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Underpaid or Denied Home Insurance Claims in Florida: What to Do Next
Reviewed by Raul Alconero, Florida Licensed Public Adjuster. Figures checked against the 2025 Florida Statutes, July 2026.
Your carrier, the insurance company that wrote your policy, hands you an estimate: a set of testable assertions about these rooms, these quantities, this unit price, this much depreciation, the value the policy subtracts for age and wear. Check each against your own measurements and photographs.
First, name what actually happened
- A denial. The carrier says the loss is not covered, pointing to an exclusion, the policy language that removes a cause of loss from coverage, or to a post-loss duty, something your policy requires you to do after a loss.
- A partial denial. Part accepted, part refused. Read the letter for which part: the roof, the mold remediation, meaning removal and cleanup, or the contents, your personal property.
- A payment you believe is too low. Coverage is agreed; the argument is scope, pricing or depreciation.
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If your letter argues wear and tear, late notice, faulty workmanship or failure to mitigate, meaning you did not take reasonable steps to stop further damage, that is a coverage fight. Our guide to Florida insurance claim denials covers those arguments; our Florida public adjuster guide covers the process.
Read the estimate line by line
Ask for every detailed estimate the carrier’s adjuster has generated. Section 627.70131(3)(e), Florida Statutes, gives the carrier 7 days to send a copy once one is generated, though it need not create one that is not reasonably necessary.
- Scope. Which rooms, roof slopes and components appear at all. A missing room is a scope gap, corrected by adding line items; a pricing dispute is corrected by changing the unit price.
- Quantities. Drywall square feet, baseboard linear feet and roofing squares, one square being 100 square feet of roof, checked against your own measurements.
- Unit pricing. Check the price-list date and ZIP code on the estimate against when the work will be done.
- Depreciation, deductible, prior payments. Actual cash value is commonly replacement cost minus that depreciation, though your policy’s definition governs. Under replacement cost coverage the withheld depreciation may be claimable once repairs are documented, and you have to ask. Check any “less prior payments” line against the checks received.
- Overhead and profit, code work, matching. A general contractor’s markup may belong where several trades must be coordinated. Ordinance or law coverage, the part of the policy that pays for code-required upgrades, decides whether code work gets paid. Matching asks whether undamaged material beside the repair must be replaced so the repair does not end up two colors.
What the carrier owes you, and by when
Section 627.70131(7)(a) requires a reasonable written explanation of the basis in the policy, in relation to the facts or applicable law, for the payment, denial or partial denial, plus an explanation of any gap between its own detailed estimate and what it paid. Check whether your letter points to specific policy language and specific facts.
Subsection (6)(b) requires any payment that is not full and final to carry a statement in at least 12-point bold uppercase type beginning “WE ARE CONTINUING TO EVALUATE YOUR CLAIM.” If it is missing, ask in writing whether the carrier treats the payment as full and final, and keep the answer. Ask a Florida attorney what that means for your claim.
These deadlines were shortened effective March 1, 2023; any page citing 14, 45 or 90 days is out of date.
- 7 calendar days to acknowledge a claim communication, from receipt, under (1)(a), unless it pays within that period or the delay is caused by factors beyond its control. Under (1)(c) that duty narrows if you are represented by counsel, meaning a lawyer, so working with a public adjuster leaves it in place. A dated notation in the claim file satisfies it, so you may never see a letter.
- 7 days to begin a reasonably necessary investigation, from receipt of the proof-of-loss statements, the documents stating what you are claiming, under (3)(a), unless your policy or other law provides otherwise.
- 30 days to conduct any physical inspection, from receipt of those same statements, under (3)(b).
- 60 days to pay or deny the claim or part of it, under (7)(a), from notice of an initial claim, a reopened claim (previously closed, reopened at your request) or a supplemental claim (more loss from the same cause, found after adjustment).
Under (7)(b) that rule covers residential coverage and small commercial risks of 10,000 square feet or less, and (9) extends it to surplus lines insurers, the non-standard market that writes what standard carriers will not. Subsection (7)(a) also addresses interest on late payment at the section 55.03 rate from the date notice was received, and says failure to comply is a violation of the insurance code but does not by itself form the sole basis for a private cause of action. A missed deadline goes to a Florida attorney.
Your deadlines are shorter, and they cover every peril
Section 627.70132(2) bars a claim or reopened claim unless notice was given to the insurer, in accordance with the terms of the policy, within 1 year after the date of loss. A supplemental claim gets 18 months. Both run from the date of loss, so the windows overlap, and your policy’s prompt-notice condition, the requirement to report promptly, still applies.
Until July 1, 2021 this section reached only windstorm and hurricane claims. SB 76, chapter 2021-77, expanded it to any peril, meaning any cause of damage your policy covers: a cast iron pipe failure, a slow roof leak, a sudden water loss, mold after a covered water event. Subsection (3) fixes the date of loss for weather events as hurricane landfall or the date the National Oceanic and Atmospheric Administration verifies the event, so count from landfall on a hurricane claim.
Reopening does not run on one clock.
- Challenging the decision on an open file. That is not the same as noticing a new or reopened claim, though the clocks above run from your date of loss either way and your post-loss duties apply.
- A reopened claim, under (1)(a). One year from the date of loss; closing the file does not restart it.
- A supplemental claim, under (1)(b). Eighteen months from the date of loss, and it requires an underlying claim noticed on time.
The next 30 days
Freeze the evidence: a wide view of each room, the damage close up and again with a tape measure in frame, and shots behind the wall and under the floor during demolition. Ask in writing for the field adjuster’s report and photographs, any engineer report, and the adjuster’s name and license number, required at the physical inspection by (3)(b) and in every later claim communication by (3)(c). Then request a re-inspection with your representative present.
Two fire claims from our files
Elena Gonzalez Perez lost a recently bought home to a fire started by a power pole downed during Hurricane Milton. She counted more than 15 public adjusters at her door with contracts to sign. In her words, translated from Spanish: “Everyone showed up and handed me a paper to sign and said, ‘Don’t worry, I’ll take care of everything.’ But I didn’t even know what I was signing or how the process worked.” Her policy covered only 70 percent of the house, no FEMA help came, and the mortgage bank held the funds. She speaks little English, so we took the calls with the bank and the carrier. The first checks arrived in about two weeks, and we worked the mortgage-bank paperwork to release the funds. They rebuilt in under six months, and the settlement reached $417,585.
Magaly’s fire claim, which we publish under her first name, started at about $24,000, the amount first presented. We documented and developed it, and the recovery reached $500,000.
Past results do not guarantee a similar outcome. Every insurance claim depends on its policy, facts and documentation.
Public Adjuster Services
Where the settlement money gets stuck
Check whether your settlement check carries your lender’s name alongside yours. On a financed property, your mortgage lender’s rights to those funds come from your mortgage documents and your policy. What the lender may do with the money, and what you can do with a check that carries its name, is a question for a Florida attorney.
Many financed policyholders find the lender holds the funds while it runs its own process on top of the carrier’s. Ask its loss draft department, the group that handles insurance checks, and ask early what it requires before releasing funds, whether it releases in stages, and what triggers each release. Elena’s policy covered additional living expenses, the coverage for somewhere to stay while a home is unlivable, and she could not reach it until the first checks cleared the lender. What your lender must release, and when, turns on those documents. Take them to a Florida attorney.
Does depositing the check end your claim?
Before you deposit, read the check, any wording on its back, and any letter that came with it. If the words release, waiver or full and final settlement appear, have a Florida attorney read it first.
What appraisal and mediation can do
Whether you can demand appraisal depends on your policy, so read the clause and check who may invoke it. Section 627.7015(1) calls appraisal a potentially expensive and time-consuming process that most policies require policyholders to participate in, and section 627.70151 describes it as a way of estimating the amount of loss through an impartial umpire. Under a typical clause each side picks an appraiser, those two select the umpire, the neutral third person, and any two of the three set the amount of loss. Your policy may also carry a binding arbitration endorsement, an add-on that sends disputes to a private decision-maker rather than a court. Have a Florida attorney explain what it does.
Appraisal settles the amount of loss. Whether the loss is covered is a separate question that turns on the facts, so a carrier disputing what caused the damage puts you in front of a Florida attorney. Your clause may also let the carrier invoke appraisal on you, and after a pre-suit notice under section 627.70152(4)(b) it can require appraisal or another dispute-resolution route. Ask a Florida attorney what that does to any deadline in your file.
Mediation is separate and cheaper. Section 627.7015 runs a Florida Department of Financial Services program, and subsection (3) puts the conference cost on the insurer. Section 627.7015(7) attaches consequences when the carrier never told you about it, and what those are worth is for a Florida attorney.
When you need an attorney instead
We are not attorneys. Take these to a Florida attorney: bad faith; an examination under oath, formal recorded questioning by the carrier with a court reporter; a release; and any deadline to sue. Florida sets a deadline to file suit separate from the notice deadlines above, so do not calculate it yourself, and its attorney fee rules for property suits have changed. Ask an attorney how both affect your file.
What this costs, and what next
Section 626.854(11)(b) caps public adjuster compensation at 20 percent of qualifying claim payments, and at 10 percent for claims made in the year after a governor’s declaration of emergency. Those statutory ceilings apply to residential property and condominium unit owner policies. Our page on what a public adjuster costs works through the math.
We work claims across Florida from our Miami office, including Southwest Florida through our pages for public adjusters in Naples and Immokalee. Bring the estimate, the payment or denial letter, your declarations page listing your coverages and limits, and photographs. We will tell you whether the gap is scope, pricing, depreciation, documentation or coverage, and some claims do not need us.
Frequently Asked Questions About Public Adjusters in Miami
How do I know if my Florida home insurance claim was underpaid?
To know whether your Florida home insurance claim was underpaid, compare the carrier’s detailed estimate against the actual repair scope one line at a time, because the total hides the line items. Look first for rooms, roof slopes or components that never appear on the estimate, then at quantities and measurements, then at the depreciation column, the deductible and any deduction for prior payments. If a room you know was damaged carries no line items at all, that is a scope gap, and the fix is to add the missing line items.
How long does a Florida insurance company have to pay or deny my claim?
A Florida insurance company has sixty days to pay or deny your claim, counted from the date the insurer receives notice of an initial, reopened or supplemental property claim, under section 627.70131(7)(a), Florida Statutes. That subsection addresses interest on late payment at the section 55.03 rate, accruing from the date notice was received, and says failure to comply is a violation of the insurance code but does not by itself form the sole basis for a private cause of action. What that leaves you is for a Florida attorney to say. The clock can also be paused, including when a document request the carrier sent goes unanswered for more than 10 days, and only where the carrier sent that request at least 15 days before its pay-or-deny deadline.
Can I reopen a denied Florida claim for a broken pipe or a water loss?
You may be able to reopen a denied Florida claim for a broken pipe or a water loss, and the deadline decides it. Section 627.70132(2) requires notice of a new or reopened claim within 1 year after the date of loss, and notice of a supplemental claim, meaning additional loss from the same cause of damage already adjusted, within 18 months after the date of loss. The one-year clock for a reopened claim runs from the date of loss. It does not restart on the day the carrier closed the file. An open file you are still contesting has not been noticed as a new or reopened claim. Those clocks run from your date of loss either way, so date your loss, count forward, and check what your policy still requires you to do.
Will a public adjuster take a percentage of money I was already paid?
No, a public adjuster will not take a percentage of money you were already paid. Section 626.854(11)(a), Florida Statutes, provides that on a reopened or supplemental claim, compensation must be based only on payments obtained through the public adjuster’s work after the contract is signed. Section 626.854(11)(b)4 sets the fee at zero for any coverage part the insurer paid or agreed in writing to pay before the contract was executed, and (11)(c) provides that compensation may not be based on the deductible. These provisions apply to residential property and condominium unit owner policies.
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This page is general information, not legal, financial or insurance advice, and creates no public adjuster-client relationship.
Alconero & Associates. Florida PA License #P197242
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