Wear and tear
“Damage is due to age, deterioration and lack of maintenance.”
The exclusion is real, but it removes only the worn-out part. A sudden event that damaged an older roof or pipe can still be covered.
Florida property insurance · Last reviewed October 2026
The insurance company denied the claim. Here is what a Florida homeowner does next.
If your homeowners insurer denied the claim on your Florida house, the letter feels final. It usually is not. Florida law makes the insurer explain its decision in writing, gives you copies of key documents, and leaves you several ways to challenge the result — but each one runs on a clock. This notebook walks through it in order.
Exhibit ASample wording
Dear Policyholder: We have completed our investigation of the loss reported on 00/00/0000.
Our inspection found the roof damage is the result of wear and tear, deterioration and improper maintenance, which are excluded under Section I – Exclusions of your policy.
Accordingly, we must respectfully deny coverage for this claim. Nothing in this letter waives any of our rights under the policy.
7 daysfor the insurer to send you a copy of any detailed estimate it generates
s. 627.70131(3)(e)60 daysafter notice of the claim for the insurer to pay or deny, in most cases
s. 627.70131(7)(a)1 yearfrom the date of loss to give notice of a new or reopened claim
s. 627.701325 yearsfrom the date of loss to sue for breach of a property policy
s. 95.11(2)(e)The playbook
Nine steps after your insurer denied the claim
Work through these in order. Most homeowners skip straight to arguing with the adjuster; the people who get denials reversed usually start by collecting paper. Each step links to a longer guide if you need more detail.
Read the denial letter as a legal document, not a verdict
When an insurer denies a Florida property claim, it must give you a reasonable written explanation of the basis in the policy for the decision. That means the letter should name a reason and point to policy language. Underline three things: the reason (for example “wear and tear” or “late reporting”), the policy section it quotes, and whether it is a full or partial denial. A partial denial or a “below your deductible” decision is really a dispute about the amount, which changes your options.
Line-by-line help: Denial letter explained, phrase by phrase.
Get the complete policy, not the declarations page
Coverage decisions turn on the full policy: the coverage form, every endorsement, and the exclusions section the letter quotes. The two-page declarations sheet you get at renewal is not enough. Ask the insurer (or your agent) for a complete certified copy of the policy in force on the date of loss. Compare the language the letter quotes to the actual text — insurers sometimes cite an exclusion from a different form, or skip an exception written into the very same paragraph.
Request the estimates, reports and adjuster list behind the decision
Florida law requires the insurer to send you a copy of any detailed estimate of the loss within 7 days after it is generated, and to keep a log of every adjuster who communicated with you and give you that list on request. Ask for those, plus the photos, the inspection report and any engineer or cause-and-origin report the denial relied on. The insurer may not hand over its entire internal file before a lawsuit, but a refusal to share the report it relied on is itself worth noting.
- Detailed estimate(s) and any re-inspection estimate
- Inspection photos and field adjuster notes
- Engineer, roofer or leak-detection report cited in the letter
- List of every adjuster on the claim, with license numbers
Name the denial reason you are actually fighting
“We denied the claim” can mean very different things. A wear-and-tear denial is fought with proof of a sudden event and the property’s condition before it; a late-notice denial is fought with dates and with whether the delay actually hurt the insurer; a misrepresentation denial is fought with the application and recorded statements. See the five common reasons below.
Preserve the evidence and keep protecting the property
Most Florida homeowners policies require you to make reasonable temporary repairs to stop further damage, keep the receipts, and let the insurer see the damaged property. A denial does not switch those duties off. Photograph everything with dates, keep pieces of the damaged roof covering, pipe or drywall if you can, and save weather reports for the date of loss. If you need permanent repairs before the dispute ends, document the condition thoroughly first.
Answer the denial with your own evidence, in writing
Insurers do reconsider. Send a short written response that disputes the stated reason, attaches your proof (an independent contractor’s estimate, a licensed roofer’s or plumber’s opinion on cause, before-and-after photos, repair records), and asks the insurer to reopen its decision. Keep it factual. Everything you write may be read later by a mediator, an appraisal panel or a judge.
Pick the right dispute path
Florida gives policyholders four main tools, and they fit different problems. If the insurer denied the claim outright on coverage grounds, appraisal is usually not the right tool, because appraisal sets the amount of loss rather than deciding whether the loss is covered. The comparison table below shows which tool fits which dispute; the long version is in how to appeal a denied homeowners insurance claim in Florida.
Put every deadline on a calendar
Notice deadlines, the pre-suit notice period and the statute of limitations all run from different dates. Enter your date of loss to see the general statutory timelines; then confirm them against your policy, because policy conditions and the version of the law in effect on your date of loss can change the answer.
Deadline worksheet
- Enter a date to see the general Florida timelines.
General statutory periods only (ss. 627.70132 and 95.11(2)(e), Fla. Stat.). Your policy, the date it was issued and the facts can change the answer — confirm with a lawyer.
Decide whether you need a lawyer — before the deadlines decide for you
Some denials are fixed with a phone call and a better photo. Others involve coverage questions, engineering reports, or a pre-suit notice that must be filed with the Department of Financial Services before you can sue. Florida’s 2022–2023 reforms also ended the old rule that usually made insurers pay a winning homeowner’s attorney fees for most newer policies, so the economics of each case matter more than they used to. See the checklist in when to call a lawyer.
Read between the lines
Why Florida insurers say they denied the claim
These five explanations account for a large share of Florida residential property denials. The quoted line is the kind of wording you will see; the paragraph under it is where the dispute usually lives.
Late notice
“The loss was not promptly reported, prejudicing our investigation.”
Two separate questions: did you meet the statutory notice deadline, and did the delay actually prevent the insurer from investigating?
Pre-existing damage
“The damage existed prior to the reported date of loss.”
Answered with dated photos, inspection reports from purchase or a prior claim, roof permits and repair invoices.
Excluded cause
“Loss caused by flood / repeated seepage / mold is excluded.”
Exclusions often carry exceptions, and the cause the insurer picked is not always the cause that started the loss.
Misrepresentation
“Material misrepresentations voided coverage.”
Under s. 627.409, a misstatement defeats recovery only if it was fraudulent, material, or would have changed the insurer’s decision. This is a serious accusation; talk to a lawyer before giving more statements.
Choosing a path
Appraisal, DFS mediation, Civil Remedy Notice or lawsuit?
None of these is an “appeal” in the courtroom sense, and choosing one can affect the others. A quick comparison:
| Tool | What it decides | Fits | Watch out for |
|---|---|---|---|
| Appraisal | The amount of loss, by two appraisers and an umpire under the policy’s appraisal clause | Partial denials, “below deductible” and low-estimate disputes | Generally does not decide coverage; you usually pay your own appraiser and share the umpire’s cost |
| DFS mediation | Nothing on its own — a neutral mediator helps both sides reach a settlement | Cause or amount disputes on residential policies; free to the homeowner (s. 627.7015) | Some disputes are ineligible (e.g. suspected fraud, under $500); you can rescind a settlement within 3 business days unless you have cashed the check |
| Civil Remedy Notice | Gives the insurer 60 days to cure an alleged statutory violation (s. 624.155) | Bad-faith claim handling, as a step toward extra-contractual damages | Specific form and content rules; generally cannot be filed within 60 days after appraisal is invoked on a residential claim |
| Lawsuit | Coverage and amount, by a court | Full denials on coverage grounds; disputes that will not settle | Notice of intent to litigate must be filed with DFS at least 10 business days first (s. 627.70152) |
The details, including who pays for what: how to appeal a denied homeowners insurance claim in Florida.
Step 9, expanded
When to call a lawyer after the insurer denied the claim
You do not need a lawyer to ask for documents or to send a written response. Consider getting a legal opinion when any of these is true:
- The letter accuses you of misrepresentation, fraud or concealment, or asks for an examination under oath.
- The denial relies on an engineer’s report you have not seen.
- You are within a few months of a notice or limitations deadline.
- The insurer wants appraisal, and you are not sure the dispute is really about the amount.
- The damage is large enough that a wrong outcome would mean paying for a roof, a remediation job or a rebuild yourself.
- The insurer stopped responding, or keeps asking for documents it already has.
The Lawgical Firm, P.A. handles residential and commercial property claims across Florida, including hurricane and windstorm, water damage, plumbing and roof leaks, roof damage, fire, mold, hail, sinkhole and theft or vandalism claims. Call (407) 433-4131 or use the form.
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Questions homeowners ask
Frequently asked questions
Is a denial letter the insurer’s final word?
No. A denial is the insurer’s position, not a ruling. You can submit more evidence and ask it to reconsider, request DFS mediation for eligible residential disputes, use appraisal for amount disputes, or file suit after giving the required pre-suit notice. The right path depends on the reason in the letter.
How long does a Florida insurer have to decide my claim?
Under s. 627.70131(7)(a), an insurer generally must pay or deny a residential property claim within 60 days after it receives notice of the claim, unless factors beyond its control reasonably prevent it. Late payments generally carry interest.
Can I still sue a year after the denial?
Possibly. The limit to sue for breach of a property insurance contract under s. 95.11(2)(e) is five years from the date of loss. But you must also have given timely notice of the claim, and you must file a notice of intent to litigate with DFS at least 10 business days before suing. Have a lawyer check your exact dates.
Does Florida still make insurers pay my attorney fees if I win?
For most policies issued on or after December 16, 2022, generally no. The 2022 special-session reform made the old one-way attorney fee statute inapplicable to suits under property policies, and the 2023 tort reform law repealed it. Older policies and particular facts can differ, so ask how fees work in your case.
Should I give a recorded statement after a denial?
Your policy may require you to cooperate, which can include recorded statements or an examination under oath. You are generally allowed to have a lawyer with you. If the denial mentions misrepresentation or fraud, get advice before you say anything more.