Florida: What Happens After You Submit an Insurance Claim — FAQ

Detailed Answer

Short overview: After you submit a claim to your insurer in Florida, the company normally acknowledges receipt, opens a claim file, assigns an adjuster, investigates coverage and damages, and then either pays, offers a partial payment, or denies the claim. If you disagree with the insurer’s decision, the policy usually contains dispute-resolution options (appraisal, mediation) and you can ultimately sue. This article explains the typical steps, what rights you have, and how to preserve them.

1. Acknowledgement and claim file

Within days of filing, insurers generally send a confirmation (by mail, email, or phone) and open a claim file with a claim number. This confirms your claim is being processed and identifies the assigned adjuster or claims representative.

2. Assignment of an adjuster and initial contact

The insurer assigns an adjuster (staff adjuster or independent adjuster). The adjuster will contact you to schedule inspections, ask for documentation, and explain next steps. Keep all communications in writing when possible and note the names, dates, and content of phone calls.

3. Investigation and documentation

The adjuster investigates both coverage (does the policy cover this loss?) and the amount of loss (how much damage and what it will cost to repair or replace). Typical investigative steps include:

• On-site inspection and photos.
• Requesting photos, receipts, inventories, estimates, repair bids, and any police or emergency reports.
• Confirming policy limits, deductibles, endorsements, and exclusions that may affect coverage.

4. Proof of loss and deadlines

Your policy may require a formal Proof of Loss document or specific timeframes for providing information. Read your policy closely and comply promptly. Failing to provide requested documentation on time can give the insurer a basis to deny or delay payment.

5. Coverage decision: approval, partial payment, or denial

After investigation the insurer will either:

• Approve the claim and issue payment (full or partial).
• Offer a partial payment explaining covered items and reasons for partial coverage.
• Deny the claim, typically in writing with reasons tied to policy language or lack of proof.

Insurers often pay undisputed portions quickly and separately from disputed items (for example, paying for emergency board-up while disputing structural repair amounts).

6. Repair estimates, supplements, and supplements review

If repairs uncover additional damage, you or your contractor can submit supplements. The insurer should review supplemental claims and adjust payments accordingly. Maintain thorough repair invoices and before-and-after pictures.

7. Appraisal, mediation, and dispute resolution

Many property policies include an appraisal clause to resolve disputes over the amount of loss. Appraisal is a binding technical valuation in many policies. Your policy may also require or allow mediation or other alternative dispute resolution before litigation.

8. Bad-faith and escalation

If the insurer unreasonably delays, denies, or underpays a valid claim, you may have remedies for bad faith. In Florida, insureds can pursue civil remedies, including a lawsuit for breach of contract and extra-contractual damages in appropriate cases. Before suing, use your policy’s internal appeal procedures and the state complaint process.

9. Time limits to sue

Statute of limitations issues matter. For most written contract claims in Florida, you generally have five years to file a lawsuit for breach of written contract. See Florida’s statute of limitations for written contracts for details: Fla. Stat. § 95.11. Always check your policy and consult an attorney early to avoid missing deadlines.

10. Official resources and consumer help

If you have problems with your insurer, you can contact Florida consumer regulators for help or to file a complaint:

• Florida Department of Financial Services — Consumer Services: myfloridacfo.com/Division/ConsumerServices
• Florida Office of Insurance Regulation (consumer information): floir.com
• Florida insurance laws and chapter pages (insurance statutes): Fla. Stat. Ch. 624 and Fla. Stat. Ch. 627.

  Practical timeline (typical)

  Timelines vary by insurer and claim complexity, but a common flow is:

  1. Day 0–3: Acknowledgement and claim number assigned.
  2. Day 3–14: Adjuster contacts you, inspects property, and requests documents.
  3. Week 2–6: Investigation continues; insurer issues payment, partial payment, or denial.
  4. After Week 6: If disputed, appraisal or appeal may be invoked; litigation can follow if unresolved.

  Helpful Hints

  • Document everything. Keep photos, videos, receipts, estimates, emails, and a log of all phone calls with dates, times, and names.
  • Read your policy. Know your limits, deductible, covered perils, exclusions, and any required proof-of-loss rules.
  • Don’t sign broad releases or final-acceptance letters until you are sure repairs and payments are complete.
  • Get independent estimates. A contractor or public adjuster can provide an independent view of damage and repair costs.
  • Beware of quick settlement offers that don’t cover all damage. Ask for a written explanation of any offer so you can compare it to your estimates and receipts.
  • Keep damaged property until inspected, unless the insurer authorizes disposal for safety reasons. If you must dispose of items, take photos first.
  • Submit supplements promptly when additional damage appears during repairs.
  • If denied or underpaid, request a written explanation with policy citations. Use internal appeals, then regulatory complaint channels if necessary.
  • Contact Florida consumer regulators for help: Department of Financial Services, Consumer Services and Florida Office of Insurance Regulation.
  • Consider hiring an attorney when: the claim denial seems wrongful, the loss is large or complex, the insurer appears to be acting in bad faith, or you need help preserving legal rights and meeting deadlines.

  Disclaimer: This article is educational and general in nature. It does not provide legal advice and does not create an attorney-client relationship. For advice about your specific situation, contact a licensed Florida attorney.