If you have ever filed a homeowners insurance claim after experiencing significant damage to your home, you might have learned the hard way that insurance carriers are not always enthusiastic about fulfilling their promise to stand behind policyholders. There are a multitude of strategies that insurance companies use to deny claims that are frequently predicated on the exclusions, conditions and limitations of your policy. This blog discusses three of the most common explanations offered for denial of a homeowners claim.
Pre-Existing Damage to the Home
Sometimes insurance companies erroneously claim that damage to a home pre-existed a hurricane or other loss This contention by the insurer may be based on the premise that prior damage to the property went unnoticed by the homeowner or that the homeowner is attempting to commit insurance fraud. If the homeowner has taken pictures to document the condition of the home and inventoried personal property inside the residence prior to the hurricane, these photos can be used to rebut claims of pre-existing damage. The homeowners insurance company might examine records pertaining to the sale of the home, building inspection reports and similar evidence when using this reason not to pay a damage claim.
Flood vs. Wind Damage
While roof damage that permits wind driven rain to penetrate the exterior of the house should be covered under a standard homeowners insurance policy, flooding generally must be covered by a separate policy. If the water damage to your home is caused by flooding, it will need to be covered by a separate policy through the National Flood Insurance Program.
This issue can be extremely complicated when there is water penetration both from wind driven rain that penetrates the residence through a damaged roof AND flooding from the street. While homeowners will attribute such damage to wind, the insurer will claim the damage to the premises was caused by flooding. Because Florida appellate courts have split on the applicable legal standard, your location in Florida can determine whether this type of claim falls within the scope of your coverage.
Some districts apply the “efficient proximate cause doctrine” which provides that the claim should be covered if the rain propelled by wind did more damage than the flooding, or the rain constituted a stronger force. Other districts apply the “concurrent cause doctrine”, which would generally provide coverage under the homeowners policy. This is an extremely complicated issue about which respected judges in courts across Florida disagree.
Failure to Provide Timely Notice
Florida’s prompt notice provision requires policyholders to give prompt notice to their homeowners insurance carrier after suffering a loss. Florida statutes do not provide a specific definition, so this term has been defined by a range of court decisions in Florida. Timely notice is necessary to enable insurance carriers to do the following:
- Potentially mitigate the property damage;
- Investigate to confirm the claim is covered;
- Evaluate the cost of repair.
If delay by the insured denies the insurance carrier the opportunity to perform any of these tasks, this might provide a basis for denying the claim. Further, there is an additional timing requirement that applies to hurricanes that make landfall in Florida. A statute enacted in 2011 requires that homeowners report damage within 3 years of the property being damaged, or the hurricane making landfall.
It is important that policyholders not read this statute as relieving the obligation to provide notice more promptly. These deadlines are independent of one another, so policyholders should provide notice of the claim as soon as possible. My law firm represents policyholders in claims disputes in Miami and throughout Florida, so we can guide you through the process. The Law Firm of J.P. Gonzalez-Sirgo, P.A. offers free consultations and case evaluations. No Recovery, No Lawyer Fees. Call 305-461-1095 or Toll Free 1-866-71-CLAIM.