Every term on your denial letter, in plain English
Carriers write claims in a vocabulary most policyholders meet for the first time on the day they get shorted: recoverable depreciation, anti-concurrent causation, sublimit, proof of loss. Here is what each one means, and where each one is fought.
Coverage A (dwelling)
The limit that applies to the house itself, including attached structures. Most other limits in a homeowners policy are calculated as a percentage of Coverage A.
Coverage B (other structures)
Detached structures such as a garage, fence, shed, or dock. Typically 10 percent of the dwelling limit unless the policy was endorsed upward.
Coverage C (personal property)
Contents. Typically 50 to 70 percent of Coverage A, usually settled at actual cash value unless replacement cost on contents was purchased, and carved up by sublimits for categories like jewelry, firearms, and electronics.
Coverage D (loss of use)
Additional living expense and fair rental value while the home is uninhabitable. Usually capped as a percentage of Coverage A, a period of time, or both.
Declarations page
The front page of the policy listing the insured, the property, the coverage limits, the deductibles, the policy period, and every endorsement number that applies. Read the endorsement list before assuming the base form controls.
Endorsement
An attachment that changes the base policy: adding coverage, removing it, or capping it. A single endorsement can convert a roof from replacement cost to actual cash value.
Exclusion
Policy language removing a cause of loss or type of damage from coverage. Exclusions are read narrowly against the drafter in most jurisdictions, and the carrier carries the burden of proving one applies.
Sublimit
A cap inside a larger coverage: debris removal, jewelry, mold remediation, or trees and shrubs. The claim can be fully covered and still pay far less than the damage because a sublimit caught it.
Hurricane deductible
A percentage deductible, commonly 2 to 10 percent of the dwelling limit rather than of the loss, that applies when damage is caused by a named hurricane. On a $400,000 dwelling limit a 5 percent hurricane deductible is $20,000.
Named storm deductible
Same percentage mechanic as a hurricane deductible but triggered by any named tropical system, not only a hurricane. Which trigger applies, and the window it runs for, is defined in the policy and varies by state.
All other perils (AOP) deductible
The flat-dollar deductible that applies to non-hurricane losses such as a pipe burst or a kitchen fire. A claim can be denied simply because the estimate landed below it.
Actual cash value (ACV)
Replacement cost minus depreciation for age and wear. An ACV settlement is what the damaged item was worth the moment before the loss, not what it costs to replace today.
Replacement cost value (RCV)
What it costs to repair or replace the damaged property with like kind and quality at today's prices, without a deduction for age. Most RCV policies pay ACV first and release the rest after the repair is actually done.
Depreciation
The dollar amount subtracted from replacement cost for age, wear, and remaining useful life. The carrier's depreciation schedule, and whether labor was depreciated too, is one of the most common places an underpayment hides.
Recoverable depreciation
The withheld portion of an RCV claim that the carrier releases once repairs are complete and documented. Non-recoverable depreciation is never paid at all, which is what an ACV-only policy means in practice.
Matching
Whether the carrier must replace undamaged adjacent material so the repair matches in color and pattern, for example a full roof slope or a run of siding rather than a patch. Florida regulation addresses uniform appearance for line-of-sight repairs; how far it reaches is frequently disputed.
Ordinance or law coverage
Coverage for the extra cost of rebuilding to current building code when the code requires more than a like-for-like repair. It is usually a percentage of the dwelling limit and is a separate coverage, not part of Coverage A.
Additional living expense (ALE)
The increase in normal living costs while you cannot live in the home: hotel or rental, added mileage, storage, pet boarding, and the food cost above your usual grocery spend. It pays the difference, not the whole bill.
Sworn proof of loss
A notarized statement of the claim: date and cause of loss, the amount claimed, and supporting documentation. Carriers can demand one, and missing the deadline in the policy or in a demand letter can forfeit the claim.
Notice of loss
The first report of the claim to the carrier. Deadlines to give notice are set by policy and by statute and have tightened significantly in Florida since 2022, so check the version that applies to your policy period.
Examination under oath (EUO)
A recorded, sworn questioning of the policyholder by the carrier's counsel, allowed by most policies as a condition of coverage. Refusing one is generally treated as breach of a policy condition, so it is the point at which most policyholders retain counsel.
Mitigation
The duty to take reasonable steps to prevent further damage after a loss: tarping, water extraction, boarding openings. Reasonable mitigation costs are reimbursable and receipts should be kept from hour one.
Scope of loss
The itemized list of what must be repaired or replaced, line by line, before any pricing is applied. Most underpayments are scope disputes rather than price disputes.
Xactimate
The estimating software most carriers, adjusters, and contractors use, with regional unit pricing updated periodically. Line-item comparison of two Xactimate estimates is how a scope dispute is argued.
Causation engineer report
A carrier-retained engineer's opinion on what caused the damage, commonly the document a denial rests on. It is rebuttable, and the qualifications, the site time, and the data relied on are the places to start.
Reinspection
A second carrier inspection, often triggered by a supplemental claim or by new documentation. Request it in writing and be present with your own documentation and, where appropriate, your own expert.
Supplemental claim
An additional demand on an already-adjusted claim when the full extent of damage is discovered during repairs. Supplemental deadlines are shorter than most policyholders expect, particularly in Florida.
Managed repair program
A policy option or endorsement letting the carrier direct the repair through its own contractor network instead of paying you to hire your own. Scope and workmanship disputes follow, and opting in may limit your remedies.
Subrogation
The carrier's right, after paying, to step into your shoes and pursue whoever caused the loss. Signing away rights against a third party before the carrier is paid can jeopardize your own claim.
Salvage
The residual value of damaged property the carrier may claim after paying for it. Salvage deductions on contents settlements are frequently applied without explanation.
Wind-driven rain
Rain forced into a building by wind. Most homeowners forms cover the resulting interior damage only if wind first created an opening in the roof or wall, which is why proof of the opening decides these claims.
Wear and tear
Gradual deterioration from age and exposure, excluded by every property policy. Reclassifying storm damage as wear and tear is the single most common denial move on roof claims.
Cosmetic damage
Damage the carrier says affects appearance but not function, typically dents in metal roofing or granule scarring. Some policies now carry a cosmetic damage exclusion or a separate cosmetic deductible.
Anti-concurrent causation clause
Policy language stating that if an excluded cause contributes in any sequence to the loss, the entire loss is excluded even where a covered cause also contributed. It is the clause behind most wind-versus-flood denials.
Ensuing loss
An exception that restores coverage for damage that follows an excluded cause, for example water damage that follows an excluded faulty repair. Narrow, heavily litigated, and often the only way back into coverage.
Concurrent cause doctrine
The rule in some jurisdictions that a loss is covered when a covered peril and an excluded peril each independently contribute, unless an anti-concurrent causation clause displaces it. Which rule applies is a question of state law and policy wording.
Constant or repeated seepage
Policy language excluding water damage from leakage occurring over a period of time, often defined as 14 days or more. Carriers use it to convert a sudden pipe failure into an excluded slow leak.
Latent defect
A hidden flaw in materials or construction that was not discoverable by reasonable inspection. Excluded as a cause, though the damage that ensues from it may still be covered.
Neglect
The insured's failure to protect property from further damage after a loss. It is both an exclusion and the reason tarping, drying, and documenting the mitigation matters immediately after a storm.
Pre-existing damage
Damage the carrier says existed before the date of loss, usually asserted from aerial imagery or a prior claim history. Dated photographs of the property before the storm are the direct rebuttal.
Appraisal
A policy clause that resolves disputes over the amount of loss, not coverage: each side names an appraiser, the two select an umpire, and an award signed by any two binds the parties. It is faster and cheaper than suit but cannot decide whether a peril is covered.
Umpire
The neutral selected by the two appraisers, or by a court when they cannot agree, whose signature with one appraiser produces a binding appraisal award.
State-sponsored mediation
A nonbinding settlement conference administered by the state insurance department for residential property claims, at the carrier's expense in Florida. It is quick and low-risk, and it does not waive the right to sue.
Storm surge
Ocean water pushed inland by a storm's wind and pressure. It is water damage from flooding for insurance purposes, so it falls to flood coverage and not to the homeowners policy, no matter that wind caused it.
Flood
General and temporary inundation of normally dry land, from surface water, surge, or overflow. Excluded by standard homeowners policies and covered only by NFIP or private flood insurance.
National Flood Insurance Program (NFIP)
The federal flood insurance program administered by FEMA, with building and contents limits set by statute. Its policy form, deadlines, and appeal path are different from a private homeowners claim.
Increased cost of compliance (ICC)
NFIP coverage that helps pay to elevate, relocate, floodproof, or demolish a substantially damaged building to meet floodplain rules. It is separate from the building limit and often unclaimed.
FEMA flood zone
The flood risk designation on FEMA's flood insurance rate maps. Zones beginning with A or V are the high-risk special flood hazard area, V zones add wave action, and X is outside the mapped high-risk area but still floods.
Elevation certificate
A surveyed document recording a building's lowest floor elevation relative to the base flood elevation. It drives flood rating and can matter in a substantial-damage determination after a storm.
Wind-borne debris region
The coastal band where the building code requires impact-rated or shuttered openings because of design wind speed. Openings that did not meet the requirement become a carrier argument after a wind loss.
Insurance bad faith
A carrier's failure to settle a claim in good faith when, under the circumstances, it could and should have done so. First-party bad faith is statutory in Florida and recognized at common law in South Carolina, and the remedy goes beyond the policy limits.
Civil remedy notice (CRN)
The statutory notice a Florida policyholder files with the Department of Financial Services identifying the violation and giving the carrier a cure window before a bad-faith action can proceed. It is a prerequisite, and the details matter.
First-party claim
A claim you bring against your own insurer under your own policy. A third-party claim is brought against someone else's liability insurer, and the bad-faith rules for the two are different.
Unfair claim settlement practices
The statutory list of prohibited carrier conduct: failing to investigate, misrepresenting policy provisions, denying without a reasonable basis, and delaying payment on claims where liability is clear.
Assignment of benefits (AOB)
A written transfer of policy benefits to a contractor or restoration vendor so they can bill and pursue the carrier directly. Florida has sharply restricted residential property AOBs since 2019 and barred them for most post-2023 policies.
Letter of protection (LOP)
A promise to pay a vendor or provider out of the eventual recovery rather than up front. It is a payment arrangement, not a transfer of the policy benefits the way an AOB is.
Statute of limitations
The outside deadline to file suit on the policy, measured from the date of loss or the breach depending on the state and the claim. It runs separately from, and much longer than, the policy's notice deadlines.
Public adjuster
A state-licensed adjuster hired by the policyholder to document, estimate, and negotiate the claim, paid a percentage of the recovery. A public adjuster cannot give legal advice or file suit.
Independent adjuster
A contract adjuster hired by the carrier, common after a catastrophe when staff adjusters are overwhelmed. They work for the carrier, not for you, regardless of the word independent.
Desk adjuster
The carrier-side adjuster who handles the file remotely and usually holds the settlement authority, while a field adjuster inspects the property. The estimate you receive is often written by someone who never saw the house.
Business interruption
Commercial coverage for lost net income and continuing expenses during the period of restoration after covered physical damage. The period of restoration, not the actual time you were closed, sets the limit.
Extra expense
Commercial coverage for the added costs of staying open after a loss: temporary space, expedited freight, rented equipment. It sits alongside business interruption and is often written with its own limit.
Coinsurance
A commercial policy provision penalizing an insured who carried less than a stated percentage of the property's value. Underinsurance discovered after a loss reduces the payment by formula.
Loss assessment coverage
Condominium unit-owner coverage for an association assessment charged to owners after a covered loss to common elements. Limits are usually small by default and can be endorsed upward.
Depopulation (takeout)
The process by which a private carrier assumes policies from a state-backed insurer such as Florida's Citizens. The policy form, the servicing carrier, and the claims handling can all change at renewal.
NAIC company code
The five-digit identifier assigned to a licensed insurer by the National Association of Insurance Commissioners. It is the reliable way to identify which entity actually issued your policy when brand names overlap.
Financial stability rating
A solvency opinion from a rating agency such as Demotech or AM Best. A downgrade often precedes non-renewals, and in the Florida market it has repeatedly preceded insolvency.
Guaranty association
The state fund that pays covered claims when an insurer is liquidated, subject to statutory caps and deductibles. Claims move to the association, and the timeline resets.
The word on the letter is not the last word
Send the denial letter or the estimate. You will get a straight read on whether the exclusion, the sublimit, or the depreciation the carrier applied actually holds up on your policy.
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