MIAMI, FL – Peter and Linda Kilfoil returned from an overnight trip in October 2024 to find water pooling in the kitchen of their Fort Lauderdale home. They filed a claim with Citizens Property Insurance, Florida's state-backed insurer of last resort. The company denied it, claiming storm surge—not wind—caused the damage.
The Kilfoils wanted their day in court. Instead, they got something else: a mandatory hearing before the Florida Division of Administrative Hearings (DOAH), where judges whose salaries are paid by Citizens would decide their fate.
They're not alone. Since Florida lawmakers passed sweeping tort reform in 2023, Citizens has rerouted over 1,500 claim disputes to DOAH. The results are stunning: Citizens wins more than 90% of these cases in final hearings. In traditional courts, by contrast, Citizens wins only about 55% of the time.
For Miami-area homeowners who rely on Citizens—often because private insurers won't cover them—this shift has quietly eliminated one of their most fundamental protections: the right to have their case heard by a neutral judge and, if desired, a jury of their peers.
The 2023 Law Change: How Florida Stripped Jury Trial Rights
In spring 2023, Florida's home insurance market was in turmoil. Natural disasters, excessive litigation, and widespread fraud had driven premiums sky-high and pushed multiple insurers out of the state entirely. Citizens, the state-created insurer of last resort, ballooned to over 1 million policies—a number that alarmed lawmakers and insurance regulators.
The Florida Legislature responded with House Bill 799, which included a provision allowing Citizens to require policyholders to resolve claim disputes through administrative hearings rather than traditional lawsuits.
What changed:
- Before 2023: Citizens policyholders could sue in court like any other insurance customer
- After 2023: Citizens can force disputes to DOAH, where administrative law judges decide cases
State Representative Hillary Cassel, a former insurance attorney, warned at the time that the law "denied a right to a trial by jury that is the foundation of our American justice system."
She was right. The numbers now prove it.
The Numbers Don't Lie: 90% vs. 55%
According to investigative reporting by ProPublica and the South Florida Sun Sentinel, Citizens has taken more than 1,500 insurance disputes to DOAH since February 2024. As of July 2025:
- DOAH hearings: Citizens wins more than 90% of final hearings
- Traditional courts: Citizens wins about 55% of cases over the past five years
Put another way: switching from courts to administrative hearings nearly doubled Citizens' win rate.
Breaking down the DOAH outcomes (March 2024 – July 2025):
- 78% ended in settlement (often after DOAH judges indicated Citizens was likely to prevail)
- Of the cases that went to final hearings: Citizens won over 90%
- Policyholder victories: Rare—representing less than 10% of contested cases
For Miami homeowners, the message is clear: if your claim goes to DOAH, you're probably going to lose.
Why Administrative Hearings Favor Insurers
The disparity in outcomes isn't random. Several structural factors tilt DOAH hearings toward insurers:
Factor 1: Citizens Pays the Judges' Salaries
DOAH is a state agency funded through appropriations—but Citizens, as a state-backed entity, effectively pays into the system. Administrative law judges (ALJs) are state employees whose salaries come from the same governmental structure that created and funds Citizens.
This creates what legal experts call a "structural conflict of interest." While ALJs are ethically bound to be neutral, the perception of bias—and potentially the reality—is unavoidable when one party funds the tribunal.
Comparison: In traditional court, judges are paid by general tax revenues and hear cases involving all types of parties. No single litigant funds the court system.
Factor 2: No Jury, No Public Pressure
Juries serve as a check on both parties. Insurance companies know juries can be sympathetic to homeowners who've suffered storm damage and been denied coverage. This fear incentivizes fair settlement offers.
In administrative hearings, there's no jury—just an ALJ who sees insurance disputes all day, every day. The emotional impact of a homeowner describing their flooded bedroom doesn't carry the same weight as it would with a jury of fellow Floridians.
Factor 3: Limited Discovery and Abbreviated Process
DOAH hearings move faster than traditional litigation, which sounds good until you realize it limits policyholders' ability to gather evidence.
In traditional court:
- Full discovery process allows policyholders to demand documents from Citizens
- Depositions of adjusters and experts
- Time to hire engineers and gather evidence
- Opportunity to appeal to appellate courts with full records
In DOAH:
- Streamlined process with limited discovery
- Faster timelines favor the party with more resources (Citizens)
- Appeals go back through administrative channels, not traditional appellate courts
- Lower procedural protections for policyholders
Factor 4: No Disclosure Requirements for Conflicts
Traditional judges must disclose conflicts of interest and can be recused if bias is shown. DOAH ALJs face less stringent disclosure requirements.
The Kilfoil lawsuit (later dismissed) alleged that administrative hearings "deprive insureds of their right to a neutral court and do not require administrative law judges to disclose conflicts of interest."
While ALJs are bound by ethical rules, the system doesn't require the same level of transparency as traditional courts.
Real-World Impact: What Miami Homeowners Are Experiencing
U.S. Representative Maxwell Frost (D-Orlando) sent a letter to Governor Ron DeSantis in September 2025 highlighting the impact on Florida families:
"Citizens plays a critical role in helping Florida homeowners obtain homeowners insurance by providing coverage to those who otherwise could not get it. Although it is important that Citizens' solvency be maintained, it is also important that Citizens policyholders are able to dispute incorrect or unfair claims decisions."
Frost's letter noted that over 700,000 homeowners are forced to resolve disputes through DOAH rather than courts—including tens of thousands in Miami-Dade and Broward counties.
The disparity is stark:
- Private insurer policyholders: Can sue in court with full protections
- Citizens policyholders: Forced into administrative hearings with a 90% loss rate
Frost called the system "harmful" because it "deprives Citizens policyholders of the opportunities that private policyholders have to litigate their claims and appeal if they lose."
Four Ways Miami Homeowners Can Protect Themselves
Strategy 1: Document Everything—Immediately
In DOAH hearings with limited discovery and faster timelines, the evidence you gather yourself becomes critical.
After any storm damage:
- Photograph and video every damaged area from multiple angles
- Hire your own engineer or public adjuster immediately
- Get written estimates from multiple contractors
- Document the storm's intensity (weather service data, radar, news reports)
- Save all correspondence with Citizens
Don't wait for Citizens' adjuster to finish. By the time they deny your claim, you may have only weeks to prepare for a DOAH hearing.
Strategy 2: Hire a Public Adjuster Early
Public adjusters work for you, not the insurance company. They:
- Understand what evidence DOAH judges find persuasive
- Can document damage before Citizens' adjuster arrives
- Prepare comprehensive damage reports
- Negotiate with Citizens before disputes reach DOAH
The cost: Public adjusters typically charge 10-20% of your final settlement. But if they prevent a DOAH loss, that percentage is worth every penny.
Strategy 3: Consider Settling Before DOAH
Given the 90% loss rate in DOAH hearings, accepting a settlement—even if it's less than you believe you're owed—may be the rational choice.
Calculate your risk:
- If Citizens offers $15,000 and you think you're owed $30,000, is it worth risking a 90% chance of getting $0?
- Factor in legal fees, expert witness costs, and the time value of waiting months for a hearing
This is an awful choice to face, but it's the reality Miami homeowners must navigate.
Strategy 4: Explore Private Insurance—Even If It's More Expensive
Citizens is supposed to be the insurer of "last resort," but the DOAH system makes it a trap.
If you can find private coverage:
- You preserve your right to sue in court if claims are denied
- Your win rate increases from 10% to 45% if disputes arise
- You avoid the structural conflicts inherent in DOAH
Yes, private insurance costs more. But if you ever face a major claim denial, the price difference may save your financial security.
The Constitutional Questions: Is This System Legal?
Several lawsuits have challenged the DOAH system as unconstitutional, though most have been dismissed or are pending.
Legal theories plaintiffs have raised:
- Due process violations: Forcing policyholders into a system where the opposing party funds the judges violates constitutional protections
- Equal protection violations: Citizens policyholders receive fewer protections than private insurer policyholders
- Separation of powers: The legislature improperly delegated judicial functions to an executive agency
- Right to jury trial: Administrative hearings eliminate constitutional jury trial rights
So far, courts have largely rejected these challenges, finding that:
- Citizens is a governmental entity, not a private insurer, so different rules may apply
- The legislature has broad authority to structure administrative processes
- Policyholders can still appeal DOAH decisions through administrative channels
But the legal fight continues. As more data emerges showing the 90% loss rate, constitutional challenges may gain traction.
What This Means for Miami's Insurance Future
Miami-Dade and Broward counties have some of the highest Citizens policy concentrations in Florida. This means tens of thousands of local homeowners face the DOAH system if they ever dispute a claim.
The broader implications:
- Chilling effect on claims: Homeowners may not file legitimate claims if they know disputes are nearly unwinnable
- Reduced accountability: With a 90% win rate, Citizens has less incentive to pay claims fairly
- Market distortion: Private insurers gain even more leverage to charge high premiums, knowing Citizens is an unattractive alternative
What needs to change:
- Restore jury trial rights: At minimum, policyholders should have the option to choose court over DOAH
- Independent funding for ALJs: DOAH judges shouldn't be funded by the entity they're judging against
- Enhanced disclosure requirements: ALJs should disclose any relationships or pressures that could affect neutrality
- Appellate review: Allow direct appeals to Florida appellate courts, not just administrative review
Next Steps: Protecting Your Interests
If you're a Miami homeowner with Citizens coverage:
- Understand your policy thoroughly: Know what's covered, what's excluded, and what your deductibles are
- Prepare for the worst: Assume any significant claim will be disputed and end up in DOAH
- Document everything: Take photos, hire experts, and gather evidence immediately after damage
- Get legal advice early: Consult an attorney experienced with DOAH hearings within days of a claim denial
- Consider your alternatives: If you can afford private insurance, it may be worth the extra cost
For policymakers: the 90% win rate should alarm anyone who cares about fairness. When one party wins 90% of the time, the system isn't working—it's rigged.
Florida homeowners deserve better than a system that strips their constitutional rights and virtually guarantees they'll lose if they dare to challenge their insurer.
Source: ProPublica, South Florida Sun Sentinel, Rep. Maxwell Frost letter, Newsweek, Insurance Journal