What Happens When Insurance Denies a Claim in Florida?

You carry homeowner’s insurance to protect your single most important asset: your home. Florida residents face many threats, from major summertime storms with hail and gale-force winds to tornadoes and hurricanes. However, the unfortunate possibility of an insurance claim denial adds an extra layer of concern.

Your insurance policy is the key to peace of mind. If something happens, you’re covered, right? Sadly, too many Florida homeowners find out the hard way that their insurance company may not have their best interests at heart. What do you do when insurance denies a claim in Florida? Let’s take a closer look.

How Many Claims Are Denied in Florida?

Before we dive into what happens when insurance denies a claim in Florida, let’s examine how many claims insurers actually deny. The number might surprise you. According to NBC’s News Channel 8, Florida insurers close three out of 10 insurance claims in the state without paying them. That’s 30% of claims denied each year

In a state so often the focus of hurricanes and beset by severe tornadoes and thunderstorms, why would insurers deny claims? In most cases, it’s due to one of two reasons:

  1. There was no damage found.
  2. The damage found was less than the homeowner’s deductible.
  3. Denial of coverage (the damage was from a peril not covered by the policy). 

Now, let’s examine each of these.

  • Why would a homeowner bother to file a claim if there was no damage? The answer is simple: they would not. 
  • Why would a homeowner bother to file a claim with their insurer if the damage wasn’t more than their deductible? Most homeowners don’t. Insurance companies regularly give lowball estimates on repairs to avoid paying out.
  • Why would a homeowner file a claim if the damage was from a peril not covered in their policy? Some homeowners are unaware that some perils aren’t covered, like flood damage. 

So, what are your options if you’re a Florida homeowner and the insurer you counted on to have your back after a disaster denies your claim?

Steps to Take When Insurance Denies a Claim in Florida

Due to Florida’s unique propensity for storm damage and severe weather, the state has enacted several specific laws related to homeowner’s insurance. First, insurers have 90 days from when a claim was filed to close it. Second, homeowners have three to five years from the date of an incident to file a claim, depending on the type of damage (storm damage is limited to three years). Finally, Florida homeowners can appeal the insurance company’s decision.

Here’s the breakdown of the type of event and how long you have to file:

  1. You have four years to submit a claim related to damage from a neighboring property.
  2. You have five years to submit a claim related to a breach of a property insurance contract.
  3. You have three years to submit a claim related to storm damage. 

So, let’s say you’ve filed your claim within the window specified by Florida law. The insurance company then takes up to 90 days to decide, but when you receive the notification, you’re shocked to see that your claim was denied. What recourse do you have? 

Review the Denial Letter, Your Claim, and Your Policy

Your first step after a denial should be to review the information you have in hand. The insurer will spell out in the denial letter why your claim was denied. Check that against your claim and your policy. Did a covered peril cause the damage? Did you have coverage against the peril? Did you get an estimate on repairs that put the amount higher than your insurance deductible?

Know What’s Not Covered in Your Policy

Many homeowners assume that their insurance policies cover pretty much anything that might happen to their home. That’s natural, given how some agents and insurance companies market these products. The truth is that there are always exclusions, and sometimes they’re hidden in the fine print. Some of the most common exclusions are:

  • Flooding
  • Earth movement
  • Pests/infestation
  • Pet damage
  • Negligence/improper upkeep
  • Mold

Gather Evidence

If you feel you’re in the right (and homeowners often are), you need to press your point. Gather evidence that supports your contention that the insurer should pay your claim. This can include a wide range of things depending on the reason for the denial and the type of damage in question. Here are just a few examples:

  • Photos/video
  • Estimates from repair companies
  • Assessments from professionals
  • Material and labor breakdowns

The goal here is to provide as much evidence and documentation as possible to support your claim. The insurer may rescind its denial if you have a propensity of evidence in your favor.

Keep Excellent Records

You need to keep records of all interactions with the insurance company. 

  • Save all written correspondence. Make copies of any letters or emails you send to the insurer, and keep those with the responses you receive.
  • Keep records of all phone calls, including the name of the representative you spoke with and the time and date of the phone calls. 

Keep all this information organized and accessible. You will need it for the next step. You may want to keep both physical copies and electronic copies (where applicable), but definitely print out any emails before taking the next step.

File an Appeal

If the insurer does not change its decision and stand by the claim denial, it’s time to file an appeal. As a Florida homeowner, you can dispute the insurance company’s decision with the state government. Sometimes, simply filing a dispute is enough to change things. However, that’s not always the case, so don’t assume this will automatically change your situation. You can also get free mediation through the Florida Department of Financial Services. You’ll also likely need expert help to convince the insurer to uphold their responsibility. 

Hire a Public Adjuster to Help

Too often, homeowners feel like they’re on their own when dealing with an insurance claim denial. However, the truth is that there are people to help. Public adjusters can step in and provide essential assistance for homeowners throughout the claims process, even after you’ve been denied.

What to Know about Public Adjusters

Most homeowners have never worked with a public adjuster before, so chances are good you have a few questions. We’ll answer those below.

What is a public adjuster?

A public adjuster is a licensed professional who works in the homeowner’s best interests. They have the experience, expertise, and knowledge required to assess the damage to your home and help you make an accurate claim. They can also assess the damage to your home after an insurance claim denial and provide you with the information you need to fight back.

Doesn’t the insurance company send an adjuster?

Yes, your insurer will send an adjuster out to inspect the home and assess the damage. However, it’s important to remember that these adjusters don’t work for you. They work for the insurance company, and the insurer’s most important goal is to save money. No matter what the company tells you in its marketing materials, it’s not there to make your life easier. The company is in business to make money, and it cannot do that if it honors all claims. Sometimes, the cost of growing a business is denying legitimate claims from paying customers.

Can a public adjuster help me make sense of a lower-than-expected offer?

Yes, public adjusters are there to help you in any way they can. That includes navigating lowball offers. Your public adjuster will provide you with accurate repair or replacement data so you can refute the insurance company’s initial offer and get something more reasonable.

How do I choose the right public adjuster?

Since you’ve probably never worked with a public adjuster before, you’ll likely need some guidance to help you choose the right one. Not all public adjusters are the same, so making an informed decision is important.

First, consider the adjuster’s experience. How many years have they served as an adjuster? Did they work in the insurance industry before becoming a public adjuster? How many losses similar to yours have they dealt with?

Second, ensure that your adjuster is licensed, bonded, and insured. This is for your own protection. Licensure shows that the adjuster knows their stuff, and if the adjuster has an accident while on your property, you want their insurance to cover it, not yours. 

Third, check for memberships with industry organizations that often mean they’re playing above board, such as the National Association of Public Insurance Adjusters.

File a Complaint with the Florida Insurance Commissioner

Finally, make sure you file a complaint with the Florida Insurance Commissioner. The state decides which insurers can operate in it based on a wide range of considerations, including how the company treats its customers. By filing a complaint, you may be able to help spare other homeowners the same fate.

The Next Step: What to Do If Your Insurance Denies a Claim

If your insurance denies your claim in Florida, the most important thing to realize is that you’re not alone. There is help available. At On Target Claims, we have deep experience working with homeowners throughout Florida and helping them fight back against predatory insurance company practices. 

Contact us today to learn more about our process or request a free claim review. You’re not alone against the insurance company. We can help you move forward and get on with your life.

Related Content: What Is Considered Water Damage for Insurance Claims in Florida?

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