What Are the Process Steps Involved in Appealing Insurance Claims in Florida?

In a perfect world, your home would never sustain storm damage. Of course, we don’t live in such a world, and storm intensity is increasing nationwide. Florida homeowners face increasing threats to their properties, and when those threats result in damage, they rightfully turn to their insurers to cover the costs of repairs. Often leading to the necessity of appealing insurance claims.

Sadly, many Florida homeowners do not receive the financial help they anticipated. Rather than a check to cover the cost of repairing their homes, they receive a claim denial. Thankfully, the state of Florida mandates a bill of homeowner’s rights, one of which is the right to appeal insurance claim denials. 

Of course, you need to follow the right process when doing so. Otherwise, you risk having your appeal denied out of hand. So, what should you know about the process steps in appealing Florida insurance claims? We’ll walk you through everything you need to know below.

Why Do Insurers Deny Claims in Florida?

First, let’s address why insurers might deny claims in Florida. A few eye-opening statistics will help lay the groundwork.

  1. Insurers deny 30% of homeowner claims every year. 
  2. Insurers lost $2 billion due to increased damage/enhanced storm intensity in Florida in 2020 and 2021.
  3. More and more insurers are going insolvent or leaving Florida, meaning homeowners have fewer options, and the remaining insurers are encouraged to deny claims they might otherwise have paid.

Those are the underlying factors affecting denials in Florida. However, insurance companies use a wide range of reasons to deny coverage. Here are some of the most common:

  • The damage stems from an uncovered peril. For instance, most homeowner policies don’t cover flood damage. However, one of the major causes of damage to homes in coastal areas during a hurricane is storm surge.
  • The insurer says that the damage was insufficient to meet the deductible or no damage was found. Insurance adjusters love this one. Let’s say you noticed signs of a water leak on your ceiling. You call the insurance company, which sends an adjuster to inspect the roof. They can find no damage and deny your claim, leaving you with a leaking roof and having to repair it out of your own pocket. 
  • The insurer claims you didn’t provide timely notice. Under Florida law, you have three years to file a claim regarding storm damage (four to five years for other causes). However, some insurers may try to claim that you waited too long even if you’re within this timeframe.
  • The insurer says the damage was “pre-existing.” When filing your claim, you must correlate the damage with a weather event (such as a named storm or a severe storm that occurred on a specific date). Your insurer may try to claim that the damage existed before this event, implying that you waited too long to file the claim for previous damage that might be outside the statute of limitations.

What can you do if your insurer denies your claim? You can file an appeal. We’ll outline the process steps below.

The Process Steps in Appealing Insurance Claims in Florida

If you’ve gone through the assessment process and waited impatiently for the insurer’s decision, only to receive a denial of your claim, it’s natural to be frustrated. The good news is that you can appeal that decision, but you’ll need to follow some specific steps.

Check Your Policy

The first thing to do is to check your insurance policy. You’re looking for language that dictates how long you must file an appeal. Florida law doesn’t stipulate a duration here, but many insurers will put a time limit on it. If your policy includes such stipulations, ensure you’re ready to go with your appeal within that timeframe.

Determine Why Your Claim Was Denied

The steps you follow when appealing insurance claims may vary depending on why your claim was denied. So, you need to read the letter carefully to determine why the insurer is denying you. Note that your insurer will likely use legalese rather than spelling out the reason plainly. Once you’ve deciphered the reason, grab your insurance policy and get to work.

Bump the Policy Against the Denial Letter

Next, you need to compare the denial letter to your policy. What you’re looking for here is a correlation between the reason for the denial and the coverage you purchased with the policy. This is important in certain situations, such as if the insurer says you don’t have coverage for a particular peril. Verify that you have the coverage you believe that you do or that the insurer is correct that you do not.

Gather Evidence to Support Your Claim

Often, claims are denied because of a lack of supporting information. Too many homeowners assume that the insurer’s adjuster will have all the information necessary, only to discover that they do not. A lack of information often leads to a claim denial. Your best defense is to gather as much evidence to support your claim as possible. That could encourage the insurer to take a second look.

What evidence might be helpful? Almost anything that supports your position and strengthens your claims can help. Here are just a few examples:

  • Images of your home that show the damage was not pre-existing. 
  • Estimates from professionals that show the actual cost of repairs or replacements.
  • Additional photos of the damage from different angles highlight the true extent of the situation.
  • Photos of any internal damage stemming from the original incident, such as water stains on the ceiling from a roof leak.
  • Information about the time, date, and severity of the storms that caused the damage (or as close as possible since you may not have noticed the damage right away).
  • Receipts for any repairs or replacements that you’ve already made that were related to the event/damage.

Follow the Appeal Steps in Your Policy

Your insurance policy will spell out the steps you must follow when appealing insurance claims. Follow these to the letter. You’ll need to submit the evidence you gathered in the previous step along with your appeal and ensure it’s well organized. The goal here is to get the insurance company to reevaluate its decision based on:

  • More Detail – If the original claim lacked documentation/information, more detail could help the insurer find in your favor.
  • Ajuster Mistakes – Adjusters are human and make mistakes. If you can prove that the adjuster’s decision was made in error, the insurer may take another look at your claim.
  • Tighter Parameters – You may be able to trigger a re-evaluation based on tighter parameters, such as a more exact storm date or more accurate repair estimates.

Once you file your appeal formally, it triggers a new review of your claim. Make sure you present a strong case as possible, or you could find that the insurer holds to its original assessment of the situation.

Bring in the Professionals

If your claim has been denied and the insurer won’t budge, it might be time to bring in the professionals. We’re talking about hiring a licensed public adjuster with experience navigating Florida’s complex insurance industry. Why hire a public adjuster? They can:

  • Verify your insurance coverage
  • Value and document your losses
  • Create accurate estimates of repair and replacement costs
  • Negotiate the maximum settlement possible
  • Help you understand the process and keep you involved at every step

The key things to remember here are that the public adjuster works for you, not the insurance company, and they have deep experience and expertise regarding insurance coverage and Florida law. Having an expert on your side is important – you can bet that your insurance adjuster will fight for the company’s best interests, not yours.

File a Complaint

Florida residents must make the government aware of companies that practice predatory tactics. You can file a complaint against your insurer for unfair practices. Call the Florida Department of Financial Services at 877-693-5236 and provide them with your policy number, the name of your insurer, your claim number, and the reason for the complaint. Note that this will become a public record, so keep your account concise.

A formal complaint triggers a multistep process. First, your insurer will be notified of the complaint. Next, they must submit a response to a government representative (within 20 days). While this does not necessarily mean that your claim will be reevaluated, it does put the company on the government’s radar and helps encourage accountability in the future.

Don’t Go It Alone Against Your Insurer

Insurance companies have deep pockets and professional adjusters who look out for their best interests. You need an expert on your side. At On Target Claims, we go to bat for Florida homeowners just like you. We bring years of experience and expertise in the insurance and construction industries, ensuring that we’re able to offer the accuracy and guidance that you need. Best of all – we don’t get paid if your claim isn’t approved. 

Ready to take the next step in your fight for your rights? Contact us today to schedule a no-obligation consultation on your claim. We’ve helped homeowners throughout Florida fight back against unfair insurance practices, and we can do the same for you.

Related Content: How to Successfully File a Residential Insurance Claim in Florida

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