Property Insurance Claim Denial Guide – Hollywood, FL

Introduction: Mold Damage & Claim Denials in Hollywood, Florida

Living in Hollywood, Florida means enjoying sea breezes from the Atlantic and easy access to Biscayne Bay, but it also means contending with year-round humidity. Persistent moisture is a breeding ground for mold, and South Florida’s frequent rainstorms and tropical systems only increase the risk. When a water leak, roof failure, or storm surge leads to mold growth inside your Broward County home, remediation costs can soar into the tens of thousands of dollars.

Unfortunately, many policyholders learn that mold losses are among the most disputed claims in Florida’s property insurance market. Carriers often deny or underpay by pointing to policy exclusions, delayed notice, or caps on mold coverage. If you have received a denial letter, this guide explains your rights, the governing Florida statutes, and the concrete steps Hollywood homeowners can take to fight back—while staying compliant with the state’s strict deadlines and procedures.

Understanding Your Rights in Florida

1. Insurance Is a Contract

Your homeowners policy is a legally binding contract between you and the insurance company. Under Florida law, both parties must perform as promised. When the insurer fails to pay covered losses, it may be in breach of contract, giving you the right to pursue damages within the applicable statute of limitations.

2. Key Florida Statutes Protecting Policyholders

• Florida Statute §627.70131(7)(a) – Insurers must pay or deny your claim within 90 days of receiving notice, unless factors beyond their control reasonably prevent a decision.

• Florida Statute §626.9541(1)(i) – Lists Unfair Claim Settlement Practices, including failing to conduct a proper investigation or misrepresenting policy provisions.

• Florida Statute §95.11(2)(e) – Gives you five years to sue for breach of a written insurance contract, measured from the date of breach (usually the denial date).

3. Right to Independent Counsel and Representation

You may hire a licensed Florida attorney at any stage of the claim. Only lawyers admitted to The Florida Bar (regulated under Chapter 454, Florida Statutes) may provide legal advice or represent you in court.

4. Right to Department-Sponsored Mediation or Neutral Evaluation

Under §627.7015, Florida Statutes, residential policyholders can request free or low-cost mediation administered by the Florida Department of Financial Services (DFS) before filing suit. This option often resolves disputes faster than litigation.

Common Reasons Property Insurance Companies Deny Claims in Florida

1. Mold Exclusions or Coverage Caps

Many Florida homeowners policies contain a $10,000 sub-limit for mold remediation or exclude mold that results from long-term leaks. However, if the mold stems from a covered peril—such as a sudden pipe burst or hurricane-related opening in the roof—carrier attempts to deny the entire mold claim may violate §626.9541(1)(i).

2. Late Notice

Insurers often assert that policyholders failed to give “prompt” notice. Florida courts, including the Fourth District Court of Appeal (which covers Broward County), have held that delayed notice creates a rebuttable presumption of prejudice, not an automatic denial. Providing photographs, plumber invoices, or environmental reports can rebut the presumption.

3. Alleged Lack of Maintenance

Carriers may say the mold was caused by long-standing maintenance issues, such as worn caulking or deteriorated roof flashing. Yet, under Florida law, the insurer must prove an exclusion with competent evidence. A cursory adjuster opinion may not meet that standard.

4. Disputed Causation

For example, the insurer might accept water damage but deny mold remediation, claiming the mold occurred later. Independent hygienist testing and expert reports can align causation with the triggering event.

5. Policy Interpretation Disputes

Ambiguous policy language is construed in favor of the insured under long-standing Florida precedent (e.g., State Farm Mut. Auto. Ins. Co. v. Pridgen, 498 So.2d 1245, Fla. 1986). If mold endorsements or exclusions are unclear, courts may side with you.

Florida Legal Protections & Regulations for Policyholders

1. Claims Handling Deadlines: §627.70131

Within 14 days of notice, the insurer must acknowledge your claim and provide necessary forms. Within 30 days of receiving a sworn proof of loss, it must begin investigation. The final pay-or-deny deadline is 90 days.

2. DFS Consumer Services Division

DFS assists policyholders with complaints and offers mediation. File a complaint online, attach your denial letter, and a DFS analyst will contact the carrier. Detailed instructions are available on the DFS Consumer Services Portal.

3. Unfair Claim Settlement Practices: §626.9541

• Failing to adopt reasonable standards for investigating claims

• Misrepresenting pertinent facts or policy provisions

• Not attempting in good faith to settle claims when liability is clear

Violations may lead to civil remedies under §624.155, Florida Statutes.

4. Florida Administrative Code 69O-166.031

This rule requires insurers to maintain claim files with supporting documentation. Missing or incomplete files may strengthen your dispute.

5. Statute of Limitations & Suit Filing

You generally have five years to bring a breach-of-contract lawsuit, but waiting can weaken evidence and bar statutory fee entitlements under recent legislative changes.

Steps to Take After a Denial in Florida

Step 1: Read the Denial Letter Carefully

Florida Administrative Code 69O-166.024 requires carriers to state the specific policy language they rely on. Highlight those provisions for review.

Step 2: Gather Evidence

• All adjuster reports and estimates

• Independent mold inspection reports (air-quality tests, moisture readings)

• Photographs or videos showing water intrusion and mold development

• Repair receipts, remediation invoices, and itemized personal-property losses

Step 3: File a Civil Remedy Notice (CRN) if Bad Faith Is Suspected

Under §624.155, you must file a CRN with DFS and give the insurer 60 days to cure the violation before filing suit for extracontractual damages.

Step 4: Request DFS Mediation or Appraisal

Mediation is non-binding but often leads to settlements. Alternatively, if your policy contains an appraisal clause, you can demand it to set the amount of loss. Florida courts typically compel appraisal when disputes involve valuation rather than coverage.

Step 5: Consult a Florida Attorney

A qualified lawyer can issue statutory “demand letters,” conduct sworn examinations under oath (EUOs), and file suit in Broward County Circuit Court if necessary.

When to Seek Legal Help in Florida

1. Denial Based on Exclusion or Technicality

If the insurer relies on complex policy language or alleges pre-existing mold, legal interpretation may be needed to overturn the denial.

2. Multiple Perils or Hurricane Damage

Post-storm mold claims often involve wind, rain, and flood exclusions. Coordinating coverage analyses of National Flood Insurance Program (NFIP) versus homeowner policies requires specialized counsel.

3. Imminent Statutory Deadlines

Approaching the five-year limitation or the 60-day CRN cure window makes prompt legal action critical.

4. Significant Remediation Costs

Mold remediation in Hollywood—where many homes are built on slab foundations with limited attic ventilation—can exceed $25 per square foot. High-dollar claims merit professional representation.

Local Resources & Next Steps for Hollywood Homeowners

1. Broward County Building Code & Permitting

Copies of permits and inspection reports from the Broward County Building Code Services Division can refute allegations of defective construction.

2. Hollywood Flood & Storm Information

The City of Hollywood provides flood-zone maps and storm-surge data at its Stormwater & Flood Management page. These documents help establish that a covered peril caused moisture leading to mold.

3. Florida Department of Health – Mold Resources

The DOH offers guidance on safe mold remediation, which can support your claim costs. See Florida DOH Mold Information.

4. Filing a DFS Consumer Complaint

• Create an account on the DFS Consumer Portal.

• Upload your policy, denial letter, and any inspection reports.

• DFS contacts the insurer, which must respond within 20 days (Florida Administrative Code 69J-128.003).

DFS mediation requests can be submitted simultaneously.

5. Recordkeeping Tips

• Maintain a claim diary with dates, times, and names of insurer representatives.

• Save all emails, texts, and voice-mail transcriptions.

• Back up documentation to cloud storage in case of additional storm damage.

Legal Disclaimer

This guide is for informational purposes only and does not constitute legal advice. Every case is different. Consult a licensed Florida attorney to obtain advice regarding your individual situation.

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