An insurance policy is a contract between the insurer and the policyholder. This means both parties have specific obligations that must be met for full coverage under the policy. In the case of an insured party, such as a homeowner, this typically includes a requirement to provide a sworn “proof of loss” within a specified amount of time following the date of loss. Failure to timely submit such proof means the insurer is not contractually bound to cover the loss.
Florida courts have been quite consistent on this point. Earlier this year, for example, the Fourth District Court of Appeals upheld a judge ruling in favor of an insurance company on these very grounds. In Edwards v. SafePoint Insurance Co., the homeowner held a policy with the defendant that required a sworn proof of loss within 60 days upon the insurer’s request.
In July 2016, the homeowner claimed they suffered a property loss after a car accident damaged their fence and septic tank. The homeowner proceeded to contract for repairs and hired a public adjuster. The public adjuster, in turn, reported the incident to the insurance company.
The insurer then exercised its contractual right to require a sworn proof of loss. This request came on August 15, 2016. More than 60 days passed and the homeowner failed to file the proof of loss. The public adjuster did maintain communication with the insurer during this time and insisted that the requested documents were “currently being completed.” But apparently, neither the homeowner nor the public adjuster ever filed a sworn proof of loss.
Eventually, the insurance company did actually pay part of the homeowner’s claim. But the homeowner insisted they were entitled to the full amount of the claim, which was about $12,000 less than the payment received. The homeowner then filed a breach of contract lawsuit.
In response, the insurance company argued that coverage did not apply at all since the homeowner had breached their contractual duty to timely file a sworn proof of loss within 60 days of the insurer’s initial request. The homeowner conceded the breach but argued it did not matter since the insurer had “waived the proof-of-loss requirement by admitting liability in an unagreed amount.” The judge disagreed with this reasoning and ruled in favor of the insurance company.
On appeal, so did the Fourth District. Indeed, the appellate court said this was a case of “total failure” by the homeowner to comply with a clearly stated proof-of-loss requirement in an insurance policy. The homeowner did not even “cooperate to some degree,” such as filing a late or incomplete proof of loss. Nor did the homeowner offer any “legitimate explanation for her noncompliance.” As a result, the insurance company was not responsible for any of the losses claimed by the homeowner.
Speak with a Florida Insurance Attorney Today
Many honest homeowners find themselves holding the bag because they did not understand their basic obligations under their insurance policy. Do not let this happen to you. If you need legal advice from an experienced Florida insurance claims attorney, contact Older Lundy Koch & Martino today to schedule a consultation.
Source:
scholar.google.com/scholar_case?case=16024650242811712847
