A denial letter is a conclusion the carrier reached, usually from one inspection, often under volume pressure. Conclusions can be wrong, and in Florida the carrier has to tell you which policy provision it is relying on.

Almost every denial falls into one of five categories. Sorting yours is the first move, because the answer to each is different.

1. Wear, tear and "gradual" damage

The most common denial and the most frequently overturned. Standard forms cover sudden and accidental losses and exclude deterioration, so a carrier that characterizes your loss as gradual has moved it outside coverage with an adjective.

This is an opinion about causation, and it is answerable with evidence: moisture mapping, plumbing inspection, the age and condition of the failed component, dated imagery, and the timeline of when the damage appeared. Cast iron pipe and long-term seepage claims live or die here. See cast iron pipe claims and water damage claims.

2. Cause-of-loss disputes: wind against flood

When two perils hit the same building and only one is covered by the policy in question, the carrier has an incentive to assign as much as possible to the other one. Hurricane Ian is the clearest recent example: the National Hurricane Center recorded 130 kt winds at landfall and storm surge inundation of 10 to 15 ft above ground level at Fort Myers Beach. A great many properties took both, within the same hour.

Separating them is documentation, not debate: water lines and their heights, wind-driven rain entry points through the envelope, direction of debris, and damage above the surge line versus below it.

3. Below the deductible

This is not really a coverage denial. The carrier priced your loss below your deductible, and on a hurricane claim that deductible is a percentage of your dwelling limit rather than a flat figure. The entire outcome therefore turns on whether their estimate is complete, and a scope short by twenty line items produces a number that fails to clear the threshold.

Which deductible applies is decided by statute rather than by judgment: Florida’s hurricane window opens when a hurricane warning is issued for any part of Florida and closes 72 hours after the last watch or warning for any part of Florida is terminated. Detail in hurricane vs all-other-perils deductibles.

4. Late notice

Florida bars a claim or reopened claim unless notice was given within 1 year after the date of loss, and a supplemental claim unless notice was given within 18 months. For a hurricane the date of loss is the date the hurricane made landfall; for a tornado, windstorm or severe rain event it is the date the event is verified by the National Oceanic and Atmospheric Administration.

These windows shortened with the December 2022 special session, so which version governs depends on your date of loss. Some owners are told they are barred when they are not. Check before accepting it.

5. Policy conditions

Missing sworn proof of loss, an outstanding examination under oath, or a failure to protect the property from further damage. The standard form lists these as duties after loss and states that failure to comply is prejudicial to the insurer. These denials are usually the most curable of the five, because the answer is to do the thing that was missed.

What the carrier was required to tell you

Florida’s unfair claim settlement practices provisions make it a violation for an insurer to fail to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement. The same provision makes it a violation to deny claims without conducting reasonable investigations based upon available information, and to fail to adopt and implement standards for the proper investigation of claims.

A denial letter that cannot name the provision it rests on is worth noting, with a date. It does not win the claim by itself, but such denials tend not to survive being asked a second time.

What to do with a denial

Request the full claim file and the specific policy language relied on, in writing.
Establish which of the five categories it actually is, because they are not equally strong.
Get an independent scope of the loss. Most denials rest on an inspection that was too short.
Check the deadlines that still apply, including the five-year window for an action on the policy running from the date of loss.
Then choose the route: re-document and resubmit, appraisal if the fight is about amount, state mediation, or suit after the required pre-suit notice.

Each route is set out in your hurricane claim was denied, what now.

Bring us the letter

We read denial letters for owners across South Florida, including Homestead, Kendall and Sunrise. It costs nothing, and one pass is usually enough to see which of the five you are dealing with and whether it holds.

Your policy is the contract, and forms vary by carrier. The provisions described here come from the standard Homeowners 3 Special Form that most Florida homeowners policies are built on. Read your own declarations page and policy form, or send them to us and we will read them with you.

Sources

Related Denial-Fighting Resources

Water Damage Claims Cast Iron Pipe Claims Public Adjuster vs. Insurance Company Adjuster

Why Florida Insurance Claims Get Denied