Guide to American Integrity Claim Denials – Miami, Florida

Introduction: Why Claim Denials Matter in Miami, Florida

Miami homeowners enjoy year-round sun but also face tropical storms, hurricanes, and flooding threats that put roofs, windows, and interiors at constant risk. Those risks translate into some of the nation’s highest property-insurance premiums, and many policyholders rely on American Integrity Insurance Company of Florida (“American Integrity”) to protect their largest investment. Yet policyholders across Miami-Dade County frequently report claim delays or outright denials. If you recently received a denial letter, you are not alone, and you are not powerless. This comprehensive guide—grounded exclusively in verifiable Florida law, Department of Financial Services (DFS) procedures, and published court rulings—explains your rights and the concrete steps you can take to reverse or challenge an American Integrity claim denial in Miami, Florida.

The information is slightly tilted toward protecting homeowners because Florida public policy and consumer-protection statutes already recognize the imbalance between individual insureds and billion-dollar insurers. Still, every statement below is supported by authoritative sources such as the Florida Statutes, the Florida Administrative Code, the Office of Insurance Regulation (OIR), and reported appellate decisions. No speculation—only facts you can cite when negotiating with adjusters, filing a Civil Remedy Notice, or litigating in a Florida court.

Understanding Your Rights in Florida

1. The Policy Is a Contract Under Florida Law

Your homeowners policy is a contract subject to Florida contract principles and the insurance code (Titles XXXVII, Chapters 624–651). When American Integrity collects premiums, it assumes a fiduciary-like duty of good faith to investigate, adjust, and pay covered losses promptly (Fla. Stat. § 624.155).

2. Prompt-Pay Requirements

Under Fla. Stat. § 627.70131, insurers must acknowledge your claim within 14 days and pay or deny within 90 days, absent factors beyond their control. Violations expose carriers to statutory interest and potential bad-faith liability.

3. Civil Remedy Notice (CRN)

If American Integrity acts in bad faith, you may file a Civil Remedy Notice with DFS, giving the insurer 60 days to cure. Failure to cure can open the door to extracontractual damages under § 624.155.

4. Statute of Limitations

For a breach-of-contract lawsuit on a property-insurance policy, Florida gives you five years from the date of breach (Fla. Stat. § 95.11(2)(e)). The “breach” usually occurs on the date of denial or the end of the 90-day claims window—not the date of loss—so mark your calendar.

Common Reasons American Integrity Denies Claims

1. Wear and Tear or Pre-Existing Damage

American Integrity adjusters regularly cite policy exclusions for “long-term seepage,” “maintenance,” or “age-related deterioration.” Florida courts, however, require carriers to prove that excluded causes are the efficient proximate cause (Sebastian v. United States Fid. & Guar., 281 So. 2d 70 [Fla. 1973]). If wind or a sudden pipe burst contributed, the loss may still be covered.

2. Late Notice

The insurer may argue that you failed to give “prompt” notice. Yet the Florida Supreme Court held in American Integrity Ins. Co. v. Estrada, 276 So. 3d 905 (Fla. 2019) that the carrier must show actual prejudice from late reporting. Delays caused by post-storm chaos in Miami seldom equal prejudice.

3. Alleged Fraud or Misrepresentation

Sometimes carriers suspect inflated estimates or undisclosed prior claims. Remember, under Fla. Stat. § 626.9541(1)(i), an insurer’s unfounded fraud accusation is itself an unfair claim-settlement practice.

4. Policy Exclusions for Flood or Mold

Standard HO-3 and HO-8 policies exclude flood and may limit mold coverage. However, wind-driven rain damage that leads to mold growth can still be compensable. Always compare the adjuster’s cited exclusion with the actual loss sequence.

5. Managed Repair Program Disputes

American Integrity often invokes its “Right to Repair.” If you prefer your own contractor, disputes over scope or quality can transform into partial denials or underpayments.

Florida Legal Protections & Regulations

1. Florida Insurance Code Safeguards

• Fla. Stat. § 624.155 – Authorizes first-party bad-faith actions against insurers who fail to settle claims in good faith.

• Fla. Stat. § 626.9541 – Lists “Unfair Claim Settlement Practices,” including misrepresenting policy terms, failing to acknowledge communications promptly, and forcing insureds to litigate to recover amounts due.

• Fla. Admin. Code 69O-166.031 – Establishes standards for prompt, fair, and equitable settlements.

2. Assignment of Benefits (AOB) Reform

As of 2023, Fla. Stat. § 627.7152 restricts AOBs; you may no longer freely assign your claim rights to contractors. If American Integrity denies based on an AOB, verify whether the assignment predates the statutory cutoff or meets new requirements.

3. Mandatory Mediation Program

DFS offers free or low-cost mediation for residential property claims under Fla. Stat. § 627.7015. American Integrity must notify you of this option within five days of the denial.

4. Attorney’s Fee Shifting

Until December 2022, § 627.428 allowed prevailing insureds to recover fees. Recent legislative changes replaced it with § 627.4282 (effective policies after 1/1/23), limiting fee shifting. Check your policy issuance date; earlier policies may still qualify.

Steps to Take After an American Integrity Denial

1. Read the Denial Letter Line by Line

Confirm the exact policy provisions cited. Florida law (Herrera v. State Farm, 233 So. 3d 451 [Fla. 2d DCA 2018]) requires clear identification of the grounds for denial. Vague language can itself be grounds for reversal.

2. Gather Evidence

• Photos/Video – Document every room, roof section, and damaged item.

• Receipts & Invoices – Keep proof of repairs, lodging, and mitigation costs.

• Independent Estimates – Hire a licensed Florida public adjuster (Fla. Stat. § 626.854) for a second opinion.

• Weather Reports – NOAA or Miami-Dade County data can corroborate storm events on date of loss.

3. Request a Claim Re-Evaluation

Florida Administrative Code allows you to submit supplemental evidence and demand a second inspection. Do so in writing via certified mail.

4. File a Complaint With DFS

Use the DFS Consumer Complaint Portal. You will need your policy number, claim number, and denial date. DFS will contact American Integrity, which must respond within 20 days.

5. Invoke DFS Mediation

Complete Form DFS-I0-C1‐1690. Mediation typically occurs in Miami or via video conference. American Integrity pays the $300 administrative fee if you accept the mediation offer within 60 days of denial.

6. Serve a Civil Remedy Notice (CRN)

Log into the DFS CRN filing system, select insurer code “AIIC,” and list each statutory violation (e.g., §§ 624.155, 626.9541). Send a copy to American Integrity’s statutory agent, CT Corporation, in Tallahassee.

7. Consult a Licensed Florida Attorney

Bad-faith timelines, evidence preservation, and recent legislative reforms are intricate. An experienced Miami insurance-claims lawyer can evaluate whether litigation, appraisal, or pre-suit notice is the best route.

When to Seek Legal Help in Florida

1. High-Dollar or Total-Loss Claims

If your damage exceeds $50,000, litigating may unlock the full value plus interest and, for older policies, attorney’s fees.

2. Pattern of Delays

Multiple inspection reschedules, requests for repetitive documents, or silent treatment beyond statutory deadlines signal bad-faith exposure.

3. Managed Repair Disputes

If American Integrity’s preferred contractor offers inferior materials, a lawyer can file a declaratory-judgment action to compel cash payment instead.

4. Pre-Suit Notice Requirements (2022 SB 2-D)

Current law (Fla. Stat. § 627.70152) mandates a pre-suit notice at least 60 days before filing any residential property action. A Florida attorney can ensure the notice meets content and timing rules.

Local Resources & Next Steps for Miami Homeowners

1. State and County Agencies

Florida Office of Insurance Regulation – Market conduct examinations and consent orders against carriers. DFS Division of Consumer Services – Hotline: 877-693-5236. Miami-Dade Emergency Management – Storm prep guides that double as evidence checklists. Florida Bar Lawyer Referral Service – Verify attorney credentials.

2. Public Adjusters

Florida requires public adjusters to hold a 6-20 license and post a $50,000 bond. Verify licenses via the DFS database before hiring.

3. Keeping Up With Legislative Changes

Florida’s property-insurance statutes changed in 2021, 2022, and 2023 special sessions. Bookmark the House and Senate bill trackers to stay current.

4. Disaster Preparedness Grants

The My Safe Florida Home program may reimburse qualifying mitigation upgrades, lowering premiums and strengthening future claims.

Conclusion

American Integrity may be a major Florida insurer, but it is not the final authority on your claim. Florida statutes, administrative codes, and Miami-Dade resources empower you to demand full, fair, and prompt payment for covered losses. Whether you negotiate, mediate, or litigate, follow the timelines, gather objective evidence, and leverage the safeguards outlined above.

Legal Disclaimer: This guide provides general information only and does not constitute legal advice. For advice regarding your specific situation, consult a licensed Florida attorney.

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