Claims Handling and Investigation
The claim lifecycle
First notice of loss, acknowledgment, assignment, investigation, evaluation, disposition (pay, partial pay, or deny), subrogation and salvage, then closure. Florida statute requires a property insurer to acknowledge a claim within 14 days and to pay or deny within 90 days of receiving a properly completed proof of loss; undisputed amounts must be paid promptly while the balance is investigated.
Investigation tools
Recorded statements, examinations under oath, document requests (receipts, financials, prior policies), scene inspection, contractor estimates, background checks, and claim-history databases. When coverage is unclear, send a reservation of rights letter or obtain a nonwaiver agreement so investigating does not waive a coverage defense. Red flags - recent inception, multiple prior losses, no police report, inflated contents schedule, refusal to provide records - go to SIU; Florida insurance fraud falls under statute 817.234 and is investigated by the Division of Investigative and Forensic Services.
Writing the disposition
Denials must cite the specific policy language and the facts, go out in writing, and preserve the insured's right to complain or litigate. Document every contact; the claim file is your defense.
Traps
- Treating an acknowledgment letter as an admission of coverage.
- Missing the 90-day clock and calling it 'still investigating' - that itself can be an unfair claim practice.
- Failing to separate covered from uncovered damage item by item (wind versus flood).
Worked example
Loss occurs March 1 and a properly completed proof of loss arrives April 15. The 90-day deadline is July 14. Acknowledge by March 15, inspect promptly, and pay, deny, or send a written status/extension notice before July 14.