exclusion application

Similar losses at neighboring properties

  • Public records where available
  • Restoration contractor knowledge of handling patterns
  • Attorney discovery in complex cases

Internal carrier documents (in litigation)

  • Claim-handling guidelines
  • Training materials
  • Exclusion-application criteria

Using inconsistency in dispute

  • CRN citing pattern
  • Depositions exploring historical handling
  • Request for same-peril handling comparison
  • DFS complaint on inconsistent application

Related

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