What to Do If an Insurance Claim Is Denied

You buy property insurance to make sure you are protected if a loss occurs to your property. What should you do if an insurance company denies your property insurance claim? The answer varies depending on multiple factors such as the type of loss, the policy coverages, and the policy provisions.

As part of the claim denial process, your insurance company will provide you a letter setting forth the reasons for the denial of your claim.

A denial could be based upon:

• The insurance company’s position that the insurance policy excludes the damages
• Failure to timely report the claim
• Repairs to your property do not exceed the policy deductible

These are just a few of the reasons an insurance company may use to deny your claim.

After reviewing the denial letter and your policy, you can challenge the insurance company’s denial if you still believe your property damage should be covered.

Send an Appeal Letter

You can send a written appeal letter to your insurance company setting forth why you believe the claim denial is wrong and ask the insurance company to reverse its denial. The policy may only provide a limited amount of time to do this, and you should send the appeal letter as soon as possible after the denial. Any required formal appeal process should be outlined in the insurance policy.

Pursuant to § 627.70131, Fla. Stat., your insurance company has 14 calendar days to review and acknowledge receipt of your communication unless payment is made within that time period. Sending an appeal letter should trigger a review of your denied claim. Include with your appeal letter as much evidence and documentation as you can to support the position that your damages should be covered. The appeal letter should be organized and contain as much detail as possible.

Consult an Attorney or a Public Adjuster

Seeking advice from an attorney or a licensed public insurance adjuster is one of the smartest moves a property owner can make after suffering an insured property loss, even if the claim is already denied. Attorneys and public adjusters can verify your coverage, review the policy for any coverage issues, assist and document the value your loss and damages, and negotiate the maximum settlement allowed under the terms of your insurance policy. The sooner you contact an attorney or public adjuster, the more they can assist you to try to avoid a denial on your claim.

Filing a Lawsuit for Breach of the Insurance Contract

Florida law allows you to challenge the insurance company’s denial of your claim in a court of law. Florida Statutes protect policyholders from wrongfully denied and underpaid insurance claims, but you must be sure to comply with the applicable statute of limitations and prerequisites. For example, pursuant to the recently enacted § 627.70152, Fla. Stat., you must file a Notice of Intent to Litigate with the Department of Financial Services at least 10 business days prior to filing a lawsuit. If you file the notice and are successful in your lawsuit, your insurance company can be held responsible to pay your attorney’s fees and costs.

Prior to filing a lawsuit, you must also confirm that you have complied with the insurance company’s requests. For example, if the insurance company “re-opens” your claim and asks for specific documentation (such as Proof of Loss as set forth in the Policy), you must comply with this request.

Again, Florida law provides limited time frames for filing a lawsuit (and re-opening claims) against your insurance company. You should consult with an attorney as soon as possible after the denial of your claim to protect your rights.

File a Complaint with the Office of Insurance Regulation

If you feel your claim was improperly denied, you can file a formal complaint with the Florida Division of Consumer Services. You can submit a complaint online via the portal.

Call 1-877-MY-FL-CFO (1-877-693-5236), or send an email to Consumer.Services@myfloridacfo.com

When filing a consumer complaint, you will need the below information:

• Full name of the insurance company involved
• Your policy number
• Claim number
• A detailed explanation of your concerns.

After submitting your request, an email will be sent to you with your

• Service request number
• Instructions for attaching supporting documentation to your request.

Pursuant to § 624.307(10)(b), Fla. Stat., your insurance company must respond to the Office of Insurance Regulation within 20 days after receipt of a written request for documents and information from the division concerning a consumer complaint.

Request Mediation – Florida Department of Financial Services

The Florida Department of Financial Services has a residential property mediation program to assist policyholders in resolving insurance disputes, including claim denials. While mediation is not legally binding, it can be an effective way for policyholders to resolve disputes with their insurance companies.

Once notified of the mediation request, the insurance company has 21 days to resolve the dispute. If the dispute is not resolved, the Department will assign a neutral third party to act as a mediator. The mediation conference will be held in the same county where the loss occurred. The policyholder may have an attorney and/or a public adjuster present at the mediation conference. A representative of the insurance company must attend the mediation with full authority to settle the claim.

Mediation is non-binding and neither the policyholder nor the insurance company is legally obligated to accept the outcome of the mediation conference. The insurance company is responsible to pay the entire cost of the mediation conference. The mediation process should be completed within 45 days of the request. Mediation settlements can be rescinded within three days of the agreement if the policyholder has not cashed or deposited the settlement check.

Mediation requests can be made by calling 1-877-MY-FL-CFO (693-5236, online at https://apps.fldfs.com/ by faxing Mediation Services (850) 488-6372, or by mailing a request to the Florida Department of Financial Services, Mediation Section, Bureau of Education, Advocacy, and Research, 200 East Gaines Street, Tallahassee, Florida 32399-0322.

Murray Law Group Can Help

Policyholders have multiple options to challenge the denial of their claims. The attorneys at Murray + Murray can guide you through any of the above processes and help you understand your options if your claim is denied. You don’t have to fight the claim denial battle alone. As attorneys who exclusively handle claims against insurance companies, we can review your claim, policy, and will advise of your best options.

If you believe that your insurance company may have improperly denied your claim, please contact an attorney at Murray + Murray. We will guide you towards the best option to help you receive the compensation that you are entitled to under your insurance policy.