What Constitutes a Sufficient Proof of Loss When Making a Claim for Flood Damage?

J.P. Gonzalez-Sirgo
Founder of J.P. Gonzalez-Sirgo, P.A.

While homeowner insurance or flood insurance can prevent valuable financial protection in the event of a harsh storm, policyholders need to be careful when complying with the terms of their policy.  Most policies require policyholders to provide a proof of loss with supporting documentation.  Insurance companies often dispute the sufficiency of the information or documentation provided.  This tactic can justify denial of the claim based on the insured’s failure to comply with the policy terms in providing a proof of loss. 

A federal case from another state provides an example of the level of scrutiny that may be focused on the proofs of loss provided by policyholders under the Standard Flood Insurance Policy (SFIP).  In the case of Young v. Imperial Fire and Casualty Insurance Company, the policyholder initially submitted a proof of loss for the policy limit of $175,100 minus the deductible.  The policyholder did not provide values for depreciation, actual cash value or the cost of repair or replacement.  The proof of loss indicated that these items were undetermined.

After the policyholder hired a public adjuster, the adjuster submitted a revised estimate of the flood-related damages that indicated a total of $260,635, which was intended to supplement the policyholder’s proof of loss.  Eventually the adjuster sent a revised proof of loss that indicated the cost of repair or replacement was $260,235, but the proof of loss also indicated that the value of depreciation and actual cash value remained undetermined.  The proof of loss submitted by the adjuster included documents substantiating the value.  A final proof of loss was subsequently submitted by the adjuster with substantially the same information as the 2nd proof of loss but without the supporting documents.

The policyholder sued the insurer after rejection of their proofs of loss.  The insurance company sought summary judgment based on the failure of the insured to submit a timely proof loss that met the terms of the Standard Flood Insurance Policy.  The judge rejected the claim of the insurer and indicated that the proof of loss forms, adjuster estimate and supporting documentation was sufficient to comply with the proof of loss requirement.

In this case, the insured essentially submitted 3 proofs of loss, the adjusters estimate and supporting documents only to have the insurance company indicate that this did not constitute a sufficient proof of loss.  This case demonstrates the extent that insurance companies that participate in the National Flood Insurance Program will go to when trying to justify not paying a claim.  If you are having challenges in having your flood damage claim satisfied, you might want to seek the advice of an experienced Miami flood damage insurance attorney.

If you are unsure if you have a viable claim after reviewing your policy, I can analyze your situation and advise you of your options.  Because paying claims affects your insurance company’s bottom line, you should never rely on your carrier to be the final word on whether you have a legitimate claim.   My law firm handles disputed claims 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. 

Be the first to comment!
Post a Comment