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What can and must not be resolved through assessment or arbitration in Florida? | Legal insurance blog for property insurance



Property insurance has long contained provisions on evaluation and arbitration. 1 Although both paths offer the insured the opportunity to resolve their claims by means of extrajudicial means, all have clear differences and similarities. In certain circumstances, certain issues can only be resolved through a court.

Assessment and arbitration differ in terms of formality and procedure. 2 Assessment is an informal process where assessors are expected to act on the basis of their expertise. and "meet only to iron out differences of opinion." 3 They are not obliged to inform about their activities or hear evidence and can carry out their own investigations in good faith. 4 On the other hand, arbitration is considered a quasi-judicial procedure governed by the Florida Arbitration Code where each party has the right to a full hearing: including the right to a lawyer, the right to present evidence and the right to question witnesses. 5 Furthermore, "unlike assessment, an arbitration panel can only decide a case on what is presented to them during the course of the proceedings." 6

Having said that, assessment and work itration have an important similarity. Florida courts have ruled that coverage issues in general are not appropriate for assessment or arbitration. 7 An example of a coverage issue is causation and the Florida courts have found that causation is a coverage issue for the court to decide and not an assessment panel. 8 That is, while any process may be an appropriate way of determining an amount of loss in question, it should also not generally be used as a means of resolving a claim that an insurer has completely denied. 9 When a determination of a loss amount is all that is in question, an assessment or arbitration panel may be an appropriate way to resolve. 1

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Although there are differences between assessment and arbitration in terms of formality and procedure, they have an important similarity. If a carrier completely denies an insured's claim, the insured can expect all questions of interpretation and coverage of the policy to be reserved for a court of law and not fall within the scope of an assessment or arbitration panel. 11 However, if a dispute arises as to the extent and price of a covered loss, assessment and arbitration may be avenues which the parties may decide, by advice, to consider. ] Nya Amsterdam Cas. Co. v. J.H. Blackshear, Inc. 156 So. 695, 695 (Fla. 1934).
2 Citizens Prop. Ins. Corp. v. Mango Hill 117 So. 3d 1226, 1229 (Fla. 3d DCA 2013); See also Allstate Ins. Co. v. Martinez 790 So. 2d 1151, 1152 (Fla. 3d DCA 2001), approved, 833 So. 2d 761 (Fla. 2002) ("However, evaluation and arbitration are not identical processes. Evaluators are expected to act on the basis of their expertise. They only need to meet to iron out any differences in their views").
3 [19659006] Id.
4 Mango Hill 117 So. 3d 1226 at 1229.
5 Mango Hill 117 So. 3d 1226 at 1230.
6 Id.
7 Atencio v U.S. Pat. Sec. Ins. Co. 676 So. 2d 489 (Fla. 3d DCA 1996).
8 Johnson v. Nationwide Mut. Ins. Co. 828 So. 2d 1021, 1022 (Fla. 2002).
9 Id
10 Id ; Atencio v U.S. Pat. Sec. Ins. Co. 676 So. 2d 489, 490 (Fla. 3d DCA 1996) ("[Q] interpretation and coverage of the police is usually for the court, rather than arbitrators or assessors, to decide") (interpretation of a car insurance policy assessment provision). [19659005] 11
Id.


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