{"id":904848,"date":"2025-09-30T14:23:52","date_gmt":"2025-09-30T20:23:52","guid":{"rendered":"https:\/\/www.myconstructionexpert.com\/blog\/?p=904848"},"modified":"2025-09-30T14:23:55","modified_gmt":"2025-09-30T20:23:55","slug":"insurance-claims-homeowners-losing-90-of-cases","status":"publish","type":"post","link":"https:\/\/www.myconstructionexpert.com\/blog\/insurance-claims-homeowners-losing-90-of-cases\/","title":{"rendered":"Homeowners Are Losing 90% of Cases Against Florida\u2019s Biggest Insurer\u2014Here\u2019s Why"},"content":{"rendered":"\n

Allaire Conte | Yahoo! Life<\/a><\/p>\n\n\n\n

Florida<\/a>\u2019s\u00a0home insurance<\/a>\u00a0crisis has left more than half a million homeowners with no choice but to rely on the\u00a0state\u2019s insurer of last resort<\/a>. As private companies have fled the market and\u00a0premiums have skyrocketed<\/a>, Citizens Property Insurance Corporation has become the only remaining option for many.<\/p>\n\n\n\n

But when policyholders challenge denied claims, Citizens wins more than 90% of the time in a little-known legal process that sidesteps traditional courts, where its win rate drops to around 55%, as first reported by\u00a0ProPublica<\/a>\u00a0and the\u00a0Sun Sentinel<\/a>.<\/p>\n\n\n\n

The disparity reveals a troubling pattern in an already fragile market\u2014one where homeowners are being pushed into a system where the odds are overwhelmingly stacked against them.<\/p>\n\n\n\n

The new ‘courtroom’ homeowners rarely chose<\/h4>\n\n\n\n

In spring 2023, amid a deepening insurance crisis, Florida\u00a0lawmakers passed a measure<\/a>\u00a0giving Citizens the power to reroute disputes with policyholders away from traditional courts and into the Division of Administrative Hearings (DOAH). The move was part of a broader legislative push backed by Citizens to make it easier for the\u00a0not-for-profit, state-backed insurer<\/a>\u00a0to raise rates and reduce its legal exposure as climate-fueled disasters mounted.<\/p>\n\n\n\n

Advertisement<\/p>\n\n\n\n

It was a time of historic losses. Florida saw four billion-dollar weather disasters in 2022, which doubled to eight in 2023, and then spiked to 11 in 2024, according to data from the\u00a0National Oceanic and Atmospheric Administration<\/a>.<\/p>\n\n\n\n

Those three years alone account for nearly 40% of all billion-dollar disasters in state history going back to 1980. As insurers became insolvent or left the market, more than 1.4 million homeowners were pushed on to Citizens, the state\u2019s \u201cinsurer of last resort.\u201d<\/p>\n\n\n\n

But the new legal channel raised alarms early on. During floor debate, then-state Rep. Erin Grall<\/strong> called the provision \u201cvery broad\u201d and warned it would harm policyholders, according to ProPublica.<\/p>\n\n\n\n

State Rep.\u00a0Hillary Cassel<\/strong>, a former\u00a0insurance attorney,<\/a>\u00a0went further, arguing that DOAH hearings strip homeowners of their right to a jury trial, limit discovery, and tilt the balance of power toward the insurer.<\/p>\n\n\n\n

\u201cI do take issue with allowing these cases to go into an administrative hearing process and being denied a right to a trial by jury that is the foundation of our American justice system,\u201d she said in what now feels like a prophetic testimony on the\u00a0House floor<\/a>.<\/p>\n\n\n\n

\u201cI\u2019ve heard the former executive director of Citizens comment that they are willing to pay to hire these administrative judges to handle these cases on behalf of Citizens which I believe creates a conflict of interest,\u201d she added.<\/p>\n\n\n\n

Unlike circuit court, DOAH hearings are presided over by administrative judges, offer no jury, and can severely limit the scope of evidence homeowners are allowed to present. Once a case is routed to DOAH, homeowners can\u2019t simply walk away\u2014they\u2019re bound to the process, which critics argue favors the very entity that lobbied to create it.<\/p>\n\n\n\n

And as Cassel\u2019s testimony suggested, Citizens pays the salaries of the judges that act as arbitrators in the disputes by design. The state created the DOAH in the mid-1970s to help resolve legal disputes involving government agencies and ensure fairness in the process, an article from the\u00a0Florida Bar journal explains<\/a>. Government entities always cover the cost of using DOAH, so taxpayers don\u2019t have to pay out of pocket, a presentation from Citizens clarifies.<\/p>\n\n\n\n

A\u00a0funding proposa<\/a>l from the company suggests that it plans to send more than 3,800 cases to arbitration per year, allotting over $19 million to fund its contract with the DOAH through 2027\u2014a nearly 10 times bump to the $2 million board-approved package for 2023 and 2024.<\/p>\n\n\n\n

The numbers don\u2019t lie<\/h4>\n\n\n\n

Since gaining the power to route disputes into the Division of Administrative Hearings, a presentation from Citizens states that only 1% of claims have been routed to DOAH hearings\u2014all of which are a matter of public record. But the results are striking.<\/p>\n\n\n\n

The insurer has prevailed in over 90% of the cases it has taken to DOAH, according to ProPublica\u2019s investigation. That\u2019s a staggering advantage compared with its 55% win rate in circuit court trials, where homeowners have access to juries, broader discovery, and stronger legal protections.<\/p>\n\n\n\n

And when cases settle at DOAH, they tend to settle for far less. Half of all settlements result in payouts of $500 or less, and nearly 4 out of 5 cases (78%) never make it to a final ruling, ProPublica\u2019s investigation found.<\/p>\n\n\n\n

Critics say the limited legal leverage pushes many homeowners to take whatever they can get\u2014even if it doesn\u2019t come close to covering the cost of repairs. And what was once pitched as a faster, simpler process has become, for many, a one-sided system where the odds are stacked.<\/p>\n\n\n\n

The human toll<\/h4>\n\n\n\n

Those outcomes are costing homeowners more than just claims money they may have been entitled to.<\/p>\n\n\n\n

After finding water pooling in their Fort Lauderdale kitchen, Peter<\/strong> and Linda Kilfoil<\/strong> filed a claim with their insurance carrier, Citizens, to cover the $40,000 of necessary repairs. The insurer denied it, blaming long-term leakage not covered under their policy.<\/p>\n\n\n\n

Hoping to challenge the denial, the couple sued\u2014but their case was routed to DOAH, where an administrative judge barred them from deposing the Citizens adjuster. Their attorney says that move deprived them of a critical chance to investigate why the claim was denied in the first place.<\/p>\n\n\n\n

At the same time, Peter was battling both prostate and skin cancer, enduring hospitalizations. Facing mounting stress from the dispute and his worsening health, the couple made the painful decision to settle the case for just $500 in February. Peter died six months later, in August.<\/p>\n\n\n\n

Theirs is just one story. After a pipe burst beneath his living room and a roof leak shorted his AC\u2014causing mold to spread\u2014Jeffery McShane<\/strong> faced an estimated $200,000 in repairs. But Citizens denied his claim too, citing policy exclusions. Fearing that pressing the case could result in an even lower payout (or none at all) he settled at DOAH for just $5,000.<\/p>\n\n\n\n

After the storm, a new battle<\/h4>\n\n\n\n

But policyholders may be reaching a turning point.<\/p>\n\n\n\n

After Hurricane Milton tore through his Tampa neighborhood in 2024,\u00a0Martin Alvarez<\/strong>\u00a0filed a claim with Citizens to repair the damage. When he disputed the insurer\u2019s settlement offer, his case was rerouted to DOAH, but Alvarez fought back. And in August 2025, a Hillsborough County judge sided with him, issuing an injunction that paused Citizens\u2019 use of the DOAH process statewide, the\u00a0Sun Sentinel reports<\/a>.<\/p>\n\n\n\n

In her ruling, Judge Melissa Polo<\/strong> said Alvarez had a \u201csubstantial likelihood\u201d of proving that the system violates policyholders\u2019 constitutional right to a fair trial. She described DOAH as \u201cstructurally biased,\u201d citing restrictions on discovery, lack of judicial review, and a pattern of awarding legal fees to Citizens\u2014even when homeowners drop their claims.<\/p>\n\n\n\n

But Citizens isn\u2019t backing down.<\/p>\n\n\n\n

CEO\u00a0Tim Cerio<\/strong>\u00a0has framed the backlash as a politically motivated campaign to unwind the legal reforms that, in\u00a0his words<\/a>, \u201cbrought Florida\u2019s insurance market back from the brink.\u201d<\/p>\n\n\n\n

At a board meeting this month, Cerio accused trial attorneys of driving up premiums through \u201cfraudulent litigation\u201d and dismissed critics of DOAH as simply angry over lost legal fees. He defended the process as fast, fair, and efficient\u2014pointing to data showing that 37% of DOAH cases result in the company reversing their initial claims decision and paying out to customers, and underlining the fact that as a not-for-profit, Citizens has no incentive to deny claims.<\/p>\n\n\n\n

Advertisement<\/p>\n\n\n\n

The state, too, is touting results. Since its 2023 peak of 1.4 million policyholders, Citizens has shed\u00a063% of its book<\/a>, with projections of just over 500,000 policies by year-end. Sixteen new private insurers have entered the market since the reforms took effect.<\/p>\n\n\n\n

But for those who remain with Citizens\u2014the homeowners with the least market choice and the most exposure to disaster\u2014it may be little comfort.<\/p>\n\n\n\n

\n\n\n\n

When one of your cases is in need of a construction expert, estimates, insurance appraisal or umpire services in defect or insurance disputes – please call Advise & Consult, Inc. at 888.684.8305, or email experts@adviseandconsult.net<\/a>.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

Allaire Conte | Yahoo! Life Florida\u2019s\u00a0home insurance\u00a0crisis has left more than half a million homeowners with no choice but to rely on the\u00a0state\u2019s insurer of last resort. As private companies have fled the market and\u00a0premiums have skyrocketed, Citizens Property Insurance Corporation has become the only remaining option for many. But when policyholders challenge denied claims,… Continue reading Homeowners Are Losing 90% of Cases Against Florida\u2019s Biggest Insurer\u2014Here\u2019s Why<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[10721],"tags":[9895,94,22],"class_list":["post-904848","post","type-post","status-publish","format-standard","hentry","category-insurance","tag-advise-consult","tag-florida","tag-insurance","entry"],"jetpack_publicize_connections":[],"yoast_head":"\nHomeowners Are Losing 90% of Cases Against Florida\u2019s Biggest Insurer\u2014Here\u2019s Why - 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