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Then filed evidence of loss – does delay result in denial? | Legal insurance blog for property insurance



After being exposed to a detergent leak to their home, policyholders filed a claim with their insurance company. The insurance company sent the policyholders a letter of reservation regarding rights and requested a signed, sworn proof of loss within 60 days. Homeowners failed to meet this deadline and submitted their sworn evidence of loss after the insurance company filed a complaint for declaration assessment and material crime. The trial court made a final summary judgment for the insurance company based on the insurers' failure to comply with their obligation to provide hard evidence of loss, and the policyholders appealed. reverse and noted that this goal was more so focused on premature conformity rather than the total failure to comply. The Court of Appeal found that in an earlier case the court had ruled that:

"[a] total failure to comply" a condition which may be a precedent may prevent the insured from recovering. Id. at 370 (citing Haiman v. Fed. Ins. Co. 798 So. 2d 81

1, 812 (Fla. 4th DCA 2001)). But "where an insured cooperates to a certain extent, an actual question remains as to whether the condition is breached to the extent that the insured is denied any recovery under the insurance." 2

The holding was confirmed by the appellate court in Kramer v. State Farm Florida stating that:

Although the insured did not comply with the provision that the feared proof of loss would be provided within sixty days Upon request, we have determined that whether an insurance company is affected by an insured's premature compliance is also a matter of fact. We similarly conclude in this case that controversial factual issues remain to the detriment of the insurer. The policy provisions state that "we [insurer] have no obligation to provide coverage under this policy if failure to comply with the following obligations is harmful to us." If the neglect of the insurance terms is not complied with, this requires the insurer to fail to constitute a material breach and allow an insurance company to deny coverage for a claim. Whether the insurer is injured is a factual question … the insurer offered no evidence of prejudice.

Florida law rejects confiscation of insurance coverage, especially when the event giving rise to the insurer's liability has occurred. … This is what the insurer has tried to do in a profound way by filing a complaint shortly after the sixty-day window to send proof of loss closed. In order to justify such a drastic result, the insurer, as the plaintiff, must prove that it has been affected by the failure [to comply expeditiously] with the obligation after loss. 3

Judge Conner agreed with Arguello states that it was "difficult to perceive prejudices" regarding the repairs that the insurer proposed to make, especially because the policy provided for assessment if the parties could not come agree on the scope of the repairs. A complete loss of coverage does not seem to be appropriate until the insured refused to sign a written permit for repairs.

Today's Thought:

Not everything that is face can be changed, but nothing can be changed until it is faced.
—James Baldwin
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1 Arguello v. People & # 39 ;s Trust Ins. Co. no. 4D19-69, – So.3d, -, 46 Fla. L. Weekly D715 (Fla. 4th DCA March 31, 2021).
2 Solano v. State Farm Fla. Ins. Co. 155 So.3d 367 (Fla. 4th DCA 2014).
3 Kramer v. State Farm Fla. Ins. Co. 95 So.3d 303, 306 (Fla. 4th DCA 2012).


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