When I wrote my first blog on this page 2009 I discussed evidence of loss in the long run. Since Hurricane Michael, these blogs have received a lot of traffic and discussion from people trying to navigate through the claim process. One problem that continues to arise is whether a policyholder must adhere to a proof of loss request after the insurer has granted coverage and paid.
As I said almost ten years ago, every situation is different. Sometimes it may be advisable to provide evidence of loss even if the claim has been waived. Other times it may not be. But in general, the Florida case law has claimed that the evidence of loss needs has been waived when the insurer allows coverage and pays the undisputed amounts owed.
In 1939, the Supreme Court of Florida examined a fire lawsuit at a commercial building in Pensacola. 1 The first fire was quickly resolved with the insurer who paid an agreed amount for the damages. The other fire caused a small amount of additional damage, the amount of which was ultimately disputed by the carrier.
A question arose as to whether the policyholder had fulfilled the evidence of loss need at the second fire. To conclude that the insurer had waived the evidence of loss need, the court stated:
It is our opinion that the insurer admitted that the liability in any unpaid amount immediately after the second fire was sufficient to renounce the formal proof of loss. .
Nearly 40 years later, the Florida Third District Court of Appeal Carried as a binding precedent in American Bankers Ins. Co. v. Terry 277 So.2d 563 (Fla. 3rd DCA 1973). The court argued:
In Bear it was claimed that the insurer's consent of certain amounts agreed was sufficient to renounce the formal evidence of loss. . .
The court continued to state
The subsequent application for the assurance of loss of an insured does not have the purpose of revoking the previous waiver of the insurer's declaration of loss. . . . When the insurer refrains from providing evidence of loss, such an exception is irrevocable.
Under this kind of case, an insurer would waive his right to proof of loss if it has already granted cover and made partial payments against the amounts owed. But again, this analysis may change depending on the circumstances. So before we refuse a proof of loss request, you should always contact an experienced professional to determine what is best for your specific situation.
1 Bear v. New Jersey Ins. Co. 189 So. 252 (Fla. 1938).