10 “Did You Know?” Facts About Property Insurance Claims That Could Save You Thousands
1. Did you know that many policies include a cap on Emergency Mitigation Services (EMS)?
Many homeowners are unaware that their insurance policies may include a cap on Emergency Mitigation Services (EMS), often around $3,000 or 1% of Coverage A. This can become a financial shock if water mitigation or emergency services exceed that amount, which is common after major leaks or floods.
For example, a homeowner who had water extraction and demolition performed after a plumbing failure received an $18,000 bill. The insurance company paid only $3,000, citing the EMS cap. With VIP Adjusting’s intervention, we secured an override of the cap by demonstrating that the emergency services were reasonable, necessary, and properly documented. Furthermore, that a large portion of the bill was a part of the overall construction process such as demolition / removal of damaged materials.
To avoid surprise out-of-pocket expenses, ask your mitigation contractor to separate EMS charges from repairs, and notify the insurance carrier promptly to request pre-approval or a cap extension.
2. Did you know that you can re-open a claim even after it's been paid?
A common misconception is that once a claim is paid and closed, it’s over. In reality, most policies allow you to supplement or reopen claims if you discover additional damage, receive higher repair estimates, or find that the initial payment was insufficient. That is, if you haven’t signed a release of liability with the insurance company. If a release has been signed, which is in no way ambiguous, then you cannot reopen or supplement the claim. If not, then it can be reopened and supplemented.
After Hurricane Ian, many homeowners discovered structural damage or hidden mold weeks after their claim was paid. By submitting additional documentation, they were able to secure substantial supplemental payments.
Keep thorough records and photos, and reach out to a licensed public adjuster to assess whether you may be entitled to more.
3. Did you know that the insurance company’s adjuster doesn’t represent you?
The adjuster sent by your insurance company works for them—not for you. Their job is to assess damage and minimize payouts within policy limits, not to advocate for your best interest.
We worked with a homeowner whose carrier estimated roof damage at $7,500. After our inspection, we documented over $45,000 in legitimate damage. With pressure applied and additional evidence provided, the final settlement was $42,800.
Hiring a public adjuster ensures someone is in your corner from day one, fighting for every dollar you’re owed.
4. Did you know Florida now requires coverage determination within 60 days?
As of recent legislative changes, Florida insurers are now required to make a coverage decision within 60 days of a properly filed claim. This timeline used to be 90 days.
This change aims to prevent unreasonable delays and protect policyholders from getting strung along while damage worsens.
If your insurer fails to provide a coverage determination within 60 days, you may have grounds to escalate the claim or file a complaint with the Florida Department of Financial Services.
5. Did you know policy language changes from year to year?
Insurance companies regularly update policy terms during each renewal cycle. Without your knowledge, your policy could gain new exclusions, reduced coverage limits, or additional repair restrictions. Insurance companies are required to notify you of policy changes and it’s up to you to pay attention.
In recent years, many Florida carriers have inserted water damage caps, cosmetic roof exclusions, and managed repair clauses that didn’t exist in previous versions.
It’s essential to review your policy annually. Better yet, have a public adjuster or attorney review it for free before hurricane season begins.
6. Did you know mold damage often has a separate limit?
Mold damage may not be fully covered under your main policy and typically has a sublimit, such as $10,000. In many cases, mold is only covered if it results from a covered peril and if all other conditions were properly followed.
One homeowner discovered extensive mold following a roof leak, only to learn their policy capped mold remediation at $10,000 and denied payment for additional removal due to the policy limit.
To maximize mold coverage, ensure timely dry-out, proper documentation, and separate invoices for mold-related work.
7. Did you know you're responsible for mitigating further damage?
Most policies contain a clause requiring you to take reasonable steps to prevent further damage. If you fail to tarp a roof or dry out an interior after a leak, the carrier may deny part or all of your claim.
For instance, after a pipe burst in a Palm Beach home, the owner delayed drying services for a week. Mold formed and spread, and the carrier denied that portion of the claim, citing policyholder neglect….and rightfully so.
Take immediate action after any loss, keep receipts, and document all emergency services. These actions protect your claim and show the carrier that you acted in good faith.
8. Did you know your policy might include a right-to-repair clause?
Some Florida homeowners policies include a “right to repair” or “managed repair” clause, which gives the insurer the right to choose the contractor and control the restoration process.
While it may sound convenient, these programs often lead to cost-cutting, delays, or subpar repairs. You may lose control over how and when your property is restored.
If your policy has this clause, consider shopping for one that doesn’t, or be ready to push back if you’re unhappy with the carrier’s vendor performance.
9. Did you know photos are your best evidence?
Photographs—especially before and after loss—are critical in proving your case. Without them, it's your word against the adjuster's notes.
We recently helped a client whose pre-loss drone photos of his roof proved that the storm caused new damage. This visual evidence led to a complete roof replacement, whereas his neighbor without photos was denied coverage.
Set a calendar reminder every six months to take photos of your roof, HVAC, attic, and exterior features. Store them in a cloud folder in case of disaster.
10. Did you know denied claims can still be reversed?
A claim denial isn’t the end. Carriers often deny claims due to lack of documentation, misapplied exclusions, or vague reports. With a proper rebuttal and new evidence, denials can be overturned.
At VIP Adjusting, we recently overturned a denial by Citizens after presenting new engineering findings and re-framing the claim using better policy interpretation.
If you’ve received a denial, don’t give up. Get a second opinion from a licensed public adjuster who knows how to build a successful appeal.
Conclusion
Understanding the technicalities of your insurance policy can prevent devastating financial losses and ensure you're treated fairly during the claims process. Whether it’s a hidden EMS cap, a right-to-repair clause, or a denied claim that deserves a second look, knowledge is power.
At VIP Adjusting, we advocate for homeowners and business owners across multiple states including Florida, South Carolina, Louisiana, Texas and Colorado helping them maximize insurance claims and avoid common traps that cost thousands.
Call us today at 833-WITH-VIP or visit www.vipadjusting.com to schedule a consultation.
