What should I do if my insurance claim is denied in Florida?

A denial is not the final word. Florida policyholders have the right to dispute a carrier's denial through several mechanisms: filing a supplemental claim with additional evidence, invoking the appraisal clause in your policy, or requesting mediation through the Florida Department of Financial Services. A licensed public adjuster can re-inspect your property, document damage the carrier missed, and present a professional challenge to the denial with supporting evidence.

Can an insurance company deny a hurricane claim by calling it 'wear and tear'?

Carriers sometimes deny storm damage claims by classifying the damage as pre-existing wear and tear. However, this determination must be based on evidence, not assumption. Wind damage produces characteristic patterns — directional damage, debris impact marks, and uplift signatures — that are distinct from age-related deterioration. NOAA weather data, drone imagery, and manufacturer analysis of damaged materials can establish whether damage was storm-caused or pre-existing.

How long do I have to dispute a denied claim in Florida?

Florida policyholders should act promptly after receiving a denial. While the statute of limitations for breach of contract claims is typically five years, the sooner you engage a public adjuster and begin the dispute process, the better — evidence of storm damage can deteriorate over time. The carrier has 60 days from the date of claim filing to respond with a coverage determination.

What evidence can overturn a denied wind damage claim?

Effective evidence for overturning a wind damage denial may include: NOAA weather data confirming storm-force winds at the property location, drone imagery documenting damage patterns consistent with wind uplift, manufacturer analysis of damaged shingles showing impact or uplift failure rather than age deterioration, a 14-point re-inspection documenting damage the carrier's adjuster missed, and comparison with neighboring properties that filed successful claims from the same storm event.

Denied Claim Case Study: $0 to $52,300

Claim Results

Carrier Offer

→

Final Settlement

$52,300

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Result

Denial Overturned

Location

Riverview, FL

Damage Type

Hurricane Wind

Timeline

38 Days

Resolution

Mediation

What Happened

A single-family home in Riverview, FL sustained significant wind damage during a hurricane event. The homeowner discovered missing shingles across two roof slopes, damaged soffit panels on the windward side of the home, and interior water intrusion in the master bedroom and living room where wind-driven rain entered through compromised roof sections. Ceiling drywall showed water staining and early signs of saturation damage.

The homeowner filed a claim within days of the storm. The carrier dispatched their adjuster approximately three weeks after the event. The adjuster inspected the roof and issued a full denial, stating that the shingle loss was due to “wear and tear and pre-existing condition” and that the soffit damage was “maintenance-related.” The denial letter made no reference to the hurricane event and did not address the interior water damage at all.

What the Carrier Tried

The carrier’s denial strategy relied on classifying all damage as pre-existing. Their adjuster noted the age of the roof (12 years on a 30-year shingle system) and used the age alone to justify a wear-and-tear finding. They did not examine shingle failure patterns, did not analyze whether the damage was directional (consistent with wind) or random (consistent with aging), and did not correlate the damage timing with the storm event. The interior water intrusion was not addressed in the denial, effectively pretending it did not exist.

What Care Claims Did

The homeowner engaged Care Claims after receiving the denial. Our team executed a systematic 14-point re-inspection protocol designed specifically for denied wind damage claims.

We deployed drone imagery to capture the full roof surface at high resolution. The aerial documentation revealed a clear directional damage pattern — shingle loss and uplift damage concentrated on the south and southwest-facing roof slopes, consistent with the documented wind direction during the hurricane. The north-facing slopes showed minimal damage. This directional pattern is a hallmark of wind damage and is inconsistent with uniform age-related deterioration, which would affect all slopes equally.

We obtained NOAA weather station data for the homeowner’s ZIP code during the storm event. The data confirmed sustained winds exceeding the threshold for shingle damage at the property location, with peak gusts well above the manufacturer’s rated wind resistance for the installed shingle product. This established that the storm was capable of causing the observed damage.

We collected samples of the damaged shingles and commissioned a manufacturer-standards analysis. The analysis showed that the shingle failures exhibited uplift-pattern tearing at the nail strip — consistent with wind forces exceeding the shingle’s wind resistance — rather than the granular loss, curling, or brittleness characteristic of age-related deterioration. The shingles still had substantial remaining useful life when properly adhered.

We submitted a comprehensive supplemental claim package including the drone imagery with directional wind overlay, NOAA weather data, shingle analysis report, complete interior damage documentation, and a fully scoped estimate. We invoked mediation through the Florida Department of Financial Services. The mediator reviewed our evidence package and the carrier agreed to settle at $52,300.

Timeline

Day 1 — Engagement & 14-Point Re-Inspection

Homeowner signed Letter of Representation. Care Claims performed 14-point re-inspection with drone imagery, interior damage documentation, and shingle sample collection.

Days 3-7 — Evidence Assembly

NOAA weather data obtained and correlated to property. Manufacturer shingle analysis completed. Drone imagery analyzed for directional damage patterns.

Day 10 — Supplemental Claim & Denial Challenge

Comprehensive supplemental claim filed with weather data, drone imagery, shingle analysis, and interior damage scope. Carrier’s “wear and tear” denial formally challenged with evidence.

Day 18 — Mediation Invoked

Carrier maintained denial. Care Claims invoked mediation through the Florida DFS.

Day 38 — Denial Overturned & Settlement

Mediator reviewed evidence. Carrier agreed to overturn denial and settle. Final settlement: $52,300.

Results vary. Past performance does not guarantee future outcomes. Case details anonymized for client privacy. All claims outcomes depend on policy terms, damage scope, and carrier cooperation. Public adjuster fees are typically 10-20% of settlement, per FL Statute 626.854.