Property Insurance Claim Denial Guide – Marathon, Florida

Introduction: Why Claim Denials Matter to Marathon Homeowners

The City of Marathon sits in the heart of the Florida Keys, surrounded by crystal-clear waters—and exposed to some of the state’s harshest environmental risks. High humidity, frequent tropical storms, and a history of major hurricanes such as Hurricane Irma (2017) create ideal conditions for mold growth, wind damage, and water intrusion. According to the Florida Office of Insurance Regulation’s annual catastrophe reports, Monroe County policyholders file proportionally more hurricane-related claims than nearly any other county. Yet many Marathon residents still find their property insurance claims denied or underpaid.

This guide explains—step by step—how Marathon homeowners can protect their rights after a property insurance claim denial, with a special focus on mold damage. Every statement below is grounded in authoritative Florida law, published court decisions, and regulatory guidance. While the information slightly favors the policyholder, it remains strictly factual and professional.

Understanding Your Rights in Florida

1. The Contractual Right to Coverage

Your homeowners policy is a binding contract. Under Florida common law, an insurer that breaches its policy obligations may be sued for damages within Florida’s five-year statute of limitations for written contracts (§95.11(2)(b), Fla. Stat.). If the denial concerns hurricane or windstorm damage—and perhaps mold that resulted from that event—timely action is essential because notice to the carrier must generally be given within one year of the date of loss under many policy forms.### 2. The Right to Fair Claim Handling

Section 627.70131, Florida Statutes sets deadlines for insurers to acknowledge, investigate, and pay or deny claims. In most circumstances the carrier must:

• Acknowledge the claim within 14 days.
• Begin investigations within a reasonable time.
• Pay or deny the claim within 90 days after receiving notice, unless factors beyond the insurer’s control prevent it.

Failure to comply may constitute bad-faith claim handling under §624.155, Fla. Stat.

3. The Right to Mediation or Appraisal

Under §627.7015, Fla. Stat., the Florida Department of Financial Services (DFS) offers a free, non-binding mediation program for disputed residential property claims, including mold-related losses. The insurer must notify you in writing of this option when it denies or partially denies your claim.## Common Reasons Property Insurance Companies Deny Claims in Florida

1. Mold Exclusions or Sublimits

Florida insurers often include specific mold exclusions or set low mold remediation sublimits (e.g., $10,000) under ISO HO-3 or proprietary policy forms. A denial letter may contend that:

• The mold was long-term and not caused by a covered peril.
• The policy’s mold sublimit has been exhausted.

However, if wind-driven rain from a named storm created the moisture, Florida courts have repeatedly held that the ensuing mold can be covered so long as the initial peril is covered (see Homeowners Choice Prop. & Cas. v. Maspons, 211 So. 3d 1067, Fla. 3d DCA 2017).

2. Late Notice

Insurers may argue that you reported the loss too late, hindering their investigation. Yet under Bankers Ins. Co. v. Macias, 475 So. 2d 1216 (Fla. 1985), an insurer still must show it was prejudiced by the delay.

3. Wear and Tear or Maintenance

Policies exclude losses due to "maintenance" or "wear and tear." High humidity in Marathon can cause gradual mold growth, giving insurers an opening to deny. The key question is whether a sudden and accidental event (e.g., pipe burst) initiated the damage.

4. Misrepresentation

Under §627.409, Fla. Stat., material misrepresentations may void coverage. Always be honest about pre-existing mold or prior claims.

5. Failure to Mitigate

Policyholders must reasonably protect property from further harm (the "Duties After Loss" clause). Promptly hiring a licensed mold remediator, especially in Marathon’s humid climate, proves you mitigated.

Florida Legal Protections & Regulations

1. Claim Investigation Deadlines

Section 627.70131(5)(a) sets a 90-day window for insurers to make a coverage decision. Failure can trigger interest penalties under 627.70131(5)(a)2.

2. Notice of Intent to Initiate Litigation (NOI)

As of 2023, §627.70152 requires policyholders to provide written notice at least 10 business days before filing suit. The notice must include an estimate of damages and supporting documents. Marathon homeowners can file the NOI through the DFS online portal.

3. Statute of Limitations

• 5 years for breach of the insurance contract (95.11(2)(b)).
• 1 year to reopen hurricane claims after the initial reopening period, per §627.70132.

4. Bad-Faith Remedies

If an insurer fails to settle a claim in good faith, §624.155(1)(b)(1) permits civil actions after a 60-day civil remedy notice (CRN) is filed with DFS.

5. Licensing and Remediation Standards

Florida requires mold assessors and remediators to hold a license issued under Part XVI, Chapter 468, Fla. Stat. Always hire licensed professionals—an insurer may deny costs from unlicensed work.

Steps to Take After a Denial in Florida

1. Read the Denial Letter Carefully

The insurer must state the specific policy language relied on (Florida Administrative Code Rule 69O-166.024). Note any references to mold exclusions or sublimits.

2. Request the Full Claim File

Under Florida’s Claims Administration Statute, policyholders may request adjuster notes, engineer reports, and photographs.

3. Document and Preserve Evidence

• Photograph mold colonies, water lines, and damaged contents.
• Retain samples or spore test results from a licensed Mold Assessor.
• Keep repair invoices, humidity readings, and remediation logs.

4. Mitigate Further Damage

Section 627.7011 requires reasonable repairs to protect the property. Marathon’s climate accelerates mold growth—act quickly.

5. Consider DFS Mediation

File a request online or by calling DFS at 1-877-693-5236. The insurer pays the mediator’s fee if the claim is less than $500,000.

6. Engage Appraisal (If in Policy)

Many policies include an appraisal clause: each side picks an appraiser, and an umpire resolves differences. Appraisal addresses amount of loss, not coverage.

7. Serve a Notice of Intent to Litigate

Use DFS’s portal, upload your estimate, and wait the 10-day cure period.

When to Seek Legal Help in Florida

1. Complexity of Mold Claims

Mold disputes often blend coverage, causation, and health-related damages. A licensed Florida attorney can dissect policy language (including endorsements like "Limited Fungi Wet or Dry Rot Coverage") and assemble expert testimony.

2. Multiple Denials or Delay Tactics

Repeated "we’re still investigating" letters beyond 90 days may warrant a §624.155 bad-faith CRN.

3. Large-Dollar Losses

If repair costs exceed policy sublimits or your mortgage lender demands repairs, a lawyer can pursue supplemental claims or litigation.

Local Resources & Next Steps

1. Monroe County and City of Marathon Contacts

• Monroe County Building Department – 305-289-2501. Permits for mold remediation often require inspection.
• City of Marathon Code Compliance – 305-289-4123. Ensures contractors meet wind-storm building codes.

2. DFS Consumer Services

Submit complaints online or call DFS Consumer Helpline. Provide policy number, denial letter, and photos.### 3. Florida Bar Lawyer Referral

Obtain a list of licensed Florida attorneys experienced in property insurance disputes.### 4. Mold Testing and Remediation

Verify licenses through DBPR License Search.### 5. FEMA and Flood Insurance

While standard homeowners policies exclude flood damage, National Flood Insurance Program (NFIP) claims can interact with mold issues. Marathon lies in FEMA flood zones AE and VE; check your Elevation Certificate.

Legal Disclaimer

This guide is for informational purposes only and does not constitute legal advice. Consult a licensed Florida attorney regarding your specific situation.

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