Articles Posted in Property Damage Insurance Claims

In Citizens Property Insurance Corporation v. Salkey (Opinion filed November `6, 2018), property owners insured with Citizens claimed losses alleged to have been caused by sinkhole activity. They had purchased coverage endorsement, which provided coverage for direct physical loss caused by sinkhole activity. An expert hired by Citizens concluded that the property damage was not caused by sinkhole activity but was caused by the ongoing decay of organic soils and phosphatic clay in the reclaimed mine zone over which the insured’s house was built. Because damage caused this way was excluded under the policy, Citizens denied the sinkhole claim, and the homeowners filed a breach of contract claim against Citizens.

Based on evidence presented at trial, the jury concluded that the damage was caused by both factors. Judgment was entered for the property owners. Citizens appealed.

While the judgment was reversed and remanded on other grounds, the Second DCA concluded that Citizens was otherwise liable on the concurrent-cause doctrine, not the efficient-proximate-cause doctrine, which applies when two or more perils converge to cause a loss and at least one of the perils is excluded from an insurance policy. (Citizens argued that policy language effectively eliminated coverage under the concurrent-cause doctrine, but the appeal court disagreed.) The DCA was informed by the Florida Supreme Court’s opinion in Sebo v. American Home Assurance Co. (Sebo II), 208 So. 3d 694 (Fla. 2016).

red-umbrella-mingling-with-grey-umbrellas-be-different-concept-300x205Making a first party insurance claim is not always the only or even the best option available to a person or corporation whose property has been damaged by wind or rain. (A first party claim is made by a policy holder to his or her own insurance company. These claims are contractual; meaning that they arise out of a contract (the insurance policy) between the insurance company and the policy holder.)

Most first party property damage insurance policies have a deductible. (Deductibles are the amount an insured must pay before the insurance company becomes responsible for making payments under the policy. The deductible amounts can range from $250 to thousands of dollars.)

Making a first party claim may also result in a premium increase. (An insurance premium is the amount of money that an individual or business must pay for an insurance policy.)

Whether the property owner has an alternative to the first party claim depends on the cause of the damage. For example, a manufacturing defect or improper installation may account for a roof leak. In these instances, the better option may be to seek compensation from the responsible third party. The downside to this avenue of recourse is the time, delay, and expense of having to prove fault and damages against a party that is likely to be more hostile than the first party carrier.

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hand-drawing-a-house-on-blackboard-real-estate-and-housing-con-300x209Every property damage insurance policy issued in Florida requires the insured to provide the insurance company (or, in some instances, the procuring policy agent) with timely notice of a loss. The notice requirement enables the insurer to conduct a timely and adequate investigation of all circumstances surrounding an accident. Bankers Insurance Company v. Macias, 475 So.2d 1216 (Fla. 1985). Many a claim has been denied for failing to meet the notice requirement.

Unless the terms of a policy run afoul of statutory or case law, they will govern the relationship between the insured and the insurer. This includes responsibilities with regard to loss reporting.

The reporting requirements can vary from policy to policy. This makes it advisable to read the insurance contract upon purchase and after a loss. The words “immediate” and “prompt” are commonly used to establish the reporting parameters.

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home-insuranceMost homeowner and commercial residential insurance policies obligate policyholders to participate in a potentially expensive and time-consuming adversarial appraisal procedure before litigation. Here’s an example, from Allstate Insurance Company v. Suarez, 833 So. 2d 762 (Fla. 2002), of a typical contractual appraisal provision:

Appraisal. If you and we fail to agree on the amount of loss, either party may make written demand for an appraisal. Upon such demand each party must select a competent and impartial appraiser and notify the other of the appraiser’s identity within 20 days after the demand is received. The appraisers will select a competent and impartial umpire. If the appraisers are unable to agree upon an umpire within 15 days, you or we can ask a judge or a court of record in the state where the resident premises is located to select an umpire. The appraisers shall then determine the amount of loss, stating separately the actual cash value and the amount of loss to each item. If the appraisers submit a written report of an agreement to us, the amount agreed upon shall be the amount of loss. If they cannot agree, they will submit their differences to the umpire. A written award by any two will determine the amount of loss.

Cognizant of this daunting burden, the Florida Legislature enacted statute 627.7015, which provides an alternative procedure for resolving disputed property insurance claims. The essential elements of the statute are: