What Should You Do If Your Insurance Claim Is Denied?

A homeowner reports roof and ceiling damage after a severe storm, only to receive a denial weeks later. The insurer attributes the damage to age and deterioration, but the homeowner’s contractor says the storm caused it. With repairs still needed and conflicting explanations for the damage, how should the homeowner respond?

The denial explains the carrier’s position, but it isn’t necessarily the final word. Challenging it starts with understanding the reason and identifying evidence that supports a different conclusion.

Read the Entire Denial Letter

Start by identifying exactly why the insurer denied the claim. Common reasons include late notice, an excluded cause of loss, insufficient documentation, failure to submit a requested proof of loss, or an allegation that the damage existed before the reported event.

Under Section 627.70131 of the Florida Statutes, an insurer must provide a reasonable written explanation of the policy basis for a denial or partial denial in relation to the facts or applicable law. Read the cited provisions alongside the rest of the policy, since an exclusion may contain exceptions or be modified by an endorsement.

Also determine whether the letter denies coverage entirely or disputes the amount owed. A carrier that accepts coverage but issues a low estimate presents a different problem from one that says the loss is not covered.

Gather Evidence That Addresses the Denial

Keep the denial letter with your policy, photographs, repair estimates, inspection reports, receipts, and insurer communications. Record the dates of inspections and phone conversations while the details remain clear.

Focus on evidence addressing the insurer’s explanation. If it attributes roof damage to deterioration, dated photographs, maintenance records, or an evaluation from a qualified roofer or engineer could help distinguish existing wear from storm damage.

Preserve damaged materials when safe and practical. If wet drywall or flooring must be discarded because it presents a health risk, photograph it before removal.

Review Your Duties Under the Policy

When reviewing the denial, check whether the insurer says you failed to meet a policy requirement. Property policies usually require prompt notice, reasonable steps to prevent further damage, and cooperation with inspections and the investigation. Depending on the policy, that cooperation can include providing records, submitting a sworn proof of loss, or attending an examination under oath.

If the denial identifies a missing document, ask whether submitting it would allow the insurer to reconsider. A dispute over a missed deadline or another unmet requirement may need a more detailed response. While challenging the decision, continue responding to reasonable requests and keep copies of everything you submit.

Request Reconsideration With Supporting Information

A reconsideration request should explain why the insurer’s conclusion does not match the evidence.

For example, if the denial attributes rain damage to an unrepaired roof, an inspection showing that wind created a new opening could change the coverage analysis. If the insurer overlooked several rooms, photographs and a room-by-room estimate can clarify the disputed damage.

Florida’s Department of Financial Services offers mediation for eligible residential property disputes. Neither party must agree to settle, but a signed settlement can become binding. Some disputes are ineligible, including those where the parties agree on the cause of loss and those facts establish that the policy provides no coverage.

Depending on the policy and dispute, appraisal may help resolve the amount of a covered loss. It is not a substitute for resolving a complete coverage denial.

Do Not Lose Track of Deadlines

While you work to resolve the denial, keep track of the time remaining to take legal action. Florida generally allows five years to bring a property-insurance breach-of-contract action, measured from the date of loss. Do not assume that reconsideration, mediation, or ongoing discussions extend that period. Separate claim-reporting deadlines and policy requirements can also affect your options.

If the denial leaves you unsure how to proceed, Abraham Law Group can review the insurer’s explanation alongside your policy and supporting evidence, including the deadlines that apply. Contact Abraham Law Group for a free case review.