Can I appeal my denial from Citizens property insurance of Florida?

Asked almost 3 years ago - Saint Petersburg, FL

I had water damage to my kitchen floor. The adjuster never went under the house to see for himself. Instead he used pictures my exterminator sent to me. Turns out that the damaged area is neither accessable nor viewable from under the house so the pictures are not of the area I am claiming. Citizens denied the claim stating that the leak occurred over a period of more than 2 weeks ("whether seen or unseen") and using the condition of the wood in the pictures as proof of the extended period over which the damage occurred. When the contractor discovered the error, I notified the Citizens adjuster who simply told me the denial still stands. The water came from a slow leak in the water line to the ice maker that saturated the floor and subfloor starting behind the refridgerator.

Attorney answers (4)

  1. Alan Bennett Garfinkel

    Contributor Level 6

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    Answered . Our firm has handled more than a hundred claims against Citizens. Although Florida's current law prevents a bad faith cause of action against Citizens Insurance company, there appears to be disputes on this issue between two appellate courts. Hopefully the Florida Supreme Court will rule that the statue requiring Citizens to adjust its claims in "good faith" will ultimately be determined that failure to do so enables a policy holder to pursue "bad faith" damages. Notwithstanding, before any claim for bad faith is ripe in the courts, there must be a court determination that Citizens improperly paid your claim.

    When Citizens denies a claim, there is no appellate process other than filling a lawsuit against them. If your lawyer obtains even an additional dollar, you are the prevailing party and Citizens, like any other insurance company, is responsible for paying your reasonable attorney's fees and costs.

    Hope this helps, and good luck!

    -Alan Garfinkel

  2. Thomas Michael Bates

    Contributor Level 13

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    Lawyer agrees

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    Answered . Your insurance policy with Citizens is a contract. Whether Citizens owes an obligation to repair damage to your kitchen floor will be controlled by the language of the policy. Generally, a homeowner's insurance policy will only cover water damage when that damage is caused by a "sudden and unexpected" or "sudden and accidental" event. The adjuster is denying the claim because he's saying the damage was not caused by a sudden and unexepected event. A "slow leak" in the water line to the ice maker is probably something that could have been discovered upon reasonsable inspection. You very well may lose a lawsuit on this claim but I strongly recommend you contact an attorney. Good luck.

    I am not seeking to represent you based on the response to this question. The answer given is for general... more
  3. Matthew A. Dolman

    Pro

    Contributor Level 13

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    Answered . My advice is to retain an attorney who primarily handles first party insurance claims for property damage. From the facts provided, it appears that the adjuster lacks a meritorious reason for denying this claim and their actions thus far appear to be in bad faith. There is an implied covenant of good faith and fair dealings in all insurance contracts. In this instance, the adjuster does not appear to have satisfied his duty of dealing in good faith or his overall fiduciary duties owed to the insured.

    I wish you the best of luck

    This advice should not be construed as forming an attorney-client relationship.
  4. Pamela Koslyn

    Contributor Level 20

    Answered . There's nothing to appeal. You're going to have to hire a lawyer to sue your insurer for bad faith denial of your claim.

    Avvo doesn't pay us for these responses, and I'm not your lawyer just because I answer this question or respond to... more

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