When you file an insurance claim for damage suffered to your home or contents caused by lightning, theft, vandalism or other peril, it is important to submit a timely proof of loss form to your insurance company. When you fail to provide a sworn proof of loss, the insurance company may deny your claim for failing to fulfill contractual conditions precedent to coverage. A Florida court will rule in favor of the insurance company unless the insured proves that the insurance company did not suffer prejudice. However, the court will presume prejudice, so the insured has the obligation of establishing that the insurance company was not prejudiced.
The Fifth District Court of Appeals case of Allstate v. Farmer was the decision that extended the presumption of prejudice reasoning to the failure to submit a timely sworn proof of loss. In Farmer, the policyholder suffered loss from two separate and unrelated sources – a lightning strike and the theft of a vehicle a short time afterwards. The insurance company investigated the claim based on its belief that the insured was engaged in some form of fraud after the insured filed a claim for both losses. While the policyholders failed to file a sworn proof of loss for either claim, they submitted documents as requested, provided recorded statements, participated in an examination under oath and furnished appraisals. All of this was done before the insured filed a lawsuit for breach of the insurance contract.
Allstate defended based on the failure of the policyholders to submit a sworn proof of loss regarding either claim. The jury in the trial court found that the policyholders did breach the proof of loss provision in the policy. However, the policyholders prevailed because the jury found that the insurance company suffered no prejudice and that the insured parties substantially complied with its obligations under the policy.
The insurance company appealed claiming that the jury was not permitted to consider whether the breach by the policyholder was material or whether the insurance carrier suffered prejudice. The Fifth District upheld the trial court ruling that no material breach occurred because the insurance company suffered no prejudice. The appellate court focused on the extent of cooperation by the policyholders with the insurance company’s investigation of the claims. This level of participation with the investigation was sufficient to prevent any prejudice to the insurance company that might have resulted from presenting a sworn proof of loss.
If your claim has been denied because you failed to submit a sworn proof of loss after you have cooperated with your insurance company’s investigation of the claim, you may still be able to have your loss covered. However, a policyholder is better advised to be pro-active in filing a sworn proof of loss in support of his or her claim. This will remove this possible defense from the insurance comapny's arsenal.
You can reach Miami Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].
