With the end of the statute of limitations for Hurricane Irma-related claims, we are increasingly facing claims denial, partly based on "prompt notification" and / or "delayed" language from insurance companies. But was the claim actually reported late? Well, it depends on the reporting requirements described in the insurance policy.
Insurance usually requires the insured "[g] to receive a prompt message" to the insurance company, but there are some who also allow you to "[g] a prompt message to … your insurance agent. "We have encountered this scenario in several statements, and the pattern looks as follows:
The loss event, ie. Hurricane Irma, takes place. The insured notices some damage and calls his insurance agent. The agent advises them not to report a claim for any reason. may be a deductible issue, may be to avoid an increase in premiums, etc.
However, when the insured begins to repair or has the property inspected professionally, significant damage becomes apparent. Now the claim is called directly to the insurance company. The carrier later denies the claim because the loss was not reported until the "X" number of days after the incident, and therefore the carrier claims prejudice. 1
In the above scenario, which we find to be more common, the first reporting to the insurance agent follows the insurance terms and conditions that make it possible to notify the insured's insurance agent. The carrier can therefore not claim denial of late notification based on when they were notified of the loss, but only from the reporting date according to the terms of the policy. In the above scenario, it would be from the day when the insurance agent was notified of the loss event.
1 Prejudice in Florida is assumed when a carrier shows that the loss was not immediately reported; however, the insured can overcome this assumption by showing that there is no actual prejudice. See, Bankers Ins. Co. v. Macias 475 So.2d 1216 (Fla. 1985).