A resident of Spring Hill, Florida, is grappling with a state-backed insurer after his insurance claim for nearly six figures was denied.
Tom Luby told WFTS Tampa Bay 28 that Citizens Insurance twice denied his nearly $100,000 vandalism claim on a rental property he owns. According to WFTS, the insurer said the extensive damage was an “incomplete remodel” of the home by the tenant, and not vandalism (1).
The property damage includes stolen and destroyed appliances, torn-up flooors and debris scattered indoors and out.
But under Florida’s insurance reform laws, Luby can’t take the insurance company to court. Because his claim has been denied twice by the company, Luby says, he is now being forced into mediation. He also said that he had taken his case to three different attorneys, and they all turned his case down
“They don’t want to take it, because you can’t win,” Luby said. “There’s nothing I can do.”
Critics are sounding the alarm on the new mediation process, which sees lawsuits against the insurer routed to arbitration through the Florida Division of Administrative Hearings (DOAH), as opposed to being heard in Florida’s circuit courts.
According to a recent ProPublica investigation, lawmakers and Citizens said this change, passed in 2023, would speed up hearings and save money (2). The report notes that “some DOAH judges have denied motions requesting that they disclose any potential conflicts they might have as arbitrators.”
According to the WFTS, Miami-based attorney Anthony Lopez, who represents Luby in the mediation, questioned the neutrality of the DOAH judges.
“The neutral arbitrators, the judges in DOAH, are basically hand-picked by Citizens. A lot of them are former defense lawyers that represented insurance companies,” Lopez said.
The ProPublica report found in the more than 1,500 disputes that Citizens has taken to mandatory arbitration, it won more than 90% of the final hearings. By comparison, the insurer won 55% of the time when cases went to circuit court trials, over the past five years.
The investigation also presented a disconcerting trend: homeowners who try and drop their cases are unable to do so. The rules of the DOAH are such that a case cannot be dropped unless both parties agree. According to ProPublica, Citizens “routinely pursues fees and costs against individuals who do not withdraw their claim early in the DOAH process.” An attorney interviewed in the report characterizes the actions as “vindictive.”
In an interview with WFTS, Citizens CEO Tim Cerio defended the mediation process, noting that there is a 6-step review of the claim before a policyholder is forced into a DOAH hearing and, he says, of all disputed claims sent to DOAH, 37% are settled before the final hearing.
“We’ve tried very hard to get it right, and if we think we’ve made a mistake, to go back and fix it. If we think we need to take the second look, we’ll take a second look, a third look,” Cerio said. “By the time that final hearing comes, we are pretty certain about the outcome.”
After the interview with Cerio, Citizens said they will review Luby’s case again, WFTS reported.
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If you are concerned about what your home insurance covers, and whether a claim you make would be denied, there are steps you can take to protect yourself.
The first step you can take is reviewing your policy. Be sure that you understand what exactly is covered by your home insurance, and what is not.
Things that are often not covered include flooding, earthquakes or landslides, insect or rodent damage, damage from war or civil unrest, normal wear and tear and results of neglect, such as mold, rust or a leak you neglected to fix. If you are concerned about flooding or natural disasters, you may consider investigating whether you can purchase a separate insurance policy that covers these events.
In some states where wildfire risk is high, homeowners have increasingly struggled to find insurance companies that will cover their homes, as was widely reported amid the January wildfires that devastated parts of Los Angeles.
If you need to make an insurance claim, and you have checked that it is covered by your policy, make sure that you also file the claim by the deadline stipulated in your policy; extensively document the issues with photos, video, any receipts you’ve collected and any other evidence; and wait to undertake major repairs until an insurance adjuster has assessed the damage.
If your claim has been rejected, you will need to contact your insurer and request that they reevaluate your claim. Be sure to document all communication with your insurer. You may need to take the step of filing an appeal; the process of how to file an appeal should be detailed in your policy.
You can also reach out to your state’s insurance department, which may, depending on your state, help mediate your dispute, but also can help explain your rights.
There is also the option of hiring a public adjuster. A public adjuster works for you, the policyholder, as opposed to the adjuster that works for your insurer. Public adjusters charge a fee, which can be up to 15% of your settlement.
When hiring a public adjuster, check if they are required to be licensed in your state, check if your state insurance department has resources for finding a public adjuster, or search the National Association of Public Insurance Adjusters. Be sure to check their references, and avoid anyone who tries to pressure you.
Check whether your state sets the percentage that a public adjuster is allowed to charge you. If you experience a natural disaster, be wary, warns the Insurance Information Institute (3), of public adjusters who go door to door afterward offering their services.
We rely only on vetted sources and credible third-party reporting. For details, see our editorial ethics and guidelines.
WFTS Tampa Bay 28 (1); ProPublica (2); Insurance Information Institute (3)
This article provides information only and should not be construed as advice. It is provided without warranty of any kind.
