What If My Homeowners Insurance Company Is Blaming Me for Damage?
Can an Insurance Company Deny a Claim Because of Wear and Tear?
Yes. A Florida property insurance policy may exclude damage caused solely by wear and tear, deterioration, aging, or other conditions specifically excluded by the policy.
However, the existence of wear and tear does not automatically mean that every part of the claimed loss is excluded.
The important question is what caused the damage for which coverage is being sought.
For example, an older roof may have age-related deterioration and still sustain new damage from hurricane-force winds. An aging plumbing system may contain corrosion before a sudden failure releases water and damages flooring, drywall, cabinets, or other insured property.
In these situations, the insurer should distinguish between the pre-existing condition and any new damage caused by the reported event. Coverage ultimately depends on the cause of loss and the specific policy language.
What If the Insurance Company Says the Damage Was Pre-Existing?
A pre-existing damage denial should be reviewed carefully.
An insurer may examine prior claims, inspection reports, photographs, permits, repair records, maintenance history, aerial imagery, or the property’s age and condition to determine whether damage existed before the reported loss.
That evidence can be relevant, but the existence of an older condition does not necessarily establish that all current damage was already present.
A hurricane, windstorm, plumbing failure, fire, or other covered event may cause new damage to property that already shows some deterioration or has undergone previous repairs. In those cases, the analysis should focus on what condition existed before the loss, what changed afterward, and what caused the new damage.
Photographs, inspection reports, repair records, weather information, contractor findings, and appropriate expert opinions can become particularly important when causation is disputed.
What If the Insurer Says I Failed to Maintain the Property?
Insurance companies may rely on policy exclusions involving neglect, deterioration, inadequate maintenance, or similar conditions when investigating a property claim.
For example, an insurer may argue that a homeowner failed to repair an aging roof, address a known leak, maintain plumbing components, replace deteriorated sealants, or correct another condition before the loss occurred.
The existence of a maintenance issue, however, does not automatically resolve the question of whether a separate covered event caused additional damage.
A proper evaluation should compare the insurer’s allegation with the policy language and available evidence. Photographs, inspections, repair invoices, maintenance records, contractor reports, and expert findings may help distinguish an excluded maintenance condition from new damage caused by a covered event.
The focus should remain on causation, not simply whether the property was in perfect condition before the loss.
What If the Insurance Company Says I Failed to Mitigate the Damage?
Most property insurance policies require policyholders to take reasonable steps after a loss to protect the property from additional damage.
Depending on the circumstances, that may include stopping an active water source, placing a temporary tarp over a damaged roof, boarding up a broken opening, removing standing water, or arranging emergency drying or mitigation services.
A dispute can arise if the insurer argues that additional damage occurred because the policyholder failed to take reasonable protective measures.
That issue should be separated from the question of whether the original loss was covered. Even when the insurer disputes later damage, it should still evaluate damage caused by the initial covered event under the terms of the policy.
Documentation is important. When reasonably possible, photograph or video the property before and after emergency repairs, retain mitigation invoices and receipts, document communications with contractors and the insurer, and preserve damaged materials when they may be relevant to determining causation.
What Should I Do if My Insurance Company Blames Me for the Damage?
Do not assume the insurer’s explanation is correct simply because it appears in an adjuster’s report, engineering report, or denial letter.
Start by reviewing the insurer’s written coverage determination. Identify what damage it says is excluded, what caused the damage according to the insurer, and what policy provisions it relies upon.
Florida Statute § 627.70131 generally requires residential property insurers to provide a reasonable written explanation, based on the policy and the facts or applicable law, for a payment, denial, or partial denial of a claim.
Next, preserve evidence documenting the property’s condition before and after the loss. Useful documentation may include photographs, videos, prior inspection reports, permits, repair invoices, maintenance records, contractor estimates, weather information, mitigation records, and communications with the insurance company.
If the insurer relies on an engineer, roofer, plumber, or other expert, review the underlying report rather than relying only on the insurer’s summary of the findings.
The goal is to determine whether the policy and the evidence actually support the insurer’s conclusion.
Can an Insurance Company Misrepresent Policy Language or Facts?
Florida insurance law identifies certain unfair claim settlement practices involving misrepresentations of material facts or policy provisions, inadequate claim investigations, and failures to provide reasonable explanations for claim decisions.
Florida Statute § 626.9541 specifically addresses conduct such as misrepresenting pertinent facts or insurance policy provisions, denying claims without conducting reasonable investigations based on available information, and failing to provide a reasonable written explanation for certain claim decisions promptly.
That does not mean every disagreement, mistake, or incorrect coverage decision automatically constitutes an unfair claim settlement practice or insurance bad faith.
The insurer’s conduct must be evaluated in context.
However, a decision deserves closer scrutiny when an insurer ignores relevant evidence, relies on an incomplete investigation, inaccurately describes the policy, or attributes damage to the policyholder without adequate factual support.
Does Florida Law Require My Insurance Company to Explain Its Decision?
Yes. Florida law imposes specific claim-handling requirements on residential property insurers.
Under Florida Statute § 627.70131, an insurer generally must pay or deny an initial, reopened, or supplemental property insurance claim, or a portion of the claim, within 60 days after receiving notice, unless the failure to do so results from factors beyond the insurer’s control.
The insurer must also provide a reasonable written explanation of the basis in the policy, in relation to the facts or applicable law, for a payment, denial, or partial denial.
If the insurer’s payment is less than the amount stated in its own detailed estimate of the loss, the statute also requires a written explanation of the difference.
For personal-lines residential property claims, Florida Statute § 627.7142 generally requires the insurer to provide the policyholder with Florida’s Homeowner Claims Bill of Rights within 14 days after receiving the initial communication concerning the claim.
The Bill of Rights summarizes certain protections and claim-handling requirements under Florida law. It does not create a separate cause of action against the insurance company.
Does an Incorrect Denial Automatically Mean the Insurance Company Acted in Bad Faith?
No. An insurance company may make an incorrect coverage determination without automatically becoming liable for insurance bad faith.
Bad faith involves separate legal standards and procedural requirements. Florida Statute § 624.155 provides a civil remedy for certain insurer conduct, including specified failures to attempt in good faith to settle claims when the insurer could and should have done so under the circumstances.
A dispute over whether damage resulted from wear and tear, inadequate maintenance, pre-existing conditions, or a covered event may first need to be resolved as an insurance coverage dispute.
For that reason, an underpayment or wrongful denial should not automatically be labeled bad faith simply because the insurer’s decision may ultimately prove incorrect.
When Should I Contact a Property Insurance Attorney if the Insurer Blames Me for the Damage?
Consider contacting a Florida property insurance attorney when the insurer relies on wear and tear, pre-existing damage, neglect, failure to maintain the property, failure to mitigate, or another policy condition to deny or substantially reduce a significant claim.
Legal review can become particularly important when the insurer relies on an engineering or other expert report, disputes the cause of a hurricane or water loss, requests an Examination Under Oath, alleges a violation of post-loss obligations, or issues a payment that does not reflect the full extent of covered damage.
An attorney can review the policy, insurer’s investigation, photographs, reports, estimates, and other evidence to determine whether the carrier’s factual and coverage conclusions are supported.
Early review may also help preserve evidence before repairs, demolition, weather exposure, or the passage of time makes the property’s original condition more difficult to establish.
How Can Williams Law Association, P.A. Help if My Insurance Company Blames Me for the Damage?
Williams Law Association, P.A. represents Florida homeowners, businesses, condominium associations, HOAs, and other policyholders in denied, delayed, and underpaid property insurance claims.
When an insurance company attributes damage to wear and tear, inadequate maintenance, pre-existing conditions, or a policyholder’s actions, our attorneys examine both the insurer’s coverage position and the evidence supporting it.
We may review the policy and endorsements, denial or coverage letter, photographs, estimates, engineering reports, repair history, maintenance documentation, weather information, mitigation records, and other evidence relevant to determining the cause of the loss.
When appropriate, we work with qualified engineers, contractors, roofers, plumbers, building consultants, and other independent professionals to evaluate disputed causation.
Since 1995, Williams Law Association, P.A. has represented Florida policyholders in property insurance disputes and has recovered more than $300 million for Florida clients across our practice areas.
We represent policyholders. We do not represent insurance companies.
If your property insurance claim has been denied, delayed, or underpaid because the insurer is blaming you or attributing the damage to an excluded condition, contact Williams Law Association, P.A. to have an experienced Florida property insurance attorney review the claim and determine what options may be available.