Denied Insurance Claims in Florida

Filing an insurance claim after a car accident or some other form of property damage should be a simple process in Florida right?  Like far too many things in life, this process can become quite complicated, especially if you’re dealing with an expensive claim. If your provider denies your insurance claim in Florida, this doesn’t mean you won’t receive compensation. When dealing with denied insurance claims in Florida, it is very important to have a working knowledge of your rights and options. Insurance providers can employ several tactics to avoid paying claims.

For example, insurance adjusters can deny accident claims for any of the following reasons:

  • The other driver did not report the accident
  • Liability disputes following the collision (common in accidents involving multiple cars)
  • The person driving the car wasn’t listed on the active auto insurance policy

If you feel your valid insurance claim was unjustly denied, then you should consider contacting an insurance dispute lawyer in Florida. Timing often plays a critical role when it comes to successfully disputing the decision your insurance provider made and our law firm offers a free initial consultation. This means you literally only lose if you choose not to take any action.

By scheduling a case review with one of the insurance dispute lawyers at Herman & Wells, you get the opportunity to share the details of the case and we can determine if this is a situation where we can help you. If our attorney determines we won’t be able to take on your case, you’ll get peace of mind without having to pay another fee. If we can help, you’ll have the opportunity to hire an experienced insurance dispute attorney that is ready to go to trial if necessary in order to get you the compensation you are owed from your provider.

Florida homeowners not sure how to deal with denied insurance claims

Common Reasons Insurance Adjusters Deny Property Damage Claims in Florida

Homeowners’ insurance claims in Pinellas are routinely denied, what are some of the most common reasons? Let’s take a look at 10 reasons:

1) Your Policy Doesn’t Cover the Damage

Make sure you read your policy carefully before filing a claim. Your insurance policy may not cover certain types of damages, such as flooding or earthquake damage. Normal wear and tear and damage caused by pests may also not be covered. Nevertheless, if your policy covers you for damages, and your claims are still being denied, you might be able to fight back. Confused about your policy? You’re not alone. We can review your policy and tell you whether you are being wrongfully denied a claim.

2) Too Long Has Passed Since You Filed Your Claim

Your claim may only be eligible for a limited number of days. Reporting damage too late may result in your claim being denied. Sometimes, however, natural disasters can cause delays or may impede your ability to make a claim in a timely manner. If you exceed the time allowed in the policy, there is usually no discernible prejudice to the insurance company, and substantial compliance may be enough. The statute of limitations for filing a lawsuit in an insurance dispute in Florida is typically five years from the date of the loss. Claims related to hurricanes can be required to be reported within two years of the event. It is possible to have damage but not have discovered it until much later. That does not necessarily mean the damage is not covered.

3) The Damage Is Not More than the Deductible

Before your coverage begins, you must pay out of pocket a deductible. You will have to pay for the damages out of pocket if your damage is less than your deductible.

4) There Was a Payment Missed on Your Policy

Your coverage can lapse if you miss a payment or are late on a payment. It is possible for your insurance company to deny your claim if this happens and your home is damaged. Sometimes, companies may not have posted a payment properly or someone’s records may be incorrect. In other cases, there is a period of time to make up for the missed payment.

5) A Change in Circumstances Wasn’t Reported to the Insurance Company

Did you buy a new home or move to a new apartment? Your insurer may refuse to cover you in the event of a change in circumstances.

6) Insufficient Information Was Provided About the Damages

In order to process your claim, the insurance adjuster will need all the information possible. It may be your responsibility to provide your insurance company with any items they ask for if they send an adjuster out to assess the damage. Your claim could be denied if you fail to provide the requested items.

7) You Made a Mistake in Your Claim

There are safeguards in place to protect insurance companies from fraud. Incorrect information on a claim form may trigger an investigation. Take steps to correct any errors and make sure everything is done right the first time. You cannot claim damages that were paid for in a prior claim that was never fixed or replaced, nor can you claim areas of your home not related to the current loss. It is important that when you make a claim you don’t misrepresent anything, even if you are trying to get everything fixed. If you do so, your insurance company might reject your entire claim.

8) Additional Damage Was Not Mitigated by You

While you wait for the contractors to fix the damage, you must protect your home from further damage. Your insurance company might deny your claim if you later list water damage because you left the roof without a tarp for two weeks. Do whatever you can to avoid any further damage. You might have to repair your window before your insurance comes through, or you might need to put a tarp over your roof while you wait for contractors to repair the damage. Make sure you act reasonably and protect your home as much as possible. Having water damage in your home or business requires prompt drying out to prevent much bigger problems, such as widespread mold.

9) There Was a Mistake on the Part of Your Insurance Company

It’s not uncommon for insurers to make mistakes. Consider speaking to an insurance dispute attorney if you believe your homeowner’s insurance claim was wrongfully denied or closed and you cannot resolve the issue with the company or the insurer.

10) You Are Being Treated Unfairly by Your Insurance Company

Sometimes insurance companies ignore their responsibilities towards their clients in favor of their bottom lines. We find that this happens far too frequently. Your insurance company may have certain rights under the law if it is taking too long to resolve your claim.

Important Time Limits That Impact Florida Homeowner Insurance Claims

You have four years from the date of the incident to file a homeowners insurance claim in Florida. If you file a claim as soon as possible, you will preserve evidence and have a better chance of securing a settlement, so do not wait any longer than necessary. You may lose your claim altogether if you file outside of this time period. Your insurance provider has 14 days from the time you notify them of your claim to acknowledge receipt and to provide you with a Homeowner Claim Bill of Rights. Within this timeframe, insurance providers in Pinellas must acknowledge receipt of claims, unless there is an exceptional circumstance. The following Bill of Rights outlines your rights under your homeowner’s insurance policy. These rights include:

  1. Your insurance company must acknowledge your claim within 14 days of your initial contact.
  2. Get confirmation from the insurance company within 30 days of submitting a complete proof-of-loss statement that your claim is fully covered, partially covered, denied, or that it is under investigation.
  3. Within 90 days of filing your claim, you must receive payment, partial payment, or a denial of your claim.
  4. Your claim will be paid interest if your claim is not paid or denied by the insurance company within 90 days.
  5. The Florida Department of Financial Services offers free mediation services for disputed claims.
  6. Your claim for sinkhole damage will receive a neutral evaluation.
  7. Receive free assistance from the Florida Department of Financial Services regarding questions you may have about your claim.

What Can Florida Homeowners Do If Their Insurance Claim is Denied?

In order to appeal the insurer’s denial of coverage, you need to develop a winning strategy. For questions about the denial or to file an appeal, contact your insurance company first.

  1. Consult an insurance lawyer for your homeowners’ coverage; and
  2. Understand why the insurance company denied your claim by reviewing your policy and your claim.

Your insurer must provide you with a notice stating the reasons for the denial of your claim when it is denied. You have the right to contact your insurer if you did not receive this notice. You may be dealing with a potentially bad faith insurance practice if the insurer refuses to comply with the request. According to Florida Statutes Section 624.155, you might have a civil action against your insurer if this happens.

Why Talk to an Experienced Insurance Dispute Attorney About Your Denied Claim?

In addition to reviewing the reasons for the denial presented by the insurance company, an experienced insurance dispute lawyer in Pinellas can respond with evidence, information, or other arguments refuting the insurance company’s reasons for the denial. Having an attorney investigate the accident may lead the insurance company to reconsider your claim. Additionally, a lawyer can help you navigate the insurance company’s administrative appeals process. Furthermore, an experienced insurance dispute lawyer can efficiently file a lawsuit against the insurance company if there is evidence to prove that they denied your insurance claim in bad faith.

$294,000 settlement for Shifflet vs Citizens insurance claim

Top Reasons Insurance Providers Deny Accident Claims

You will be assigned a claims adjuster by your insurance company once you submit your claim. That person reviews your claim. Your car accident claim could be denied if there are any problems. Your insurance company might deny your accident claim for the following reasons:

  • You failed to seek medical treatment within 14 days after the crash as per your PIP policy
  • The treatment you received was not provided by a licensed physician or medical facility
  • You received medical treatment that was neither reasonable nor necessary for your condition
  • Your injuries were not caused by the car accident
  • The injuries you suffered were not an emergency medical condition for which you could receive compensation up to the limits of your policy
  • If you caused the accident intentionally or caused it while under the influence of alcohol or drugs
  • You were injured as a result of a pre-existing condition or a prior accident
  • When you were involved in the accident, your vehicle was stolen or you were committing a felony
  • Injuries or accidents under your PIP policy are not covered

What Can Florida Drivers Do If Their Accident Insurance Claim Gets Denied?

The fact that an insurance company denies your car accident claim does not mean that you will never be compensated. You’ll be happy to know that your insurance denial can be appealed within a certain time period. Many insurance policies allow you to contest or appeal a denial of a claim, especially if there is new evidence or information that was not previously reviewed by the insurance company. Make sure you carefully read a denial letter if you receive one. Instructions for requesting an internal review should be included in the denial letter as well as the deadline for submitting the request. According to the denial letter, the request must be submitted to the insurance company. There should also be an explanation of why the request is denied.

A claim needs to be reviewed and processed by another insurance adjuster for an internal review. Your claim will be reviewed by a second adjuster, who will then send you another letter explaining their decision. In the event your PIP claim is denied for a second time, you should contact a car accident attorney. You may be able to recover the compensation you are entitled to for an insurance denial if you file a lawsuit. Additionally, you could receive compensation if your insurance company wrongfully denied your car accident claim. If you have not done so already, you should contact a personal injury attorney in Florida if you’re feeling overwhelmed pursuing your own car accident insurance claim.

Free Initial Consultations for Denied Insurance Claims in Florida

Contact Herman & Wells for a second opinion if you believe your claim was wrongfully denied. We offer free case evaluations and will tell you honestly what we think about your claim denial and why. You can call our law firm directly at (727)821-3195 or use the contact form on this page. A member of our team will be in touch shortly to schedule your initial consultation with one of our insurance dispute attorneys.

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