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The "Request for Mediation - Florida Department of Financial Services" is a formal document used by individuals or entities seeking to resolve disputes concerning automobile insurance claims in Florida. The form is designed to facilitate communication between the claimant and the insurer, promoting an environment conducive to reaching a mutually agreeable resolution through mediation. This approach aims to avoid lengthy legal procedures by providing a structured yet flexible platform for dialogue.
Personal Information: Begin by providing your full name, address, contact information, and insurance policy details. Ensure all information is accurate to avoid processing delays.
Claim Details: Include specifics about the insurance claim, such as the claim number, date of the incident, and a detailed description of the circumstances surrounding the claim. This section should accurately reflect all material facts.
Dispute Description: Lay out the core issues in dispute, emphasizing areas where there is disagreement with the insurer’s assessment or decision. Providing clear and concise descriptions helps mediators understand your perspective.
Supporting Documentation: Attach all relevant documents supporting your claim and the dispute. This can include correspondence with the insurer, photographs of the incident, and repair estimates.
Signature and Date: Conclude by signing and dating the form, confirming that all information provided is true and accurate to the best of your knowledge.
Policy Holder: You must be a policyholder with an active automobile insurance policy within the state of Florida.
Coverage Dispute: The dispute must pertain to coverage issues related to property damage or personal injury claims.
Insurer Notification: Before filing for mediation, there should be a documented attempt to resolve the issue directly with the insurance company.


Mediation: A non-binding negotiation process with the assistance of a neutral third-party mediator to help resolve disputes.
Claimant: The individual or entity filing the request for mediation, usually the insured party.
Insurer: The insurance company providing the automobile insurance coverage in question.
The form is legally recognized in Florida for mediating disputes related to automobile insurance claims, focusing on property damage and personal injury. Mediation is underpinned by state law to ensure fair practice and is aimed at achieving settlement without litigation. All parties in mediation must act in good faith during proceedings.
Florida mandates specific procedural rules for mediation under the Department of Financial Services. These stipulations include the formal appointment of a mediator, adherence to scheduling protocols, and a commitment to confidentiality throughout the process. Additionally, Florida law requires that a mediation request be initiated within a specific timeframe following a claim dispute.
Automobile Accidents: A claimant whose vehicle was damaged in an accident uses the mediation process to negotiate the repair costs after an initial offer from the insurer falls short of estimates.
Personal Injury Disputes: In cases where an insurer disputes the severity or treatment costs related to injuries from an accident, mediation provides a platform for discussing these discrepancies.
Insurance Policy Copy: A complete copy of the relevant insurance policy covering the incident.
Claim Correspondence: All communication between the claimant and insurer regarding the claim.
Incident Reports: Police reports, if applicable, detailing the incident.
Damage Estimates: Documentation from auto repair shops or medical records substantiating the claim amount.
Online Submission: You can submit the form electronically via the Florida Department of Financial Services portal, which streamlines processing and feedback.
Mail Submission: Alternatively, print and fill out the form, then send it via postal mail to the designated department address.
In-Person Delivery: Submit the form directly at a local Department of Financial Services office, ensuring all required documents accompany the submission.
Selecting the appropriate submission method can impact processing times, with online submissions generally being the fastest.
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