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Public adjusters are obliged to correctly comply with the requirements for proof of loss – Blog about real estate insurance protection legislation



One of the basic obligations that public adjusters are supposed to perform for their policyholders' clients is to evaluate the extent of the damage and correctly submit proof of loss if required. I was thinking of this when I read a fairly recent Florida case 1 in which a public adjuster failed to file a loss certificate on behalf of the policyholder even though the insurance company required a written statement. This failure to submit a loss certificate cost the policyholder an otherwise valid claim.

In a requested proof of loss must be provided before requiring an assessment or applying for a lawsuit I tried to make a point about the disadvantage of not follow a request for proof of loss:

Loss proof was a topic in my first speech to the National Association of Public Insurance Adjusters in Carmel, California, 1

985. In general, if an insurance company arrived on time requires a proof of loss or if required under an insurance, and the insurer does not waive the requirement, a proof of loss must be provided.

So, what is the disadvantage of submitting a proof of loss if required by an insurer? In general, nothing. What is the disadvantage of refusing to submit a loss certificate? Maybe lose the whole claim. So, if an insurer correctly requests proof of loss, provide proof of loss.

All members of the Florida Association of Public Insurance Adjusters have heard me teach (after I asked them to listen) on several occasions that one of the first things that should be done is to determine if a proof of loss is a "proof of claim" or a "time limit proof". Time limit certificates should be submitted within a time frame (ask for an extension if this cannot be done in time) and request proof must be submitted if required. The forms provided by insurance companies are sometimes not what is required under the insurance. So read what the insurance requires and submit an appropriate proof of loss.

The basic steps that a public adjuster should follow when it comes to proof of loss are as follows:

  1. Determine if the insurance requires a proof of loss to be submitted within a certain time after the loss has occurred or within a certain time after a claim.
  2. Determine what the insurance requires in order to be submitted with proof of loss. This is usually found in the Duties After Loss section of the insurance.
  3. Get all the information needed to properly file a proof of loss. the loss. requirements and submit it to the insurance company within the time frames required.

What is required in a damage certificate varies from insurance company and insurance form. They are not always the same. In a recent blog post, Failure to Comply with Post-Loss Bonds: Affidavits by Themselves May Not Be Enough to Win Summary Judgment Under Florida Rule 1.510 it seemed to me that insurance companies might use a checklist to argue for everyone possible reasons for not paying an otherwise valid claim because a technical requirement for information contained in the duties after loss provisions was undoubtedly not met. That post pointed to the insurance company's argument that the claim was insufficient because a detailed estimate was not provided.

In the case that gave rise to this post, the public adjuster never submitted a claim to the policyholder, which led to a loss in court: [19659003] Here, the medical records show that the insured "totally failed to meet the requirement for proof of loss". The insured "did not cooperate to any extent" with the requirement for proof of loss. For example, this is not a case where the insured submitted a proof of loss prematurely or submitted a proof of loss that was not duly certified.

On the contrary, it is undisputed that the insured never submitted a proof of loss after SafePoint requested it. SafePoint requested proof of loss in its August 2016 email to the public adjuster and in its September 2016 letter to the insured. The question is not whether the insured in the general sense to any extent cooperated with SafePoint's investigation; rather, the question is whether the insured has to some extent cooperated with the tort certificate condition. The fact that the insured ultimately provided an estimate and other documents is irrelevant. See Rodrigo, 144 So. 3d of 692 ("While the insured claimed that she provided the insurer with bills, estimates, invoices and other documents to prove her damages, she failed to submit sworn proof of loss.").

The Court of Appeal apparently focused on the fact that the sworn form is not provided rather than the estimates and other information sent by the public adjusters. While this technical avoidance of paying an otherwise valid claim and getting a forfeiture may seem harsh, it is much safer to avoid all of this by submitting proof of loss when asked to do so with the information required in the insurance. [19659004] Thought for the day

A proof is a proof. What kind of evidence? That's proof. A proof is a proof. And when you have good evidence, it's because it's proven.
—Jean Chretien
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1 Edwards v. SafePoint Ins. Co. 318 So.3d 13 (Fla. 4th DCA 2021).


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