How Are Insurance Claims Calculated in Florida?

Florida is a great place to live, work, and play. From sunny beaches to crystal clear springs ideal for diving, bustling city nightlife, and expansive horse ranches, there’s something here for everyone. Something that many residents will need to deal with at some point is the process of filling an insurance claim. 

Florida might be a beautiful state with varied opportunities for enjoyment and relaxation, but it’s also prone to storms. From massive summer thunderstorms and tornadoes to tropical storms and hurricanes that move up from the Caribbean and the Gulf, threats to your property abound. If you find yourself dealing with property damage, understanding insurance claim calculations in Florida will help you make sense of the situation and understand how to move forward.

Florida Rules, Regulations, and Property Owner Rights

Florida’s government strives to support both property owners and insurance companies. It has set out a long list of rules and regulations for both parties during the claims process. However, understanding these and how they apply to your situation can be tricky. We recommend working with a public insurance claims adjuster from the beginning so that you’re not surprised at any point during the process. 

Factors Involved in Florida Insurance Claim Calculations

Florida insurance claim calculations are based on several different factors. We’ll break those down for you below.

Your Policy

The most important consideration here is your insurance policy itself. This contract spells out your rights and obligations, as well as your insurer’s obligations. It includes all the details that you must know after an event that damages your property or a disaster, such as a hurricane. These include the following:

  • Your Coverages – Your policy will spell out exactly what coverages you have from the insurer. It’s important to understand these because they may not be what you think. For instance, many homeowners assume that wind damage or hail damage is covered, only to find that there’s an exclusion on their policy. 

We highly recommend reviewing your policy and studying what’s covered, what’s not, and what might be covered up to a certain point. Of course, understanding the jargon in these contracts can be challenging, so it’s important to work with an unbiased party that can explain everything to you in black and white.

  • Your Deductible – Your policy’s deductible is the amount you must pay out of pocket before the insurance kicks in. This will vary from property owner to property owner. Lower deductibles usually mean paying higher premiums. Lower premiums come with higher deductibles, which means paying more before your insurer covers the damage. 

Note that in cases where the amount of damage does not exceed your deductible, you will have to pay for all the repairs out of pocket. Some property owners in Florida may have separate deductibles for different covered perils, such as hurricane damage.

  • Exclusions – Exclusions are things that your policy specifically does not cover. These are usually spelled out clearly. Flood damage is a common exclusion, as is pet damage, mold, damage from neglect or poor management, sewer backups, and more. 
  • Additional Living Expenses – Usually abbreviated ALE, additional living expenses are those expenses you incur if you’re unable to live in your home due to covered damage. This will tell you how much you’re allotted for these expenses, as well as the breakdown (lodging only, food and lodging, additional fuel for your vehicle due to longer distance drives, etc.). Note that it will only pay for “reasonable” expenses but will do so until the property is livable once more. 
  • Replacement Cost vs. Actual Cash Value – Florida allows both replacement cost and actual cash value insurance contracts, but they do not work the same way. Replacement cost means that you will receive the amount it would cost to replace an item today, regardless of what you paid for it or its age/condition. 

Actual cash value means that you receive the item’s value today, not what you paid for it or what it would cost to replace it. Note that most replacement cost policies mandate that the insured carry limits that equal at least 80% of the replacement value. Choosing to carry less could mean that your claim will be calculated differently and leave you owing some out-of-pocket.

The Adjuster’s Visit

Once you contact the insurance company or your agent, they’ll arrange for an insurance adjuster to visit your property. During this visit, several things will happen, including:

  • The adjuster will review your policy and determine what deductibles apply. They will also determine if there are any limits to the coverage or if the event/damage is covered at all. 
  • The adjuster will physically inspect your structure and document the damage. This can include taking photos, taking measurements, and more.
  • The adjuster will speak with you about the incident to get your view of what happened and what needs to occur to resolve the situation.
  • The adjuster should also consider any evidence or supporting documentation you might have collected before their arrival, such as receipts for damaged property or before and after photos of the structure.
  • In addition to your coverages and deductibles, the adjuster will also factor in damage to the structure, as well as damage to your personal property. 
  • Based on the process above, the adjuster will create an offer. Note that this may be the first of several payments.

Understanding the Offer

Every insurance contract is unique, and your offer will be specific to you and your situation. You may receive more than one check depending on how things break down. Let’s take a closer look at these insurance claim calculations.

First, you may receive a check/payment specific for additional living expenses or ALE. This check should come early in the claims process to help offset the costs of being unable to live in your home.

Second, you’ll receive a check for damage to your personal belongings (unless you choose to file a combined structural and property damage claim, which isn’t recommended). This check can be used to replace the personal items destroyed or damaged in the incident.

Finally, there should be a payment for structural damage. This money is specifically for rebuilding or repairing the structure of your home. 

It’s important to note that there might be multiple parties on your check. For instance, if you have a mortgage on your home, the money might go to them to be doled out over the course of the process. If you already have a contractor to handle the repairs or rebuilding, they may be on the check, too.

What to Do If You Feel Your Florida Insurance Claim Is Incorrectly Calculated

Was your settlement different from a neighbor’s even though your properties were similar and damaged by the same storm? It’s easy to wonder why that might be. However, remember that every settlement is different. You cannot compare your settlement to anyone else’s because of differences in deductibles, coverages, and policy limits. 

However, that doesn’t mean that your offer was a fair one. While you would hope that insurance adjusters and companies would get it right the first time, the truth is that errors occur pretty often. Adjusters are human and can make mistakes. 

It’s also possible that the damage to your structure might be more substantial than it seemed during the initial assessment. Of course, there’s also the fact that insurance adjusters work for the insurance company, and the company’s goal is to turn a profit. That’s hard to do when you’re paying out millions of dollars per year in claims. Insurance adjusters routinely look for ways to reduce your claim and protect the insurer’s bottom line.

If you feel that your insurance claim calculations are not right, you have several potential courses of action available. 

First, you could contact the insurer and request that they re-evaluate the claim. If you can provide new information or more accurate figures, this may encourage them to do so, but if the insurer doesn’t feel that a re-evaluation would influence their decision, they won’t go through the process.

Second, you can file a formal appeal. This requires following specific steps outlined in your insurance policy and automatically triggers a re-evaluation of your claim. However, there is no guarantee that the outcome will be different.

Finally, you can choose to work with a public insurance claims adjuster, like our team at On Target Claims. Public adjusters aren’t beholden to the insurance companies. Instead, they work for the property owner. That puts an expert in your corner to help you understand your coverages and exclusions, as well as the fairness of any settlement offer made. A public claims adjuster can even negotiate with the insurer on your behalf, potentially getting you a better offer than would otherwise be possible.

The Insurance Claim Calculations Assistance You Need

At On Target Claims, we aim to ensure that you get the offer you deserve and that insurance companies are held accountable. We can work with you through the entire process, from the initial assessment all the way through negotiating with the insurance company for a better settlement. We work for you, so if you don’t win, we don’t either. Don’t leave your future in the hands of the insurance company. Contact us today to schedule a consultation on your claim and to learn more about how we can support you through this challenging time.

Related Content: What is the Time Limit for Filing an Insurance Claim in Florida After Property Damage?

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