American Integrity Claim Denial Guide – Clermont, Florida

Introduction: Why Clermont Homeowners Need a Local Guide

Clermont, Florida sits on the Lake Wales Ridge, about 20 miles west of Orlando. While its rolling hills earn it the nickname “the Choice of Champions,” Clermont is still squarely in Central Florida’s wind, hail, and summertime thunderstorm corridor. The National Oceanic and Atmospheric Administration (NOAA) reports that Lake County, where Clermont is located, records frequent severe-weather events every year—especially between June and November. Many Clermont homeowners rely on American Integrity Insurance Company of Florida (often shortened to “American Integrity”) for property insurance coverage against these perils.

Unfortunately, some policyholders learn that filing a claim is only half the battle; getting that claim paid in full and on time can be just as challenging. If you recently received an American Integrity claim denial—or a payment that seems far too low—understanding your rights under Florida law is critical. This comprehensive legal guide, slightly tilted toward protecting policyholders, walks Clermont residents step-by-step through the statutes, regulations, and practical tactics that matter most after a denial.

1. Understanding Your Rights in Florida

1.1 The Policyholder Bill of Rights

Florida enacted a Homeowner Claims Bill of Rights in 2014, codified at Florida Statutes § 627.7142. The statute requires every residential insurer, including American Integrity, to send policyholders a summary of rights within 14 days after a claim is filed. Key protections include:

• Right to acknowledgement of your claim within 14 calendar days (§ 627.70131(1)(a)).

• Right to receive a coverage decision within 90 days unless there are factors beyond the insurer’s control (§ 627.70131(5)(a)).

• Right to receive any undisputed payment within 90 days of the claim’s filing date.

1.2 Prompt Investigation Standards

The Florida Office of Insurance Regulation (OIR) enforces prompt, thorough, and unbiased investigations. Florida Administrative Code 69O-166.031 classifies unreasonable delays, failure to properly investigate, or misrepresenting facts as unfair claims settlement practices.

1.3 Statute of Limitations

Under Florida Statutes § 95.11(2)(e), you generally have five years from the date of breach (often interpreted as the date of denial or underpayment) to file a lawsuit against your insurer for contract disputes. Clermont homeowners should calendar this deadline immediately after any denial.

2. Common Reasons American Integrity Denies Claims

Based on thousands of Department of Financial Services (DFS) complaint records, the most frequent denial grounds include:

• Wear and Tear or Maintenance Issues – Insurers often label roof leaks as “age-related” rather than wind-related. Florida law allows insurers to exclude normal deterioration, but they bear the burden of proof (Fla. Stat. § 627.428 case law).

• Late Reporting – Florida policies typically require “prompt” notice. However, courts such as Hernandez v. Protective Ins. Co., 174 So. 3d 498 (Fla. 3d DCA 2015) hold that an insurer must show it was prejudiced by any delay to deny coverage outright.

• Alleged Material Misrepresentation – If the insurer believes an application or proof-of-loss contains false statements, it may void the policy under Fla. Stat. § 627.409. The misrepresentation must be material and made with intent to deceive.

• Excluded Perils – Flood, earth movement, and certain mold damages may be excluded unless a specific endorsement applies. Read exclusions carefully.

• Insufficient Documentation – Missing receipts, photographs, or contractor estimates often lead to partial or total denials.

3. Florida Legal Protections & Regulations

3.1 Bad-Faith Remedies

If American Integrity fails to settle a claim when it could and should have done so, you may pursue a civil remedy under Florida Statutes § 624.155. Before filing suit, you must submit a Civil Remedy Notice (CRN) to the Department of Financial Services and allow the insurer 60 days to cure.

3.2 Attorney’s Fees for Policyholders

Florida historically awarded prevailing policyholders their reasonable attorney’s fees under § 627.428. Amendments in 2022 and 2023 narrowed fee-shifting for suits filed after December 2022, but fees may still be available for older claims or under specific circumstances. A qualified Florida attorney can clarify eligibility.

3.3 Mandatory Mediation Option

The Department of Financial Services administers a free or low-cost property insurance mediation program under Fla. Stat. § 627.7015. Either you or American Integrity can request mediation; insurers must pay the fee if you opt in first and the dispute is within coverage.

3.4 Appraisal Clause

Most American Integrity policies contain an appraisal provision for disputes limited to valuation, not coverage. Each side selects an appraiser; the two appraisers choose an umpire. While faster than litigation, appraisal determinations are binding only on the amount, not whether the loss is covered.

4. Steps to Take After a Denial

Step 1 – Review the Denial Letter in Detail

Florida law requires the insurer to cite specific policy language supporting its decision (Fla. Admin. Code 69O-166.024). Verify that American Integrity actually quoted the correct section.

Step 2 – Gather Independent Evidence

• Obtain a licensed Florida contractor or public adjuster’s estimate.

• Collect photographs, drone footage, or weather reports from the date of loss.

• Request a certified copy of your policy from American Integrity under Fla. Stat. § 627.4137.

Step 3 – File a Department of Financial Services Complaint

You can submit a complaint online through the DFS Consumer Services Portal. Attach your denial letter and supporting documents. DFS will assign a complaint number and contact American Integrity for a written response within 20 days. Many disputes settle at this stage.

Step 4 – Consider Mediation or Appraisal

If DFS involvement does not resolve the matter, request statutory mediation or invoke appraisal in writing, following your policy’s timelines.

Step 5 – Preserve Litigation Rights

Serve a Civil Remedy Notice if you believe American Integrity acted in bad faith (§ 624.155). Keep track of the five-year contract statute of limitations and any one-year suit-limitation clauses that might apply after an appraisal award.

5. When to Seek Legal Help in Florida

5.1 Complex Coverage Issues

Roof damage causation, concurrent wind and water losses, or alleged misrepresentations usually require expert testimony. A Florida-licensed attorney can preserve crucial evidence and navigate expert disclosures.

5.2 Re-Opened or Supplemental Claims

Under Fla. Stat. § 627.70132, hurricane and windstorm claims must be reported within one year of the date the hurricane first made landfall in Florida. An attorney can help you file supplemental claims timely.

5.3 Assignment-of-Benefits (AOB) Disputes

A 2019 reform (Fla. Stat. § 627.7152) restricts contractors’ rights to sue insurers directly. If you signed an AOB before or after those changes, get legal advice to avoid jeopardizing your rights.

6. Local Resources & Next Steps

6.1 Clermont Building Department

Obtain historical permits or inspection reports to prove roof age or compliance: 685 W. Montrose Street, Clermont, FL 34711.

6.2 Lake County Clerk of Court

For filing lawsuits or reviewing prior insurance litigation: 550 W. Main Street, Tavares, FL 32778.

6.3 Weather and Storm Data

Download certified storm reports from the National Centers for Environmental Information to corroborate wind speeds in Clermont on the date of loss.

6.4 Florida Office of Insurance Regulation

Review rate filings, market conduct exams, and solvency data for American Integrity via the OIR’s Company Search.

Legal Disclaimer

This guide provides general information about Florida insurance law and is not legal advice. Always consult a licensed Florida attorney for advice about your specific situation.

If American Integrity denied your claim, call Louis Law Group at 833-657-4812 for a free case evaluation and policy review.