A Denial Is Not a Verdict

What Just Happened to You

You filed a claim. You waited. And then a letter came, and it used words like “wear and tear,” “pre-existing,” “maintenance,” “excluded,” “not a covered peril.”

Or worse — they didn’t deny it. They approved it, and sent a check for a fraction of what the damage actually costs to repair, and now you’re supposed to be grateful.

And here’s what you’re feeling right now, and it’s the feeling that keeps most people from ever doing anything about it:

You’re not sure they’re wrong.

You don’t know the policy. You’ve never read it end to end, and if you did, you’re not certain you’d understand it. The letter sounds official. It cites language. It sounds like it was written by people who know something you don’t.

So you sit with it, and you wonder if maybe this is just how it works.

It isn’t.

A Denial Is a Position, Not a Verdict

An insurance company denying a claim is not a court ruling. It is not final. It is an opening negotiating position taken by a business that profits by paying you less.

They are permitted to take that position. You are permitted to move it.

And here is what almost nobody outside this industry understands: most denials are not about whether the damage exists. The carrier can see the damage. The fight is almost always about one of three things:

Every one of those is arguable. Most people never argue, because they don’t know they can and they don’t know how.

We Are the People Who Argue

Public Loss Adjusters is a licensed Florida public adjusting firm. We work only for policyholders. Never for an insurance company. Not ever.

When a claim is denied or underpaid, we take the file apart: we re-inspect the loss, we re-document the damage the carrier’s adjuster never found, we read the policy for the coverage they didn’t volunteer, and we build the case that moves their position.

And you pay nothing out of pocket. We are paid a percentage of what we recover for you. If we recover nothing, you owe nothing. There is no version of this where calling us costs you money.

That single fact is what the insurance company is counting on you not knowing.

It Doesn’t Matter Who Your Carrier Is

We handle denied and underpaid claims against every carrier writing property insurance in Florida — the national names, the Florida-only carriers, Citizens, and the ones that went insolvent and left their claims to the Florida Insurance Guaranty Association.

Every carrier denies claims. That is not a scandal — it is the business model. The claims department’s job is to pay as little as the policy allows. Your policy allows a great deal more than most people ever collect, and nobody at the insurance company is going to tell you that.

We have recovered on claims that were denied outright. We have recovered on claims where the carrier had already closed the file. We have recovered on claims where the carrier went bankrupt mid-claim and the case moved to FIGA — $50,000, signed release.

The Clock Is Real, and It’s Shorter Than You Think

Florida law puts hard deadlines on property claims — on reopening them, on supplementing them, on disputing what the carrier decided.

Those deadlines do not care that you were waiting to feel ready. Once they pass, they do not reopen, and a claim that was worth tens of thousands of dollars becomes worth nothing at all.

If you have been denied, or underpaid, or you’ve been sitting on a letter you don’t know what to do with — the single worst thing you can do is nothing.

Five minutes on the phone tells you whether there’s money in it. There usually is.

Robert Mack · Licensed Florida Public Adjuster

In the insurance industry since 1991. Licensed public adjuster, Lic. #A161638. SPPA · AIC · AIC-M.
Public Loss Adjusters, LLC has served Florida policyholders since 2019.

Based in Montverde, Central Florida. Not a call center. Not a national firm reaching in from another coast.

We work for you, not the insurance company. No recovery, no fee.

★ 4.8 Google reviews · Not affiliated with any insurance company

Denied or Underpaid Claim Questions

My insurance claim was denied. What do I do now?

A denial is the insurance company’s position — not a final ruling. It can be re-documented, challenged, and reversed. The first step is having someone who reads policies for a living look at the denial letter and the loss. It costs nothing: a licensed public adjuster is paid only out of what is recovered.

The insurance company denied my claim. Can I fight it?

Yes. Denials are reversed regularly. We have taken a denied hurricane claim from the carrier’s position of about $5,000 to a settlement of approximately $45,000. The damage never changed. Only who was arguing for it.

What do I do if my homeowners insurance denies a claim?

Do not accept the denial as the end of the matter, and do not re-file it yourself on the same record. Have the file reviewed first. What the carrier wrote in that letter is a position built on their own inspection and their own reading of your policy — both of which can be challenged with better evidence.

How do I dispute an insurance claim?

The word “dispute” makes it sound like an argument. It isn’t. It is a documentation contest — the side with better evidence about what caused the damage and what it costs to repair usually wins. That is what a public adjuster does for a living.

What to do if insurance denied my roof claim?

Roof denials almost always turn on age, wear and tear, or “pre-existing damage.” Whether those apply is a question of evidence, not opinion. A denial for wear and tear is one of the most reversible denials there is — if someone documents the loss properly.

My insurance company won’t pay my claim. What can I do?

An insurer refusing to pay is taking a position that it profits from. You are entitled to move it. The question is never whether they said no — it’s whether the policy and the evidence support the no. Usually they don’t.

The insurance company offered me far less than the repairs cost. Is that legal?

An insurer may make any offer it likes. You are not obligated to accept it. Lowball offers usually come from a limited inspection — the adjuster photographed what was visible and wrote a number for that. The damage behind the wall was never counted.

What is a lowball insurance settlement offer?

An opening number, built on a partial inspection and a narrow reading of your policy. It is a starting position. We have moved carriers from about $11,500 to a first bump of $16,000 — and then to a final settlement of roughly $19,000. The first offer is never the last offer, and the second offer isn’t either.

How do I appeal an insurance claim denial?

There is a right way and a costly way, and most people find out which one they used after it’s already on the record. That is exactly what we handle. Do not appeal it alone. Have it reviewed first — it costs you nothing to find out.

Can a denied insurance claim be reopened?

Often, yes. Florida law provides windows for reopening and supplementing property claims — but those deadlines run from the date of loss, not from the day you were denied, and they are shorter than most people expect.

Can an insurance company deny a claim for any reason?

No. A denial has to rest on the policy and on the facts. Carriers routinely lean on exclusions — wear and tear, maintenance, pre-existing, gradual damage — because those exclusions are hard for a homeowner to argue against. They are not hard for someone who does it every day.

Why was my claim denied for wear and tear?

Because “wear and tear” converts your loss from a sudden event (covered) into gradual deterioration (excluded). It is the single most common denial ground in Florida, and it is frequently wrong. Whether the damage happened on a day or over a decade is a matter of evidence.

Insurance denied my claim — should I sue?

That is a legal question and a lawyer’s decision. But a great many denied claims never need a lawsuit — they need documentation the carrier cannot dismiss. That’s cheaper, faster, and it’s what a public adjuster does.

What does it cost to have a denied claim reviewed?

Nothing out of pocket. A public adjuster is paid a percentage of what is recovered. If nothing is recovered, nothing is owed. Five minutes on the phone tells you whether there’s money in it.

What is the difference between a public adjuster and the insurance company’s adjuster?

The insurance company’s adjuster is paid by the insurance company. A public adjuster is paid only out of what the policyholder recovers. They are not on the same side, and only one of them is on yours.

How long do I have to challenge a denied claim in Florida?

Less time than you think. Florida sets statutory deadlines for reopening and supplementing property claims, measured from the date of loss. Once they pass, they do not reopen — and a claim worth tens of thousands becomes worth nothing.