Homeowners insurance

You pay premiums for years so that when something goes wrong, the money is there. Then a pipe bursts or a storm takes part of the roof, and instead of a repair you get an inspection, a reservation of rights letter, a request for documents, and an offer that will not cover the work.

Florida property insurance is its own world. The state has been through repeated waves of legislative reform, and several of those changes shifted the balance materially. Deadlines are shorter than they used to be. The fee-shifting statute that once made it economic to fight a modest underpayment has been repealed for these claims. Assignment of benefits, which built an entire industry, is gone for property policies.

The practical consequence is that what you do in the first weeks matters more than it used to, because the tools available afterwards are fewer. This page sets out how these claims work and where they go wrong.

What a homeowners policy covers

A standard Florida homeowners policy is really several coverages in one document:

• Dwelling, the structure itself.
• Other structures, such as a detached garage, fence or shed.
• Personal property, the contents, usually with sub-limits on categories like jewellery, art and firearms.
• Loss of use, covering additional living expenses if the home is uninhabitable while repairs are done.
• Personal liability and medical payments, which respond to injuries to others rather than damage to your home.

Two further coverages are frequently overlooked and frequently valuable. Ordinance or law coverage pays the additional cost of rebuilding to current building codes, which in older Florida homes can be a very large number. And loss of use is routinely under-claimed by people who move in with family and never think to record what the disruption cost them.

What it does not cover

Most disputes are about exclusions rather than about whether damage occurred. Typical exclusions include wear and tear, deterioration, marring, rust, mould in many circumstances or subject to a low sub-limit, settling and cracking, faulty workmanship or design, neglect, earth movement, and damage from long-term seepage as opposed to a sudden event.

Exclusions interact with each other and with exceptions to exclusions, which is why two adjusters can look at the same bathroom and reach different conclusions. The question is rarely "is there damage" and almost always "what caused it and when".

Where a loss has more than one cause, some covered and some not, Florida law addresses concurrent causation in ways that depend on the policy wording and the facts. It is a technical area and it decides real cases.

Flood is a separate policy

This is the most expensive misunderstanding in Florida.

Homeowners policies do not cover flood. Rising water, storm surge and water that comes in at ground level are generally excluded, and are covered only under a separate flood policy, most often through the National Flood Insurance Program or a private flood insurer.

After a hurricane this produces genuinely difficult claims, because wind damage and water damage may both be present and are covered by different policies with different adjusters and different deductibles. Whether water entered because wind opened the building envelope, or because water rose from outside, determines which policy pays. Documenting the sequence at the time is far easier than reconstructing it a year later.

Flood policies also carry their own strict proof of loss requirements and deadlines, which are unforgiving.

Deductibles, including hurricane deductibles

Florida policies typically carry two deductibles. The ordinary all other perils deductible is a flat dollar amount. The hurricane deductible is usually a percentage of the dwelling coverage limit, commonly two, five or ten per cent.

On a home insured for a substantial amount, that percentage is a large number, and it applies before the insurer pays anything. Homeowners who have never read the declarations page are regularly shocked to discover that a claim they assumed was covered falls almost entirely within their own deductible.

The hurricane deductible applies to damage caused by a hurricane during a defined period tied to National Weather Service watches and warnings. Whether a particular storm event triggers it, and whether the deductible applies once per season or per event, are questions worth checking on the actual policy rather than assuming.

Actual cash value and replacement cost

How the loss is valued matters as much as whether it is covered.

Actual cash value is replacement cost less depreciation. A fifteen-year-old roof valued this way pays a fraction of what a new roof costs.

Replacement cost pays what it takes to repair or replace with like kind and quality. In practice insurers usually pay actual cash value first and hold back the depreciation, releasing that recoverable depreciation only after the work is completed and documented.

That holdback creates a real problem for homeowners who cannot fund the repair up front, and it is a common reason claims stall. It also means the first payment is not the offer. Understanding what has been withheld, and what must be submitted to release it, is often worth more than arguing about the estimate.

Watch too for policies that pay roof damage on a schedule based on age, which some Florida policies now do.

The notice deadlines

Florida has shortened these substantially, and the current periods are much tighter than the ones many homeowners remember.

A claim, supplemental claim or reopened claim under a property insurance policy is barred unless notice is given to the insurer within the statutory period running from the date of loss, and the period for supplemental claims is longer than for the initial claim but still measured in months rather than years. These periods were reduced by legislation in recent years, and they apply regardless of when you discovered the damage in many cases.

Separately, there is a limitation period for bringing a lawsuit for breach of the policy, which is longer than the notice deadline. The two are different and both must be met. Satisfying the limitation period does no good if notice was late.

Because the current periods depend on when the policy was issued or renewed as well as when the loss occurred, the safe approach is simple: report promptly, in writing, and keep proof of the date.

Your duties after a loss

The policy imposes obligations on you, and failing them gives the insurer a defence independent of the merits.

• Prompt notice of the loss.
• Mitigate, meaning take reasonable steps to prevent further damage: tarp the roof, stop the water, board the opening. Keep the receipts, which are usually reimbursable.
• Protect the evidence. Do not carry out permanent repairs before the insurer has had a reasonable opportunity to inspect. Emergency mitigation is different from replacement.
• Document everything, extensively, before anything is cleaned up.
• Cooperate, providing requested records, submitting to inspection and sitting for an examination under oath if required.
• Submit a sworn proof of loss if the insurer requests one, within the period stated.

On documentation, more is better and it costs nothing. Photographs and video of every affected room from multiple angles, wide shots that establish context, close shots of specific damage, the exterior from all sides, and a written inventory of damaged contents with age and approximate value. Do this before removing anything.

A useful habit for anyone in Florida: photograph the whole house, inside and out, including the roof if it can be done safely, once a year and before hurricane season. Pre-loss condition evidence resolves the arguments that otherwise become disputes about whether damage pre-existed the storm.

What the insurer must do

Florida law imposes timeframes on insurers handling residential property claims, including acknowledging communications, beginning an investigation, conducting any physical inspection within a set period, and paying or denying the claim within a statutory deadline after notice, subject to defined exceptions for circumstances beyond the insurer's control.

Insurers are also required to provide a reasonable explanation in writing for a denial or partial payment, and to give the policyholder a copy of any detailed estimate the adjuster prepared.

That last right is worth exercising. Asking for the full adjuster's estimate and field notes often reveals that the insurer's own inspector recorded damage that the payment did not reflect, or scoped the repair in a way that omitted obvious items.

The adjuster's inspection

The adjuster who visits is retained by the insurer. They may be a staff adjuster or an independent contractor. They are not your representative, however pleasant the visit is.

Practical points for the inspection:

• Be present, and walk the property with them.
• Point out everything, including damage that seems minor. Items not identified during the inspection tend not to appear in the estimate.
• Take your own photographs during the visit, including of areas they inspect.
• Note who attended and when, and follow up in writing summarising what was discussed.
• Do not speculate about causes or dates. If you do not know when something started, say so rather than guessing, because a guess becomes a recorded admission.

Getting an independent contractor's estimate of your own, early, gives you a baseline to compare against. Where the two differ substantially, the difference is the dispute.

Proof of loss

A sworn proof of loss is a formal document stating the amount claimed, signed under oath. Insurers frequently request one, and the policy sets a period for returning it.

Treat the request seriously. Failure to submit a timely proof of loss is a recognised basis for denial, and the fact that the request arrived in a stack of paperwork is not an answer. If the amount is not yet known, it can usually be stated as an estimate subject to revision, but the document must go in.

The examination under oath

An examination under oath is a formal proceeding: you answer questions under oath, on the record, with a court reporter, conducted by the insurer's attorney. It is a policy condition, not litigation, and it usually happens before any suit is filed.

Insurers request an examination under oath where the claim is large, where there is a suspicion about the cause or the loss history, or where the documentation has been inconsistent. It is frequently paired with a broad demand for financial records, including tax returns, bank statements and mortgage documents.

Two points matter. Refusing to attend, or refusing to produce documents, is itself grounds for denial for breach of a policy condition. And an examination under oath is not a chat: answers are transcribed and used, and inconsistencies with earlier statements become the centrepiece of a later denial for misrepresentation.

This is the stage at which representation makes the clearest difference, because preparation and the scope of the document demand are both negotiable.

Why claims are denied or underpaid

The reasons repeat:

• Late notice of the claim.
• Wear and tear, deterioration or maintenance rather than a sudden accidental loss.
• Pre-existing damage, said to predate the policy or the storm.
• Excluded cause, most often flood, earth movement, mould or faulty workmanship.
• Damage below the deductible, particularly with a percentage hurricane deductible.
• Misrepresentation, either on the application or during the claim, which can void coverage entirely.
• Failure to comply with policy conditions, such as proof of loss or examination under oath.
• Scope disagreement, where coverage is accepted but the estimate is far below the cost of the work. This is the most common of all, and it is not technically a denial, which is why many homeowners do not realise they have a dispute.

Wear and tear versus sudden damage

The line between a covered sudden loss and excluded gradual deterioration is where most roof and plumbing claims are fought.

A pipe that bursts is generally a sudden event. A pipe that seeped slowly behind a wall for months is generally excluded, though the resulting damage may be treated differently from the pipe itself depending on wording. A roof damaged by a storm is a covered peril. A roof at the end of its service life that finally failed is not.

Evidence decides these. Weather data for the date of loss, the age and maintenance history of the component, photographs before and after, and an engineer's or contractor's opinion on causation all carry weight. Insurers frequently retain engineers whose reports conclude the damage was long-term, and those reports can be met with evidence rather than argument.

Matching and undamaged areas

A recurring and practical dispute: the storm damaged one slope of the roof, or one section of tile flooring, and the insurer offers to repair only that area. The replacement material no longer matches the rest.

Florida law addresses this in the context of repairs requiring replacement of items, providing for matching within the same area where a reasonably uniform appearance cannot otherwise be achieved. The scope of that requirement, particularly as between roofs and interior surfaces and following legislative changes, is an area that has generated significant litigation.

It is worth raising specifically rather than accepting a patch estimate, because the difference between repairing a section and replacing a surface is frequently the largest single number in the claim.

The appraisal process

Most policies contain an appraisal clause that provides a mechanism for resolving disputes about the amount of loss, as distinct from whether the loss is covered at all.

Either party may invoke it. Each side appoints an appraiser, the two appraisers select an umpire, and an award agreed by any two of the three is binding as to amount. It is generally faster and cheaper than litigation.

Its limits matter. Appraisal decides quantum, not coverage. Where the insurer denies that the loss is covered at all, or asserts a policy condition was breached, appraisal is usually not the right route and may not be available. Choosing a competent appraiser matters a great deal, since the process is only as good as the people conducting it.

Invoking appraisal also has consequences for later litigation, so it is a decision to take deliberately rather than reflexively.

Managed repair programmes

Some Florida policies include a managed repair or preferred contractor programme, under which the insurer arranges the repair using its own network instead of paying you to have the work done.

The attraction for the insurer is cost control. The concern for homeowners is quality, scope and the loss of choice over who works on their home, together with the practical difficulty of complaining about work you did not commission.

Whether the programme is mandatory or optional depends on the policy, and the answer is frequently not obvious from the correspondence. It is worth establishing before agreeing to anything.

Public adjusters

A public adjuster is licensed to represent policyholders in presenting a claim, and is paid a percentage of the recovery, subject to statutory caps that differ for declared emergencies.

A good public adjuster adds real value on scope and estimating, particularly on large or complex losses. Two cautions. Their percentage comes out of your recovery, so the arithmetic should be understood at the outset. And a public adjuster cannot give legal advice or file suit, so where the dispute is about coverage, policy conditions or an alleged misrepresentation rather than about the numbers, an adjuster is not the right tool.

Florida regulates solicitation by public adjusters, including restrictions on contact after a loss, which exist because of well-documented abuses following storms.

Assignment of benefits

For years Florida contractors routinely took an assignment of benefits, allowing them to pursue the insurer directly. The practice drove a large volume of litigation and was blamed for a substantial part of the state's insurance cost problem.

Florida legislation has since prohibited assignment of post-loss benefits under residential property insurance policies for policies issued after the relevant date. The practical effect is that a contractor cannot step into your shoes, and any document presented for signature purporting to do so should be treated with caution.

It also means the homeowner remains the claimant throughout. There is no longer a route by which the roofer takes the fight off your hands.

The change to attorney fees

This is the most consequential shift for policyholders, and many are unaware of it.

Florida historically had a one-way fee statute: a policyholder who obtained a judgment against their insurer recovered their attorney fees, while an insurer that won recovered nothing. That asymmetry made it economically viable to litigate relatively modest underpayments, because the insurer faced the policyholder's fees as well as its own.

Recent legislation repealed that entitlement for property insurance claims. Subject to narrow exceptions, a policyholder pursuing a property insurance dispute now generally bears their own attorney fees.

The consequences are practical and immediate:

• Small disputes are much harder to litigate economically.
• The insurer's incentive to resolve modest claims quickly has weakened.
• Presenting a well-documented claim correctly at the outset is now considerably more valuable than the ability to sue about it later.
• Appraisal, where available, has become relatively more attractive.

None of that means a wrongly denied claim should be accepted. It means the strategy has to reflect the current landscape rather than the one that existed a few years ago, and that the early stages of a claim now carry most of the leverage.

Bad faith and the civil remedy notice

Separately from breach of contract, Florida provides a statutory route for a first-party bad faith claim where an insurer has not attempted in good faith to settle when it could and should have done.

The procedure is strict. A civil remedy notice must be filed with the state and served on the insurer, specifying the statutory provisions violated, the facts relied on and what is required to cure. The insurer then has a statutory cure period, and paying the amount owed within that window generally defeats the bad faith claim.

Timing and sequence matter enormously. A bad faith claim generally requires a determination of liability and the extent of damages first, meaning the contract claim usually has to be resolved before bad faith can proceed. Recent legislation has also addressed what does and does not constitute bad faith and has introduced considerations about the conduct of the claimant.

This is a technical area where a procedural misstep forfeits the remedy, so it is worth advice before serving anything.

Suing the insurer

Where a dispute cannot be resolved, the claim is for breach of the insurance contract.

Florida requires a pre-suit notice to the insurer before filing suit on a property insurance claim, with a specified period for response, and the notice must contain particular information including the disputed amount and an estimate of damages. Failure to comply results in dismissal.

Litigation then follows the ordinary course described on the civil litigation page: pleadings, discovery, expert evidence on causation and scope, mediation, and trial if it does not settle. Insurance cases are document and expert heavy, and the engineers' reports on either side usually do most of the work.

Citizens Property Insurance

Citizens Property Insurance Corporation is the state-created insurer of last resort, and it now covers a large number of Florida homes because private capacity has contracted.

Claims against Citizens differ in some respects, including aspects of the claims process and certain defences available to it as a governmental entity, and there are eligibility and depopulation rules under which policyholders may be offered coverage by a private insurer. If your policy is with Citizens, the differences are worth understanding early rather than assuming the process mirrors a private carrier.

What to do next

If a claim has been denied, delayed or underpaid, the useful steps are concrete:

• Get the complete policy, including the declarations page and all endorsements, not the summary.
• Request the insurer's full file, including the adjuster's estimate, photographs and any engineer's report.
• Check the dates: date of loss, date notice was given, and any deadline stated in correspondence.
• Obtain your own contractor's estimate for the full scope of repair.
• Keep every receipt for mitigation, temporary repairs and additional living expenses.
• Do not sign anything presented by a contractor purporting to transfer your rights under the policy.

Bendel Law assists Florida homeowners with denied, delayed and underpaid property claims: reviewing the policy and the insurer's file, dealing with the carrier, preparing for examinations under oath, and pursuing the claim where the insurer's position does not match what the policy provides.

This page is general information about Florida property insurance claims. It is not legal advice for your situation, statutory deadlines and requirements have changed repeatedly in recent years and depend on when your policy was issued or renewed, and reading this page does not create an attorney-client relationship.