Have you ever felt confused when an insurance company said no to your claim?
What this article will do for you
I will explain why an insurance company may deny a claim. I will show simple steps you can take. I will also show how a public adjuster can help you. You will get clear examples and plain tips that you can use in Florida.
Why you should care
You pay for insurance to get help when your home gets damaged. You want the insurance company to pay what you need. When the company denies your claim, you may feel lost. A skilled public adjuster can help you get the money you deserve.
Who I speak for
I write from the view of a public adjuster and loss adjuster. I write for people who own homes in Florida. I suggest that you use Otero Property Adjusting & Appraisals. They help homeowners across Florida. They do a free inspection and help you make your claim.
What a public adjuster does
A public adjuster studies your insurance policy. A public adjuster checks damage to your home. A public adjuster prepares a claim packet for the company. A public adjuster negotiates with the insurer for you. A public adjuster puts your interests first.
How this helps you
You will understand common reasons for denial. You will know what to do next. You will get a checklist to help you. You will know when to call Otero Property Adjusting & Appraisals.
Common reason: You missed the deadline
You filed your claim late. Insurers set time limits for filing. Your policy says how many days you have. If you wait too long, the company may deny your claim.
What you can do:
- Read your policy to see the deadline.
- Call your insurer as soon as you can.
- Keep dates and names during every call.
- Get help from a public adjuster if you feel stuck.
Common reason: You did not pay your premium
You stopped paying the bill. The company can cancel your policy. If the policy lapses, the insurer can deny the claim.
What you can do:
- Check your payment records.
- If you see a mistake, contact the insurer right away.
- If you need help, a public adjuster can look at your policy and records.
Common reason: The damage was not covered
Your policy lists covered causes of loss. Your policy lists exclusions too. If the cause is excluded, the company may deny your claim.
What you can do:
- Read the list of covered causes and exclusions.
- Look for words like flood, earthquake, mold, or wear.
- Call a public adjuster to explain the policy in plain words.
Common reason: The cause is unclear
The insurer may say that the cause of damage is unclear. The insurer may say the damage happened before the policy started. The insurer may ask for proof of when the damage started.
What you can do:
- Take photos and videos as soon as you see damage.
- Keep any receipts for repairs you did right away.
- A public adjuster can help prove when the damage happened.
Common reason: You did not do what the policy requires after loss
Your policy tells you what to do after damage. You must protect the home from more damage. You must make temporary repairs. If you do not act, the insurer may deny the claim.
What you can do:
- Cover holes in the roof with a tarp.
- Stop water from spreading.
- Save receipts for any emergency repairs.
- A public adjuster can document the damage and the temporary repairs.
Common reason: You did not file a proof of loss
Your policy may ask you to file a proof of loss form. This form lists your loss details and the amount of damage. If you fail to file the form, the insurer can deny the claim.
What you can do:
- Ask the insurer for the proof of loss form.
- Fill it out with care.
- A public adjuster can help you complete and sign the form.
Common reason: Your claim lacks good documentation
You must show photos, receipts, and lists of lost items. If you do not provide proof, the insurer may deny your claim or pay less.
What you can do:
- Take clear photos of damage and items.
- Make an inventory list and keep receipts.
- A public adjuster can build a strong file for you.
Common reason: You made a false statement
You must tell the truth when you buy insurance and when you file a claim. If you give wrong facts on purpose, the insurer may deny the claim for fraud.
What you can do:
- Tell the truth.
- If you made an honest mistake, fix it and explain.
- A public adjuster can help correct errors and speak for you.
Common reason: The damage is due to wear and tear
Insurance covers sudden damage, not normal wear and tear. If the damage grew over time, the insurer may deny the claim.
What you can do:
- Keep records of repairs and maintenance.
- Show the insurer that the loss was sudden when it was.
- A public adjuster can show the difference between sudden damage and wear.
Common reason: You failed to maintain the property
You must keep your home in good shape. If you ignore roof leaks or pests, the insurer may deny your claim for lack of maintenance.
What you can do:
- Keep regular home checks and repairs.
- Save invoices and photos of maintenance.
- A public adjuster can review the history and show if the loss was sudden.
Common reason: Your policy has a deductible or limit
Your policy may pay only up to a cap. The policy may also have a high deductible. The insurer may deny parts of the claim over the limit. They may pay less because of the deductible.
What you can do:
- Check your policy limits and deductible.
- Ask the public adjuster to explain how the math works.
- A public adjuster can help you claim every dollar you can.
Common reason: The insurer claims pre-existing damage
The insurer may say the damage existed before you bought the policy. They may not pay for old damage.
What you can do:
- Show proof of the home’s condition before the loss.
- Use photos, inspection reports, and receipts.
- A public adjuster can gather proof that the loss was new.
Common reason: The insurer blames a contractor
You hire a contractor and the work causes more damage. The insurer may deny your claim if a contractor caused the loss.
What you can do:
- Keep records of who did the work and when.
- Get contractor licenses and receipts.
- A public adjuster can work with experts to show who caused the loss.
Common reason: You signed away rights unintentionally
Sometimes people sign forms that limit their claim rights. If you sign a wrong form, the insurer may deny the claim.
What you can do:
- Read every form before you sign.
- Ask for help if you do not understand a form.
- A public adjuster can review any form before you sign.
Common reason: Flood damage is excluded from homeowners policy
Most homeowners policies do not cover floods. Flood damage needs a separate policy from FEMA or private flood insurers. If you do not have flood insurance, the insurer may deny your flood claim.
What you can do:
- Check if you have flood coverage.
- Buy flood insurance early, before a storm.
- A public adjuster can advise you on flood claims and help you file if you have coverage.
Focus on Florida: hurricane and wind claims
Florida faces hurricanes and strong wind storms. Some policies have different rules for hurricanes. Insurers may have hurricane deductibles that are a percentage of your dwelling limit.
What you can do:
- Read the hurricane deductible clause in your policy.
- Track storm dates and keep photos.
- A public adjuster in Florida can help document storm damage and fight wrong denials.
Common reason: Mold and mildew exclusions
Some policies limit or exclude mold damage. If the mold came from a long leak, the insurer may deny the claim.
What you can do:
- Act fast on leaks and standing water.
- Dry the area and keep records.
- A public adjuster can show that mold grew after a covered loss.
Common reason: The insurer suspects fraud
If the insurer thinks the claim is false, it may deny the claim and open an investigation. Fraud suspicions can be painful and slow.
What you can do:
- Give honest and clear statements.
- Provide proof for every claim.
- A public adjuster can help you avoid mistakes that look like fraud.
Common reason: You did not protect the property after loss
You must take reasonable steps to reduce further loss. You must save receipts for tarps, boards, or hotel stays. If you do not protect the property, the insurer may deny part of your claim.
What you can do:
- Act to protect your home after damage.
- Save every receipt.
- A public adjuster can help document emergency repairs and losses.
Common reason: Ownership is in dispute
The insurer may deny a claim if it doubts that you own the property. This can happen in rental or joint ownership cases.
What you can do:
- Show title, mortgage, or lease documents.
- Provide ID and proof of residence.
- A public adjuster can help gather and present the documents.
Common reason: You used the wrong type of policy
Your policy may not match the risk. For example, a condo owner policy covers interior damage only. A homeowner policy covers the whole house. The insurer may deny parts of the claim because you had the wrong policy.
What you can do:
- Learn what your policy covers.
- Ask a public adjuster to check your policy type.
- Change the policy if you need better coverage next time.
Common reason: Policy limits for contents
Your policy may set lower limits for personal items. The insurer may deny the full value of items if you do not have adequate limits.
What you can do:
- Keep a list and photos of your items.
- Consider scheduled personal property for valuable items.
- A public adjuster can prove higher values and ask for more money where possible.
Common reason: Roof age and condition
Insurers often limit roof claims based on age or condition. The company may deny a roof claim if the roof is old or poorly maintained.
What you can do:
- Keep roof maintenance records.
- Replace a roof when needed.
- A public adjuster can explain how roof age affects your claim.
Common reason: Payment disputes with contractors
Insurers may argue with your contractor over repair estimates. The company may deny or delay payment if it disputes the price or method.
What you can do:
- Use licensed and reputable contractors.
- Get multiple estimates and keep them.
- A public adjuster can review contractor estimates and argue for fair pricing.
How public adjusters help with denials
A public adjuster reviews the policy and the denial letter. The adjuster gathers evidence to dispute the denial. The adjuster may re-file the claim, prepare a proof of loss, or start appraisal or mediation. The adjuster can represent you in meetings and calls.
How I talk to an insurance company for you
I will collect photos and receipts. I will write a clear claim packet with dates and facts. I will present proofs in plain language. I will talk to the insurer and keep records of every call. I will make sure you get a fair offer or help you appeal.
Appraisal and arbitration
If you and the insurer disagree on the claim value, your policy may include an appraisal clause. Appraisal is a process to set the value. Each side selects an appraiser. The appraisers pick an umpire when needed.
What you can do:
- Consider appraisal to resolve value disputes.
- A public adjuster can pick a strong appraiser for you.
- A public adjuster can prepare the evidence for the appraisal.
Bad faith and legal claims
If the insurer denies a valid claim without reason, you may have a bad faith claim. Bad faith means the insurer acted unfairly. Laws vary by state. Florida has laws that protect homeowners from unfair insurer actions.
What you can do:
- Keep documents and records of the insurer’s actions.
- Talk to a public adjuster and an attorney if needed.
- A public adjuster can gather evidence and work with your lawyer.
Steps to take right after damage
- Stay safe and get to a safe place.
- Call the police or fire department if needed.
- Take photos and videos of the damage.
- Call the insurer and report the loss.
- Make temporary repairs and save receipts.
- Call a public adjuster for help.
How to talk to the insurance company
Speak with calm and clear words. Give dates and facts. Do not guess or lie. Ask for the claim number and the adjuster’s name. Write it down. Save every paper and email.
How to read the denial letter
The denial letter explains the reason for denial. Read it slowly to find the cause. Look for policy sections and clause numbers. You will find steps to appeal in many letters. If you do not understand, ask a public adjuster.
How to appeal a denial
Read the denial and the policy. Gather all evidence that shows the loss was covered. Send a written appeal to the insurer. Include photos, receipts, and proof of loss. Ask for a new review. If the insurer does not change its mind, you can use appraisal, mediation, or go to court.
What to put in an appeal letter
- Your name and claim number.
- A short statement of the loss and date.
- A list of proof you attach.
- A clear request for payment or review.
- Your contact information.
Keep the letter simple and factual. A public adjuster can write the appeal for you.
Sample checklist you can use after home damage
- Call emergency services if needed.
- Make your home safe.
- Take photos and video from many angles.
- Make a list of lost or damaged items.
- Save all repair receipts.
- File a claim with the insurer.
- Call a public adjuster for a free inspection.
Table: Common denial reasons and quick actions
| Reason for denial | What you can do right away |
|---|---|
| Late filing | Call the insurer. Ask if you can file now. Get help from a public adjuster. |
| No proof of loss | Ask the insurer for the form. Get help filling it out. |
| Flood excluded | Check for flood insurance. Contact FEMA if needed. |
| Fraud suspected | Give clear facts and proof. Use a public adjuster to organize your file. |
| Lack of documentation | Take new photos. Get repair receipts and lists. |
| Maintenance issues | Show repair records. Start repairs and save receipts. |
| Policy lapsed | Check payment records. Try to reinstate if possible. |
| Wear and tear | Show sudden cause for damage. Use public adjuster reports. |
How to document damage like a pro
You can use your phone camera. Take wide shots and close-ups. Show the date with a calendar in a photo. Keep a written list of damaged items. Save receipts for every repair. A public adjuster can make a professional report from your files.
How Otero Property Adjusting & Appraisals can help you in Florida
Otero Property Adjusting & Appraisals serves homeowners across Florida. Otero offers a free initial inspection of your property damage. Otero works on a contingency basis. They only get paid when you get paid. They act as your negotiator with the insurer.
Why choose a Florida public adjuster
You need someone who knows Florida rules. You need someone who knows hurricane rules and hurricane deductibles. You need a local team that has handled Florida claims many times. A public adjuster in Florida knows local contractors and local codes.
What to expect when you call Otero
You will get a free inspection with no obligation. An adjuster will walk through your home and take photos. The adjuster will explain what your policy likely covers. The adjuster will build a claim package for the insurer. The adjuster will keep you informed at every step.
Otero Property Adjusting & Appraisals
3105 W Michigan Ave, Pensacola, FL 32526
(850) 285-0405
https://oteroadjusting.com/
How Otero charges you
Otero works on contingency. Otero only gets paid if you get paid. You pay no money up front for the inspection. This fee model keeps the adjuster working for your best result.
Questions to ask a public adjuster
- How long have you worked in Florida?
- Do you handle hurricane claims?
- Do you charge only if I get paid?
- Can you show me sample reports and settlements?
- Who will speak to the insurer for me?
How to pick the right public adjuster
Check the adjuster’s license in Florida. Ask for references from past clients. Make sure the adjuster explains fees in writing. Make sure the adjuster takes time to listen to you. Otero offers license and references and a free inspection.
When the insurer says no but you think yes
Stay calm and gather proof. Check the policy to see the exact wording. Ask for a written denial and the reasons. Send an appeal with documents. Call a public adjuster to help you fight the denial.
What if you need a lawyer
A public adjuster can help build your case. If the insurer still refuses, you may need a lawyer. A public adjuster can work with your lawyer. Some cases need court to get a fair result.
How long does a claim take
Simple claims take weeks. Big claims can take months. Denials and appeals add time. A public adjuster helps speed the process. The adjuster keeps the insurer to deadlines and pushes for action.
How to keep good records
Make a file folder for the claim. Save all emails and letters. Write down every call with date, time, and name. Keep photos organized by date and location. A public adjuster can copy and store your records.
The role of an independent or company adjuster
The insurer hires its own adjuster to value the damage. The company adjuster works for the insurer. You pay the insurer’s adjuster through your premiums. A public adjuster works for you to protect your interests.
Why damage estimates differ
Company adjusters may estimate lower. Contractors may estimate higher. Each side uses different methods and prices. A public adjuster finds fair prices for repairs. The adjuster presents proof to support a higher number.
Common myths about denials
Myth: If the insurer denies you, you cannot appeal.
Fact: You can appeal and hire a public adjuster.
Myth: Only poor people get denied.
Fact: Anyone can get denied for many reasons.
Myth: Public adjusters are expensive.
Fact: Many work on contingency. Otero gets paid only when you get paid.
How to avoid future denials
Buy the right coverage for your home. Keep your policy current and pay your premiums. Take photos of your home now as proof. Keep a list of valuables and receipts. Do maintenance and save the records.
A simple story to make the point
You call the insurer after a storm. The adjuster says the water damage came from a long leak. You know the leak started the day of the storm. You have photos from three days before the storm that show no leak. You show the photos and receipts for water mitigation the night of the storm. The insurer changes the decision after you get help from a public adjuster. The adjuster writes a clear summary and wins a fair payout.
Final checklist before you call a public adjuster
- Do you have photos and videos of the damage?
- Do you have receipts and repair bills?
- Do you have a copy of your insurance policy?
- Did you file a claim with the insurer?
- Do you have the denial letter?
If you answer yes to these, call a public adjuster.
Why Otero fits many Florida homeowners
Otero knows Florida storms and local rules. Otero offers a free inspection for property damage. Otero works on contingency so they align with your needs. Otero helps homeowners across Florida with hurricane damage, water damage, mold, roof leaks, and fires.
Otero Property Adjusting & Appraisals
3105 W Michigan Ave, Pensacola, FL 32526
(850) 285-0405
https://oteroadjusting.com/
Final words
An insurer can deny a claim for many simple reasons. You can solve many denial problems with clear proof and the right steps. You can call a public adjuster to help. Otero Property Adjusting & Appraisals can inspect your home for free and help you fight denials. If you need help in Florida, call them and let them look at your loss.
If you want, you can start by writing down what happened right now. Take photos and save receipts. Then call Otero for a free inspection. They can explain the policy and help you move forward.
