The three scenarios
Denial: the carrier paid $0 and issued a denial letter citing a specific basis. Lowball: the carrier offered a specific amount that's materially below the repair cost. Underpayment: the carrier paid something but missed scope, applied the wrong policy provision, or depreciated aggressively.
Each has a different playbook.
Common denial bases and their counters
| Denial basis | Counter |
|---|---|
| Wear and tear | Specific event documentation; expert correlation; prior maintenance records |
| Excluded peril | Careful peril-definition parsing; cause-of-loss documentation |
| Insufficient documentation | Submit the missing documentation |
| Gradual / long-term | Timeline of discovery; plumber/contractor statement; sudden-event evidence |
| Below deductible | Full-scope re-estimate (often crosses the deductible threshold) |
| Late notice | Reasonable-notice argument per Florida case law; prompt-notice record |
| AOB violation | Direct policyholder representation (no AOB) |
Common lowball patterns
- Scope missing entire rooms or areas
- Unit pricing set to Xactimate defaults instead of Florida-current
- Code upgrades not included
- Matching statute ignored
- ACV paid without RCV holdback track
- Overhead and profit (10-and-10) not applied when it should be
- Temporary repair / mitigation costs omitted
Reversal tools under Florida law
- Supplemental claim (Fla. Stat. 627.70132): 18 months from date of loss. Preserves policy limits; no denial of the original claim required.
- Reopened claim: 1 year from date of loss for new-claim notice; the claim can be "reopened" if additional damage emerges.
- Appraisal invocation: most Florida HO-3 policies include an appraisal clause. Either party may invoke. Three-appraiser panel (two parties' appraisers + an umpire) sets the amount of loss.
- DFS mediation (Fla. Stat. 627.7015): state-sponsored, low-cost, non-binding. Often resolves in a single session.
- Civil Remedy Notice (Fla. Stat. 624.155): statutory bad-faith notice. Carrier has 60 days to cure or face potential bad-faith exposure.
How Ocean Point handles denied / underpaid claims
- Denial-letter review. Identify the exact basis; parse the policy language cited.
- Full re-estimate in Xactimate with Florida-current pricing.
- Policy review for missed coverages, endorsements, and sublimits.
- Counter-documentation: expert reports, photos, timelines as needed.
- Submission: supplemental, reopening, or direct demand letter depending on the situation.
- Escalation: appraisal, mediation, or CRN if the carrier maintains the position.
Who leads denial / underpayment claims
Eli Goins (FL DFS #P159790) leads complex denials, appraisals, and CRN filings. The full team supports across claim types.