American Integrity Claim Denial Guide – Miami, Florida

Estimated read time: 13 min read

Introduction: Why Every Miami Homeowner Must Understand American Integrity Claim Denials

The number of residential insurance policies issued by American Integrity Insurance Company of Florida (AIIC) has grown sharply since the carrier entered the market in 2006. The company writes more than 300,000 homeowners policies statewide, with a particularly heavy concentration in South Florida. Because Miami is uniquely exposed to hurricanes, wind-driven rain, roof damage, and water losses, claims frequency is high—and so are denials. If you receive an American Integrity claim denial in Miami, you need to know your rights under Florida insurance law and the practical steps that tilt the scale in favor of policyholders.

This guide delivers exactly that. It draws on the Florida Insurance Code, regulations from the Florida Office of Insurance Regulation (OIR), recent court decisions, and the lived experience of Miami homeowners. While balanced, the information here is intentionally focused on protecting insureds—because facing a denial from a well-funded carrier often feels like David versus Goliath. If American Integrity has denied, delayed, or underpaid your claim, keep reading, then call Louis Law Group at 833-657-4812 for a free case evaluation and policy review.

Understanding Your Rights in Florida

Key Statutes Protecting Policyholders

• Florida Statute §627.70131 – Imposes prompt claim-handling requirements. Insurers must acknowledge receipt of a claim within 14 days and pay or deny within 90 days, absent factors beyond their control.

• Florida Statute §624.155 – Authorizes civil actions against insurers for bad faith. If American Integrity fails to settle claims when it could and should have done so, you may sue for extra-contractual damages.

• Florida Statute §626.9744 – Regulates replacement cost and repair practices, relevant when roof or interior damage requires a full replacement rather than a “patch.”

• Florida Administrative Code 69O-166 – Provides detailed claims-handling standards enforced by the OIR.

Leverage Points for Miami Homeowners

One-Way Attorney’s Fees (F.S. §627.428 as applied to legacy claims)* – Historically, a prevailing insured could recover reasonable attorney’s fees. While 2022 legislative amendments tightened new lawsuits, legacy claims and certain disputes may still qualify. Consult counsel to confirm.

• Statute of Limitations – For breach of an insurance contract, Florida generally provides five years from the date of loss (or sometimes from denial). Do not delay; evidence becomes harder to preserve in Miami’s humid climate.

• Appraisal Clause – Most American Integrity policies include an appraisal provision. When used strategically, appraisal can force the insurer to the table without formal litigation.

Florida Bad-Faith Notice Requirement – Before filing suit under §624.155, you must submit a Civil Remedy Notice (CRN) via the Florida Department of Financial Services portal. The insurer then has 60 days to cure.

*Legal update: Senate Bill 2-A (2022) modified one-way fee provisions for lawsuits filed after December 16, 2022. Discuss with a licensed Florida attorney how the change affects your case.

Common Reasons American Integrity Denies Claims

American Integrity publicly states it strives for fair claim handling, yet data from the Florida OIR’s quarterly “Closed Claim” reports shows a higher-than-average denial or partial payment rate compared with other domestic carriers. Below are frequent rationales cited in denial letters, along with counterpoints that Miami homeowners can raise.

1. Wear and Tear vs. Sudden and Accidental Damage

Insurer’s position: Roof leaks or plumbing failures stem from long-term deterioration, excluded under your policy.

Homeowner’s counter: Under Florida law and common policy language, sudden water discharge—even from a deteriorated pipe—may still be covered if the proximate cause is accidental. A licensed engineer or public adjuster can document storm-created openings.

2. Late Notice

Insurer’s position: You reported the loss outside the policy’s prompt notice requirement, prejudicing the investigation.

Homeowner’s counter: Florida courts (e.g., Estrada v. Citizens, 276 So.3d 905, Fla. 3d DCA 2019) place the burden on the insurer to prove actual prejudice. If American Integrity cannot show specific investigative harm, coverage may still apply.

3. Excluded Flood vs. Covered Wind-Driven Rain

Miami’s low elevation means flood exclusions loom large. However, under the concurrent causation doctrine the insurer must show that flooding—not wind—was the efficient proximate cause. Post-storm roof damage photos, meteorological data, and NOAA wind reports can rebut the exclusion.

4. Alleged Material Misrepresentation

Insurer’s position: You misrepresented prior losses or renovations in your application, voiding the policy.

Homeowner’s counter: Florida’s “innocent insured doctrine” under Universal Prop. & Cas. Ins. v. Johnson, 114 So.3d 1031 (Fla. 1st DCA 2013) limits voidance unless the misstatement was intentional and material. An unintentional error rarely justifies a total denial.

5. Failure to Mitigate

American Integrity may assert you did not take reasonable steps to prevent further damage. Keep receipts for tarps, water extraction, and temporary repairs; the policy reimburses reasonable mitigation expenses.

Florida Legal Protections & Regulations

Role of the Florida Office of Insurance Regulation (OIR)

The OIR licenses carriers, approves policy forms, and audits claims handling. Miami homeowners can file consumer complaints online. A pattern of mishandled claims can trigger a Market Conduct Examination—an official review that may result in fines or corrective action.

Recent Court Precedents Involving American Integrity

• American Integrity Ins. Co. v. Estrada, 276 So.3d 905 (Fla. 3d DCA 2019) – Court compelled appraisal, reminding insurers appraisal is appropriate when coverage exists but amount is disputed.

• American Integrity Ins. Co. v. Guadalupe, 276 So.3d 428 (Fla. 3d DCA 2019) – Denial for late notice overturned; insurer failed to prove prejudice.

• American Integrity Ins. Co. v. Reale, 347 So.3d 420 (Fla. 4th DCA 2022) – Confirmed that expert testimony may establish a storm-created opening despite post-loss roof deterioration.

Bad Faith Considerations

To prevail on a bad-faith claim under §624.155, you must show the underlying coverage obligation is clear (often via a favorable appraisal award or breach-of-contract judgment) and that American Integrity failed to act fairly and honestly. Penalties can include consequential damages exceeding policy limits.

Regulatory Timeframes

Remember the 90-day rule. If American Integrity has not paid or denied within 90 days, Florida law presumes the carrier is liable for payment, shifting the burden of proof. Delays are common after major hurricanes such as Irma (2017) and Ian (2022); document every call and email.

Steps to Take After an American Integrity Denial

1. Read the Denial Letter Carefully

Identify the precise policy provisions cited. Note any deadlines for supplemental information or alternative dispute resolution (ADR).

2. Gather and Preserve Evidence

• Photograph all damaged areas, including close-ups and wide shots.

• Secure meteorological records: the National Weather Service archives wind speeds at Miami International Airport.

• Obtain contractor or engineer reports refuting wear-and-tear allegations.

• Keep receipts for emergency repairs and alternative living expenses (ALE).

3. Request a Certified Copy of Your Policy

If you do not already have the full policy, submit a written request under F.S. §627.4137. American Integrity must provide it within 30 days.

4. Consider a Supplemental Claim

Florida allows supplemental submissions within three years of the hurricane’s landfall or the date you first knew of the loss for non-hurricane claims. Provide additional evidence and a revised estimate.

5. Invoke Appraisal (When Appropriate)

Most AIIC forms include a mandatory appraisal clause for amount-of-loss disputes. File a brief written demand and appoint a qualified appraiser. The process is generally quicker than litigation but requires strategic timing.

6. File a Complaint with the Florida Department of Financial Services

The DFS’s Division of Consumer Services can informally mediate claims. File online or phone 877-MY-FL-CFO. While not binding, a well-documented complaint places regulatory pressure on the carrier.

7. Consult a Licensed Florida Attorney

If American Integrity maintains its denial, legal action may be necessary. Under certain circumstances, litigation costs—and potentially attorney’s fees—shift to the insurer.

When to Seek Legal Help in Florida

Although some claims resolve through direct negotiation, Miami homeowners often reach an impasse when disputes involve roof replacement scope, causation, or alleged misrepresentation. Seek counsel immediately if:

• The 90-day decision window passes with no payment.

• You receive a partial payment that does not match repair estimates.

• The denial letter cites fraud or intentional misrepresentation.

• American Integrity refuses to enter appraisal or delays selecting an umpire.

A Florida-licensed insurance attorney understands local building codes (e.g., Miami-Dade County’s High Velocity Hurricane Zone requirements) and how they affect repair costs. Legal counsel can also preserve evidence via letters of spoliation and secure sworn testimony early in the process.

Louis Law Group has recovered millions for Florida homeowners, including numerous six-figure settlements on American Integrity policies. The firm’s attorneys litigate in Miami-Dade Circuit Court and federal courts statewide.

Local Resources & Next Steps

Florida Department of Financial Services – Consumer Services (file complaints, mediation requests) Miami-Dade Consumer Protection Division (local consumer disputes) Florida Bar Consumer Pamphlets (free legal education)

Miami Climate Note: Hurricane season runs June 1 – Nov 30. Storm surge along Biscayne Bay and rainfall-induced flooding in Little Havana, Brickell, and Coconut Grove exacerbate property losses. Being proactive with roof inspections and maintaining an updated hurricane preparedness plan can reduce claim disputes.

Final Call to Action

If American Integrity denied, delayed, or underpaid your homeowners claim, you do not have to accept that decision. Call Louis Law Group today at 833-657-4812 for a free case evaluation and comprehensive policy review. Our Miami-based attorneys know the local courts, the weather challenges, and the tactics insurers use. Let us fight for the benefits you paid for.

Legal Disclaimer

This article provides general information about Florida insurance law and is not legal advice. Every claim is unique. Reading this guide does not create an attorney-client relationship with Louis Law Group. For advice on your specific situation, consult a licensed Florida attorney.