On September 20, 2017, Hurricane Maria caused disasters through the passage of Puerto Rico. As mentioned in previous blogs 1 many policyholders submitted their insurance claims and as soon as they received a response from the carrier along with a check, they continued to deposit the check unaware that even if they did not agree with the amounts, these were considered " total and final "payments and therefore an exemption from their right to demand. Since then, as I have discussed in other blog posts, many policyholders have struggled in court over the application of compliance and the doctrine of satisfaction to their claims. 2
However, it was not until May 28, 2021
In Aguayo v MAPFRE the defendant asserted that the Court of Appeal and the Court of Appeal erred in arguing that the requirements complied with the doctrine of conformity and satisfaction. The Supreme Court considered that it was clear that the insured was right. The lower courts determined as sufficient facts the following events: the offer of the check as a total payment, notification of termination of the claim and deposit of the check. The courts applied the doctrine in a mechanical manner without regard to the requirements of case law – specifically, they did not consider the requirement of a bona fide (genuine) controversy and good faith in the offer in accordance with fair and equitable treatment. The lower courts only found that the insurer had sent a letter to the insured with the check and that he signed and deposited the check. But as discussed, only a deposit of a check does not constitute compliance and satisfaction, therefore the debt and obligation are not obliterated. Lower courts also did not analyze the information in the letter sent to the insured and, most importantly, whether the insured clearly understood the letter and the consequences of accepting the payment, and whether this would prevent him from requesting reconsideration.
Therefore, agreement and satisfaction will be established when all legal and statutory requirements are compatible. The revocation of all affirmative rights granted by law requires that the person who waives recognizes his right and has a clear intention to abandon it. The Supreme Court concluded that there was no clear existence of facts, or whether the insurer followed the reasonable fair treatment to establish preference for conformity and satisfaction by summary judgment. None of this, however, prevents the parties from agreeing to resolve the dispute or using the summary assessment mechanism if the requirements exist. This issue cannot be analyzed in a simple and mechanical way. The Supreme Court set aside the decision of the appeal and ordered that the case be returned to the trial court and proceeded with the case based on the decision. solve hurricane Maria claims.
1 https://www.propertyinsurancecoveragelaw.com/2019/07/articles/insurance/accord-satisfaction-will-my-insurance-claim-be-dismissed- if-i-deposit -a-payment /; Posted July 21, 2019.
2 https://www.propertyinsurancecoveragelaw.com/2019/11/articles/insurance/merlin-law-group-pr-llc-wins-accord-and-satisfaction-appeal / , Posted on November 19, 2019. https://www.propertyinsurancecoveragelaw.com/2020/10/articles/insurance/puerto-rico-court-of-appeals-revokes-two-accord-satisfaction-rulings-on-hurricane -maria -statements /; Posted on October 23, 2020. https://www.propertyinsurancecoveragelaw.com/2021/01/articles/insurance/accord-satisfaction-will-my-insurance-claim-be-dismissed-if-i-deposit-a-payment – Part 2/; Posted January 18, 2021
3 Aguayo v. MAPFRE Pan American Ins. Co. 206 DPR – (28 May 2021).