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Home / Insurance / How to Force an Insurer to Assess in Florida – Satisfaction with Liabilities After Loss | Legal insurance blog for property insurance

How to Force an Insurer to Assess in Florida – Satisfaction with Liabilities After Loss | Legal insurance blog for property insurance



Although valuation can be used by an insurance company as a method of delaying claims and avoiding full payment, there are circumstances when the insurance's assessment is made in the assessment. Regardless of the reason for seeking this cost-effective procedure, it is important to consider what the courts see as preconditions for using their scope for assessment.

As a first question, why would an insurance company try to avoid the evaluation process, and what defenses are at their disposal? As noted by Merlin Law Group lawyer Larry Bache in his blog post When can policyholders demand assessment? the first question is simple: “Why? One can only speculate, but it probably has something to do with money. Insurers, however, are more limited in what defense they can take for assessment, however, as described by the Florida Supreme Court: 1

Thus, where there is a requirement for an assessment under the policy, the only defense remains for the insurer to claim is that there is no coverage under the policy for the loss as a whole or that there has been a violation of the usual insurance terms such as fraud, failure to notify and failure to cooperate …

A direct denial of coverage is a simpler defense based on claiming that assessment is inappropriate for a claim where coverage is the primary dispute. The second defense, and the focus of this blog, aims to prove any violation on behalf of the insured and establish that the assessment is not mature. This defense is generally asserted when either full or partial coverage has been assumed, but the insurer is opposed to proceeding to the assessment. This assertion is crucial to the insurer because Florida courts have consistently held that before an insurance grant is granted to compel an assessment, all liability after loss under the insurance must be complied with. The following rule statements show this concept in action:

Courts have considered that an insured must fulfill all police obligations after loss before the evaluation clause is triggered. 2 Adequate compliance requires that all post – loss obligations be met before the court can exercise its discretion. 3 Until these [post-loss obligation] conditions are met and the insurer has a reasonable opportunity to examine and adjust the claim, there is no "disagreement" (for the assessment provision in the policy) regarding the value of the property or the amount of the loss. 4 When the trial court has ruled that a requirement of assessment is mature [that is, that a disagreement exists]the court has room for discretion to review the order in which the assessment and coverage provisions continue. 5

As these cases show, a primary step in the mandatory assessment is that the insured has fulfilled all obligations after loss required under the insurance. The insurer can then try to disprove this claim by quoting the specific obligations that the insured is alleged to have violated. Courts have ruled that a hearing is necessary to determine whether the party seeking an assessment has sufficiently complied with the policy's requirements for loss, as this is a 'factual issue' that is appropriately taken into account in an evidentiary hearing. 6

Although at first glance it can be concluded that these cases impose a significant burden on the insured. It should be noted that the proper handling of a claim by the judge and the plaintiff's lawyers by its nature leads to the fulfillment of all obligations after loss.
_______________________________________ [19659009] 1 State Farm Fire & Cas. Co. v. Licea 685 So.2d 1285 (Fla. 1996).
2 Citizens Prop. Ins. Corp. against Mango Hill Condo. Ass & # 39; n 12 Inc. 54 So. 3d 578, 581 (Fla. 3d DCA 2011).
3 State Farm Florida Ins. Co. v.Cardelles 159 So.3d 239 (Fla. 3d DCA 2015).
4 Citizens Prop. Ins. Corp. v. Galeria Villas Condo. Ass & # 39; n 48 So. 3d 188, 191 (Fla. 3d DCA 2010).
5 Id.
6 Mango Hill Condo. Ass & # 39; n 12 Inc. 54 So. 3d 578 at 582.


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