What is a Public Adjuster?

A Public Adjuster is someone who helps you with your insurance claim after something like a fire, storm, or water damage happens. They work for you—not the insurance company—to make sure you get the money you deserve to fix the damage.

What’s the difference between a Public Adjuster, Company Adjuster, and Independent Adjuster?

A Public Adjuster works for you and helps you with your claim. A Company Adjuster works for your insurance company and looks out for their interests. An Independent Adjuster is hired by the insurance company but isn’t one of their employees. They still work for the insurance company, not for you.

What should I give my Public Adjuster to help with my claim?

To make things go smoothly, give your Public Adjuster: a full copy of your insurance policy (or at least the Declarations Page), receipts or bills for any repairs you’ve done, and photos or videos showing the damage.

How can a Public Adjuster help me?

Insurance claims can be confusing. A Public Adjuster knows what to do—from filling out paperwork and meeting deadlines to talking with your insurance company. They take care of everything so you don’t have to stress. Most of the time, they also help you get more money than you would on your own.

How much does it cost to hire a Public Adjuster?

Most Public Adjusters don’t charge upfront. Instead, they get paid a percentage of the money they recover for you. For example, in Florida, the fee is usually up to 20%, but only 10% if it’s after a big storm. In Texas, the fee is usually 10%. This setup makes sure they work hard to get you the most money, as quickly as possible.

What’s the difference between hiring a Public Adjuster and an Attorney?

Public Adjusters help right from the start: documenting the damage, making estimates, and talking with your insurance company. If they can’t get the job done, then you might need to hire an Attorney. Public Adjusters usually finish claims in 1 to 4 months. If you bring in an Attorney, it could take a year or longer.

Can a roofer or contractor help me the same way a Public Adjuster can?

No. Roofers and contractors can help fix your home and give estimates, but they can’t talk to your insurance company about your coverage or argue for more money. Only Public Adjusters and Attorneys are allowed to do that. A Public Adjuster can handle your whole claim, start to finish.

How long does a claim take with a Public Adjuster?

Most claims handled by a Public Adjuster are finished in 1 to 4 months. Insurance companies have up to 90 days to look into the claim. The Public Adjuster keeps things moving and pushes to get it done fast. If it takes longer, you might need an Attorney to step in.

What’s the difference between doing a claim myself and hiring a Public Adjuster?

You can do the claim on your own, but it’s hard if you don’t know all the rules and steps. Public Adjusters are trained pros who know how to get the most money. People who hire them often get 50% to 500% more than those who go it alone.

Where do I find my policy or claim number?

You can find it on the Declarations Page, which is usually the first page of your insurance policy. It also has your coverage details, deductible, and contact info for your insurance agent. If you don’t have it, call your Insurance Agent or Company to get a copy.

What to Do When Your Homeowners Insurance Denies a Fire or Water Damage Claim

Feb 23

Written By Drew Miles

Home Owners Insurance Claim Denial Support

Fire or Water Damage Claim Denied? Your Authoritative Guide to Fighting Back

Experiencing a fire or a major water leak in your home is a deeply traumatic event. In an instant, your sense of security is shattered, and your life is thrown into chaos. Amid this distress, you turn to the one safety net you’ve diligently paid for: your homeowners insurance. But then comes the second disaster—a formal letter from your insurer denying your claim.

This denial can feel like a profound betrayal. It leaves you feeling powerless, facing the overwhelming prospect of funding your own recovery. However, it is critical to understand this: a claim denial is not the final word. It is the insurance company’s opening position in a complex negotiation, and you have the right to challenge it.

Understanding precisely why claims are denied, knowing the strategic steps to build a powerful appeal, and recognizing when to bring in a professional advocate can completely change the outcome. This comprehensive guide will serve as your roadmap, empowering you to fight back effectively and work towards the fair settlement you deserve.

The Insurer's Playbook: Why Are Fire and Water Claims Denied?
Decoding Water Damage Denials: The Most Common Battleground
Unpacking Fire Damage Denials: It's More Than Just the Flames
Your Strategic Action Plan After Receiving a Denial Letter
The Shoreline Advantage: How a Public Adjuster Turns the Tide
Frequently Asked Questions (FAQs) About Denied Claims
Don't Let a Denial Define Your Recovery

The Insurer's Playbook: Why Are Fire and Water Claims Denied?

Insurance companies are for-profit businesses. While they provide an essential service, their financial model is based on collecting more in premiums than they pay out in claims. To this end, they employ teams of adjusters and experts to scrutinize every claim for reasons to deny it or reduce the payout. Understanding their common tactics is the first step to building your defense.

Decoding Water Damage Denials: The Most Common Battleground

Water damage is the single most frequent type of homeowners insurance claim, and consequently, it's also one of the most commonly denied. The denial almost always hinges on the insurance company's interpretation of the source and duration of the water damage.

The Critical Question: "Sudden and Accidental" vs. "Gradual"? Standard homeowners policies are designed to cover damage that is "sudden and accidental." A classic example is a pipe that suddenly bursts, flooding your kitchen. This is almost always a covered event.

However, policies explicitly exclude "gradual" damage. This refers to issues that develop over time, such as:

A slow, persistent leak from a toilet seal that rots the subfloor over months.
Water seeping through a cracked foundation after every rainstorm.
Mold growth resulting from constant high humidity and poor ventilation.

The insurer will argue that gradual damage is a maintenance issue, not an insurable event. This distinction is where countless legitimate claims are wrongfully denied. The company's adjuster may claim the evidence points to a long-term problem, even when the damage was, in fact, sudden.

The Maintenance Myth: Proving You Weren't Negligent Insurers will often deny a claim by citing a "lack of maintenance" or homeowner negligence. They might claim you should have noticed the leaky faucet or replaced your aging water heater before it failed. To counter this, meticulous record-keeping is your best defense. Keep receipts and invoices for any plumbing work, roof repairs, appliance maintenance, or other home upkeep. This documentation can prove you are a responsible homeowner and that the damage was not due to neglect.

The Flood Exclusion Trap It's crucial to understand that standard homeowners policies DO NOT cover flood damage. A flood is specifically defined as rising water from an outside source (e.g., an overflowing river, storm surge). If your home is damaged by this type of event, you will need a separate policy from the National Flood Insurance Program (NFIP) or a private flood insurer. Insurers often deny water damage claims by incorrectly classifying them as floods.

The Mold Complication If you have a mold problem, coverage will depend entirely on the initial cause of the water that allowed the mold to grow. If the mold resulted from a covered "sudden and accidental" event (like the burst pipe), then its remediation is typically covered, often up to a certain policy limit. If the insurer decides the water damage was "gradual," the resulting mold claim will be denied as well.

Unpacking Fire Damage Denials: It's More Than Just the Flames

Fire damage claims are complex and expensive, giving insurers significant incentive to limit their liability.

Cause and Origin Investigations Following a fire, the insurance company will launch a "Cause and Origin" investigation to determine how it started. If their investigator flags anything suspicious or labels the cause "undetermined," it can lead to a denial based on a suspected arson (an intentional act), which is a policy exclusion. This triggers a much more intense level of scrutiny, and the burden will be on you to prove the fire was accidental.

Disputes Over the "Scope of Loss" This is a major point of contention. A denial can come in the form of a "partial denial" or a grossly insufficient settlement offer. The dispute often centers on:

Repair vs. Replace: The insurer may propose simply cleaning items that are permanently damaged by smoke and soot, such as textiles, electronics, or furniture. They may argue for patching a roof when a full replacement is necessary to ensure structural integrity.
Matching: If part of your cabinetry or flooring is damaged, the insurer might only offer to replace the directly damaged section, leaving you with a mismatched and devalued kitchen or room. A proper claim should argue for replacement of the entire area to ensure a uniform appearance.

Code Upgrades and Coverage Gaps If your home is older, rebuilding it after a fire will require bringing it up to current building codes (e.g., updated electrical, plumbing, or structural requirements). These upgrades can be extremely expensive. Many standard policies offer very limited "Ordinance or Law" coverage, and insurers may deny the costs associated with these mandatory upgrades, leaving you with a massive out-of-pocket expense.

Your Strategic Action Plan After Receiving a Denial Letter

Receiving a denial is disheartening, but it's a call to action. Follow these steps methodically.

1. Dissect the Denial Letter This document is the key to your appeal. Read it carefully and identify:

The specific reason(s) cited for the denial.
The exact policy language (sections, definitions, exclusions) they are using to justify their position.
The names of the adjusters and investigators involved.
The deadline for filing an appeal.

2. Become a Master Archivist Gather every piece of information related to your home and your claim. This is your evidence locker.

Your Policy: Request a complete, certified copy of your insurance policy.
Photos/Videos: All photos and videos you took of the damage.
Communications: Every email and letter sent to or received from the insurer. Keep a log of every phone call with dates, times, and notes on what was discussed.
Maintenance Records: Proof of any repairs or upkeep done on your home.
Original Purchase Receipts: For high-value damaged items.

3. Draft a Professional Written Appeal Your appeal should be formal, professional, and evidence-based—not an emotional rant.

Clearly state that you are appealing their decision.
Address each of their reasons for denial one by one.
For each point, present your counter-argument and reference your supporting evidence.
Quote language from your own policy that supports your position.
Send the appeal via certified mail to create a legal record of receipt.

4. Engage a Professional Advocate: The Public Adjuster If the process is overwhelming, the claim is complex, or the stakes are high, this is the single most important step you can take. A public adjuster is a state-licensed insurance professional who works exclusively for you, the policyholder.

The Shoreline Advantage: How a Public Adjuster Turns the Tide

Fighting an insurance company on your own is like representing yourself in court against a team of seasoned lawyers. At Shoreline Public Adjusters, we level the playing field.

We Master the Fine Print: We are fluent in the dense, often ambiguous language of insurance policies. We identify where your insurer has misinterpreted its own contract and use that knowledge to dismantle their reasons for denial.
We Build an Unassailable Case: Our team conducts its own independent, in-depth damage assessment. We bring in our own network of trusted engineers, contractors, and inventory specialists to create a detailed "Scope of Loss" that documents the true cost of restoring your home. This professional claim package is far more difficult for an insurer to dismiss.
We Manage the Entire Process: We handle every phone call, email, and meeting with the insurance company. This removes the immense stress and burden from your shoulders and prevents you from making any missteps that could harm your claim.
We Maximize Your Financial Recovery: The insurance company's adjuster is paid to protect their employer's financial interests. We are paid to protect yours. Our sole mission is to negotiate aggressively on your behalf to secure the full, fair, and just settlement you are entitled to.

Frequently Asked Questions (FAQs) About Denied Claims

Q: What if the insurer’s offer is too low but not a full denial? A: This is effectively a partial denial. You should never accept an initial lowball offer. Treat it as the start of a negotiation and consult with a public adjuster to build a counter-offer based on a true valuation of your damages.

Q: What is "bad faith," and how do I know if it's happening? A: Bad faith is when an insurer fails to uphold its contractual duty without a reasonable basis. This can include unreasonable delays, failing to conduct a thorough investigation, or deliberately misinterpreting policy language. If you suspect bad faith, it is crucial to consult a professional immediately.

Q: How long do I have to file an appeal after a claim denial? A: The timeframe varies by policy and state law but can be as short as one year from the date of loss. It is critical to act quickly.

Don't Let a Denial Define Your Recovery

Facing a denied homeowners claim for fire or water damage is an uphill battle, but it is a battle you can win. By arming yourself with knowledge, being meticulous with documentation, and partnering with a dedicated advocate, you can challenge the insurance company and fight for the funds you need to rebuild your life.

The team at Shoreline Public Adjusters is committed to serving as that advocate for homeowners throughout Florida, Minnesota, and Wisconsin. Our experience and expertise ensure you have a powerful ally working to turn your denial into a successful settlement.

For personalized, expert assistance, contact us today for a free consultation. Let us help you navigate the complexities of your insurance claim and work towards restoring your home and your peace of mind.

📞 Call us today (954-546-1899) or fill out our contact form: Shoreline Public Adjusters Contact Page

🔎 Check out our Google Reviews: Shoreline Public Adjusters Google My Business

Protect your investment—get the expert representation you need before time runs out!

Local Service Areas: Florida (FL), Minnesota (MN), Wisconsin (WI)

Help with Your Claim

Shoreline Public Adjusters, LLC
780 Fifth Avenue South
Suite #200
Naples, FL 34102

Email: hello@teamshoreline.com
Phone: 954-546-1899
Fax: 239-778-9889

Drew Miles