Claim Denial.
If you are like one of millions of people affected by Hurricane Ian and have homeowners insurance, chances are you are currently navigating the claims process on your property. Despite having damages you may be, unfortunately dealing with a claim denial. You do have recourse and can find out how to appeal insurance denials. Knowing your damages are real and getting a claim denial can be quite the gut punch if you weren’t expecting it.
Now what? Re-adjustment.
To start, don’t feel complete dismay as you have a few options when it comes to a denial. First and foremost, you can always request a re-adjustment if you feel there was an error in claim coverage determination or if you feel damages may have been missed.
If you decide you want to do a re-adjustment we recommend you do not do this alone as you may get another result like the first. Hiring a Florida licensed public adjuster would be a viable option to assist and advocate for your loss on the re-adjustment. This is always our first step with new clients who were previously denied before seeking our help.
If the first step does not result in a favorable result, there are still a few remaining options for homeowners, so do not fret just yet. There are still avenues for how to appeal insurance denials.
Before continuing, it is important to highlight the policy between the homeowner and the insurance provider is a contract. The insured pays premiums and in return the insurance company covers ‘perils’ also known as damages to a property and/or dwelling. The policy also states dispute resolution options available in the occurrence a disagreement does arise between an insured and the insurer. We always review your policy and ensure prior to making any first moves we understand your policy thoroughly. The fine print is key to understanding your rights in how to appeal insurance denials.
Mediation.
Most policies have a provision for mediation, which is the process of filing a motion with the state of Florida requesting a state appointed mediator to assist with the dispute resolution process. This is a non-binding proceeding and is a step to avoid litigation as litigation can take much longer to find resolution. Once mediation is demanded both parties have a 20 day window to find resolution prior to a mediator being appointed. It is most beneficial for both parties to find resolution to the claim prior to mediation. If at the end of the 20 day window resolution has not been agreed upon, mediation will occur.
Going into mediation, the goal is for both sides to meet and make concessions in an effort to find an amicable resolution. During mediation the claim will be discussed in the presence of the mediator who will assist to find resolution.
Mediation is at no cost to the homeowner, unless the homeowner misses the scheduled mediation and requests rescheduling. This results in a fee of $350 to the homeowner. It is most important to remember most mediations do not result in one side ‘winning’ and one side ‘losing’.
Once a best and final offer has been received, you decide if the offer is fair to walk away from the dispute. You do have time during mediation to consult with your public adjuster to weigh whether or not the offer is reasonable to cover your damages.
If mediation fails to yield an agreeable result it would be termed an ‘impasse’ and would then proceed to either appraisal or litigation at the decision of the homeowner. Appraisal and litigation are the next steps in how to appeal insurance denial that you have access to.
Appraisal.
Unlike mediation, appraisal is a binding proceeding which means the result is final and neither party will have the ability to discuss the claim with one another regardless of what happens. It is a ‘washing of the hands’ of the claim by both parties once a lump sum payment has been issued by the insurer.
There are costs associated with appraisal on both sides which typically start at $350-$500 and are dependent on the size and scope of the appraisal. At minimum, you are to select and pay for an appraiser to conduct the appraisal with the insurance companies appointed appraiser. The two appraisers evaluate the damages and the costs of the damages in total. They do not consider causation of damages, they only make a determination on damage costs and provide an estimate.
If they are unable to agree upon the costs of the damages, the claim would be moved onto an Umpire. An umpire has additional costs to the insured, which also can vary in range and is determined based upon scope of the dispute and is required to review the claim documentation in full.
Upon the umpire assessment and claim review, the umpire will make a binding determination, which is final. Both parties and the umpire will sign the determination letter provided by the umpire. Once signed and provided to insurance, a lump sum payment is made to the insured and the insured has the expectation to perform the necessary repairs on the dwelling.
Legal Action.
If a homeowner would like to avoid alternative dispute resolution they always have the option to seek legal representation by finding an attorney who handles property claims. This option of how to appeal insurance denials does have its positives and negatives and should be thoroughly considered prior to seeking legal representation.
Contact Us.
If you find yourself having additional questions or if you would like to suggest a topic to discuss please feel free to email us at [email protected].
People that use a public adjuster like Fair Claim Experts save time, save money, have a better understanding of their claim actions, remove stress, and gain peace of mind. Let us help you get your property back to the condition it was in before damages occurred. We serve clients from all areas across the state of Florida: Tampa, St. Petersburg, Orlando, Miami, Miami Beach, West Palm Beach, Ft. Lauderdale, Jacksonville, Tallahassee, Gainesville, The Villages. Click here to begin your free consultation.
