The Supreme Court of Puerto Rico has continued to rule in favor of Hurricane Maria policyholders.
In its most recent decision, Diaz Altagracia v. MAPFRE 1 ] the insured had insurance cover for both structural and personal content. Dissatisfied with the insurer's adjustment, the insured requested reconsideration but claims that in this second adjustment, the insurer incurred in false representations and unfair practices by failing to inform about the possibility of reconsidering or claiming additional damages not included in the adjustment. The insured also claimed that his payment delay was delayed, underpaid and that covered damages were ignored. The insured lodged a complaint and the insurer claimed that the elements of Accord & Satisfaction had been met when the requirement was adjusted, two checks were issued to the client which he received, accepted and deposited without objection. The insured then claimed that he never received a claim related to his claim and not all of his covered damages were considered, in addition, the insurer did not warn about the consequences of depositing the checks. Therefore, the elements of conformity and satisfaction were not met and there was unnecessary benefit to the insurer's benefit.
In this case, the court granted the insurer's summary judgment on the grounds of conformity and satisfaction and held that there was no evidence of malicious consent when accepting and depositing the checks. The Board of Appeal also upheld this judgment based on not finding any undisputed facts showing that the insurer incurred in unfair acts or bad faith.
As discussed in, Accord & Satisfaction: Will My Insurance Claim Be Rejected If I Deposit Payment? ̵
- A claim must have a monetary value or a bonafide controversy must
- The debtor makes a payment offer .
- The creditor accepts the payment offer.
In addition, the payment must be made in the absence of repression or undue advantage from the debtor and there must be clear indications that the payment is total and final, therefore it will extinguish the obligation under the agreement. As I discussed last month in, Accord & Satisfaction: Puerto Rico Supreme Court Rules for Hurricane Policyholder Maria states 3 The Supreme Court of Puerto Rico held Feliciano Aguayo v. MAPFRE 4 that compliance and satisfaction cannot be applied automatically to insurance claims and must be evaluated on a case-by-case basis. All parts should comply with the requirements of the Puerto Rico Insurance Code.
In Diaz Altagracia v MAPFRE the Supreme Court held that there was a real controversy over the real value of the damages, information is not provided by the insurer, there was unnecessary benefit in favor of the insurer, controversy in intent to accept the payment as final and unfair practice during the adjustment. Therefore, both previous courts limited their judgments to the basic elements without taking into account all the circumstances of this case and it is the court's duty to ensure that all doctrinal and status requirements are met in order to close a complaint in a summary judgment. The Supreme Court reversed the Board of Appeal and ordered that the case be returned to the Court and proceeded with the case based on its precedent in Feliciano Aguayo v MAPFRE .
1 Diaz Altagracia v.MAPFRE CC-2020-0149 (13 July 2021).
2 https://www.propertyinsurancecoveragelaw.com/2021/01/articles/insurance/accord-satisfaction-will -min-försäkring-anspråk-avskedas-om-jag-sätter-in-betal-del -2 /
3 https://www.propertyinsurancecoveragelaw.com/2021/06/articles/insurance/ consent-satisfaction-puerto-rico-supreme court-rules-for-policyholders-in-hurricane-maria Claim /
4 Aguayo v. MAPFRE Pan American Ins. Co. 206 DPR – (28 May 2021).