When policyholders experience a loss after faithfully fulfilling their obligation to make premium payments, it is reasonable to presume that the insurance carrier will cover a loss when disaster strikes. Unfortunately, many claims are denied or underpaid when policyholders lack legal representation. Sometimes policyholders notify their insurance company of a claim and presume it is being resolved only to discover that they have run afoul of some policy term or condition. There are other times that an insured does not pursue a claim because it does not appear that the claim is covered. An experienced insurance claims attorney will carefully analyze the policy language and may be able to develop a persuasive argument for coverage.
The recent case of Rodrigo v. State Farm Florida Insurance, Case No. 4D12-3410 (4th Dist. 2014) provides a compelling example of how easy it is for an insured to make a mistake in pursuing a claim when unrepresented. The insured made a claim for property damage to her condominium, the property within the condo and related expenses. While she never filed a sworn notice of loss, she did supply invoices and a list of specific damages. An adjuster for the insurance company directed a contractor to inspect the policyholder’s condo. The insurer tendered payment to the insured who rejected the payment because it did not cover personal property damage.
Failure to Provide a Proof of Loss
The language of the policy specifically provided in pertinent part:
“Loss Payment. We will adjust all losses with you. . . . Loss will be payable 60 days after we receive your proof of loss and:
a. reach agreement with you;
b. there is an entry of a final judgment; or
c. there is a filing of an appraisal award with us.”
The appellate court upheld the trial court’s ruling that filing a sworn proof of loss was a condition precedent for payment of the claim under the policy. The policyholder contended that the insurer waived the proof of loss prerequisite for payment of a claim by tendering payment. However, the court noted that an insurance company does not waive any policy provision or defenses by investigating a claim or negotiating a potential settlement.
Because the insurance company did not waive the sworn proof of loss requirement, the insured had to rebut the presumption that the insurance company suffered prejudice. The policyholder did not present any evidence rebutting this presumption, so the court upheld the trial court’s ruling in favor of the insurance company because of the policyholder’s failure to provide the proof of loss.
While the policyholder’s belief that submission of invoices and other documents satisfied the notice requirements, this decision demonstrates the importance of careful compliance with all conditions and policy terms when pursuing a claim. When policyholders are represented by an experienced Florida homeowner’s insurance attorney, the lawyer can assist an insured in navigating the procedures necessary to obtain the full value of a claim.
Potential Benefit of Novel Miami Attorney Insurance Policy Interpretation
The damage to the condominium was caused by a decomposing body in the next door unit. Since the policy did not include a decomposing body as a covered peril, the insured provided an affidavit from a physician indicating that the internal contents of the deceased’s body “explosively” expanded and leaked. The insured contended that this brought the loss within a covered peril for damage caused by “explosion.” While the argument was unsuccessful in this case, experienced Miami insurance claims attorneys often develop novel theories like this that are successful.
If you have not been dealt with fairly by your property insurance carrier, our Miami insurance coverage law firm invites you to contact us. Florida bad faith insurance claims lawyer J.P. Gonzalez-Sirgo handles property damage claims against insurance companies in Miami and throughout Florida. The Law Firm of J.P. Gonzalez-Sirgo, P.A. offers free consultations and case evaluations. No Recovery, No Lawyer Fees. Call 305-461-1095 or Toll Free 1-866-71-CLAIM.