When I first left insurance coverage in 1985 and started representing policyholders exclusively, the number of evaluation cases decided by the courts of appeal on a national basis was about the same as the number of profits the Tampa Bay Buccaneers had during the first two years. in the NFL. With evaluation today as the ever-growing dominant method for dispute resolution of property insurance, evaluation matters are the common topic for property insurance laws and disputes.
A water loss reduction company recently claimed that its service invoice was not subject to evaluation. when the insurer contested the amount it claimed. The Court formulated the receptionist's argument: 1
Claiming that the language of the evaluation provision is ambiguous, EDR argues that the provision can reasonably be interpreted as applying only to property damage resulting from a covered loss, and not to water reduction services provided to prevent further damage to the property.
EDR proposes that the evaluation provision only applies to cover for housing and other structures that also appear as cover under the first part of section I of the insurance
Can you imagine if a policyholder had to assess all coverage for losses in real and personal property but then had to have a separate court assessment of the remaining reduction costs for these losses? That would be an extremely impractical method of dispute resolution.
The Court did not agree with the mitigation company and reasoned:
We simply find no support for this argument in any provision of the policy or in the structure of the policy. In fact, the language of the evaluation provision and the structure of the policy clearly and unambiguously stipulate that disputes concerning the valuation of "Reasonable repairs" carried out under the policy – such as those carried out by EDR in this case – are subject to the policy evaluation provision.
That provision on subject assessment provides that either party may require an assessment to resolve a "disagreement as to the amount of the loss covered." It is not disputed that the water reduction services provided by EDR are part of the amount of the loss covered. When we read the policy as a whole and give the evaluation provision its clear meaning, we conclude that the evaluation provision is unambiguous and that the provision applies to the current requirement for water reduction services.
Whether the evaluation is to remain an effective alternative dispute resolution. a process that can put an end to a whole controversy for property insurance in the end, it can not have these partial resolutions which then invite further disputes and further claims for late payment. This decision was correct according to the law and correct in the practical application of the law.
Thought for the day
Y you can never protect yourself 100%. What you do is protect yourself as much as possible and mitigate the risks to an acceptable degree. You can never remove all risks.
1 Express Damage Restoration v. Citizens Prop. Ins. Corp. No. 3D21-141, – So.3d – (Fla. 3rd DCA 5 May 2021).