American Integrity Claim Denial Guide – Doral, Florida

American Integrity Claim Denial in Doral: What Homeowners Must Know

Read time: 12 min read

Introduction

Doral’s rapidly growing neighborhoods, proximity to Miami International Airport, and exposure to heavy summer downpours and Atlantic hurricane threats create unique insurance challenges. When a major carrier such as American Integrity Insurance Company of Florida denies or underpays a property claim, the financial blow can be severe. This guide explains the rights and remedies available to Doral homeowners under Florida insurance law, and outlines the exact steps to contest a denial while slightly favoring the policyholder’s perspective. Every statement below is based on verifiable Florida statutes, administrative rules, or other authoritative publications.

1. Understanding Your Rights in Florida

1.1 The Policyholder Bill of Rights

Florida law requires insurers to treat consumers fairly and to investigate claims promptly. The “Homeowner Claims Bill of Rights,” mandated by Fla. Stat. § 627.7142, must be sent within 14 days after a residential property claim is filed. It reminds policyholders that they are entitled to:

• Free mediation through the Department of Financial Services (DFS) for claims under $500,000 not involving a commercial policy.

• Prompt communication from their insurer, including acknowledgment within 14 days (Fla. Stat. § 627.70131(1)(a)).

• A coverage decision within 90 days of loss notification (§ 627.70131(7)(a)).

1.2 Statute of Limitations for Property Claims

Under Fla. Stat. § 95.11(2)(e), lawsuits for breach of a property insurance contract generally must be filed within five years from the date the insurance company breaches the contract—usually the denial or underpayment date. Because the clock starts when the breach occurs, not necessarily on date of loss, timely action after any American Integrity claim denial is essential.

1.3 Bad-Faith Protections

If a carrier fails to settle a claim when it could and should have done so, the policyholder may pursue a statutory bad-faith action under Fla. Stat. § 624.155. Before suing, you must file a Civil Remedy Notice (CRN) with DFS and give American Integrity 60 days to cure.

2. Common Reasons American Integrity Denies Claims

Publicly available complaint data filed with the Florida Office of Insurance Regulation shows recurring denial themes. While each loss differs, the following justifications appear frequently in American Integrity denial letters:

• Wear and Tear or Maintenance Exclusion — Insurers often cite policy language excluding “aging,” “deterioration,” or lack of maintenance.

• Late Notice of Loss — Florida contracts require “prompt” notice. American Integrity may argue that delayed reporting prejudiced its investigation.

• Water Damage Not from a Covered Peril — Claims arising from long-term leaks or seepage more than 14 days are often denied under policy water exclusions.

• Hurricane Deductible Trigger — After events such as Hurricane Irma (2017) or Eta (2020), the insurer may assert damage did not exceed the percentage hurricane deductible.

• Misrepresentation or Concealment — Any alleged inaccuracy on the application or during the claim process can be used to rescind or deny.

Many of these reasons are challengeable with proper documentation and, if needed, litigation.

3. Florida Legal Protections & Regulations

3.1 Prompt Payment Requirements

Under Fla. Stat. § 627.70131(7), American Integrity must pay undisputed amounts within 90 days of receiving notice of the claim, unless the failure to pay is caused by factors beyond the insurer’s control. Failure to meet that deadline may expose the company to interest penalties (currently the statutory rate set by the Chief Financial Officer).

3.2 Claim Investigation Standards

Florida Administrative Code Rule 69O-166.020 requires insurers to adopt and implement reasonable standards for the prompt investigation of claims, mirroring the national Unfair Claims Settlement Practices Model Act. Alleged violations can form the basis for DFS consumer complaints and later bad-faith suits.

3.3 Appraisal and Mediation

• The American Integrity policy includes an appraisal clause allowing either side to demand a three-party appraisal panel when coverage is admitted but the amount is disputed.

• DFS also runs the Residential Property Mediation Program outlined in Fla. Stat. § 627.7015. Participation is free, non-binding, and can resolve many scope and pricing disagreements.

3.4 Assignment of Benefits (AOB) Limitations

Effective May 2019, Fla. Stat. § 627.7152 imposes strict rules on post-loss Assignments of Benefits, including mandatory written estimates and a 14-day rescission option for homeowners. Knowing these rules can help you avoid inadvertently jeopardizing your claim.

4. Steps to Take After an American Integrity Claim Denial

Step 1: Review the Denial Letter Line-by-Line

Carefully compare the cited policy provisions with your actual policy jacket. Look for:

• Endorsements or amendments American Integrity may have overlooked.

• Ambiguous exclusions — Florida courts interpret ambiguity in favor of coverage (see Fayad v. Clarendon Nat’l Ins. Co., 899 So.2d 1082, Fla. 2005).

Step 2: Gather Objective Evidence

• Independent contractor or public adjuster estimates.

• Photos and videos of damage immediately after the event.

• Receipts for emergency repairs (board-up, drying, tarping).

• Weather data—e.g., National Hurricane Center storm advisories relevant to Doral.

Step 3: File a DFS Consumer Complaint

You may submit a complaint online through the DFS Insurance Consumer Helpline. DFS will forward the issue to American Integrity and request written justification within 20 days, often prompting faster review. File at: Florida DFS Insurance Assistance.

Step 4: Invoke Appraisal or Mediation

If the denial is partial (amount only), consider mediation or appraisal. Mediation requests must be made within 60 days after the denial (§ 627.7015(2)).

Step 5: Issue a Pre-Suit Notice

As of 2021 reforms (Fla. Stat. § 627.70152), a policyholder must serve a detailed pre-suit notice at least 10 business days before filing suit. The notice must state the amount in dispute and the attorney fees sought.

Step 6: File a Civil Remedy Notice (If Bad Faith Suspected)

The CRN form is available on the DFS website. It triggers a 60-day “cure” window for the insurer. DFS Civil Remedy Notice Portal

Step 7: Litigate within the Five-Year Limitations Period

Once pre-suit conditions are satisfied, suit can be filed in Miami-Dade County Circuit Court (Eleventh Judicial Circuit). Florida follows comparative fault principles, but in first-party property cases, the core issue is contract breach.

5. When to Seek Legal Help in Florida

5.1 Complex Denials or High Dollar Losses

If the loss approaches or exceeds $50,000, retaining a Florida attorney early can prevent procedural missteps. Counsel licensed under Rule 4-5.5, Rules Regulating The Florida Bar, may only practice if in good standing and carrying minimum malpractice insurance.

5.2 Suspected Pattern of Bad Faith

Repeated low-balling or delays may justify a § 624.155 claim for extra-contractual damages, including attorneys’ fees under § 627.428 (now § 627.70152 for post-2021 cases). Legal guidance is recommended to navigate evolving fee-shifting statutes.

5.3 Mortgage or Condo Association Complications

Doral’s condo boom means many policies involve additional insureds, assignment of benefits to associations, and lender loss-payee clauses. An experienced lawyer can coordinate stakeholder interests and ensure proper disbursement of settlement funds.

6. Local Resources & Next Steps

6.1 Miami-Dade Emergency Management

For hurricane preparedness checklists and post-storm permitting rules, visit Miami-Dade Office of Emergency Management.

6.2 NOAA Climate Data

Doral averages more than 60 inches of rainfall annually according to NOAA Climate Data. Heavy rainfall statistics can support causation arguments in water intrusion claims.

6.3 Florida Bar Lawyer Referral Service

If you need counsel outside of the Louis Law Group, contact the statewide referral line at 800-342-8011.

Legal Disclaimer

This guide is for informational purposes only and does not constitute legal advice. Laws change, and the application of law depends on specific facts. Consult a licensed Florida attorney before taking action.

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