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An Experienced Miami Insurance Claims Lawyer Can Make a Significant Difference in Claims Disputes

Most Florida property owners purchase homeowner’s insurance either because it is required by their mortgage lender and/or to obtain financial security against the risk of loss.  The owner of a Florida residence probably has a reasonable expectation that an insurance company will fulfill its contractual obligations under the policy.  If your home has suffered significant damage or been destroyed, the funds you receive to rebuild or repair your home can protect your financial investment.  However, many policyholders have their claims denied for spurious reasons particularly when they do not have legal representation.  There are unsuccessful claims that do not get paid because the policyholder is informed by the insurer that some term or condition precludes coverage.  In other cases, an insured might abandon a claim based on a mistaken belief the claim is not a covered peril under the policy.

An experienced Miami homeowner’s insurance claims lawyer can guide you past insurance company pitfalls and through the claims process.  The insurance claims process involves an abundance of traps for the unwary that can derail a potential claim.  This blog post provides an example of a lawsuit involving a common mistake by unrepresented policyholders, as well as ways a creative insurance claims lawyer might assist you in avoiding or mitigating such missteps.

Insurance Company Uses Common Defense: No Timely Proof of Loss

In the case of Rodrigo v. State Farm Insurance*, the insured submitted a claim for property damage to her condominium and the personal property inside the unit along with ancillary expenses.  The policyholder was diligent in providing extensive documentation to the insurance company in support of her claim, including a detailed list of damages to the unit and personal property inside the condo along with invoices for repairs.  However, the documentation provided to her insurance company did not include a sworn proof of loss.  The insurance carrier assigned a contractor to conduct an inspection of the unit, and the insurer tendered payment to the insured based on the contractor’s report.

The requirement to file a sworn proof of loss is a standard condition in standard homeowner’s polices in Florida.  However, the policyholder was not initially represented by counsel, so she apparently presumed her cooperation in providing invoices and the list of damages was sufficient.  The specific language of this policy provided that the insurer would make payment after submission of the sworn proof of loss and within sixty days of any of the following:

  • Entry of final judgment
  • Mutual agreement between the insurer and insured
  • Filing of an appraisal award with the insurer

The policyholder filed a lawsuit for breach of the insurance agreement after rejecting the insurance company’s tender of payment as inadequate.  According to the trial judge, compliance with the proof of loss requirement was a “condition precedent” to the in the insurer’s duty to pay the claim.  Although the insured attempted to argue on appeal that the insured waived the proof of loss provision because it tendered payment.  The appellate court ruled that the insurance company’s actions in investigating the claim and attempting to reach a settlement did not constitute a waiver of the proof of loss condition.

Benefits of Retaining an Innovative and Experienced Florida Homeowner’s Insurance Claims Lawyer

Although the policyholder did not provide a sworn proof of loss, the court conceded that this did not end the inquiry.  The insured had a burden to rebut the presumption that the insurer was prejudice by the failure to provide a timely proof of loss.  Ultimately, the insured was not able to overcome this presumption, so the failure to provide a timely proof of loss constituted a valid defense to payment of the claim.

Proof of loss issues constitute one of the most common grounds insurance companies use to deny legitimate claims.  Even if the proof of claim is provided, the insurance company will often contend that the document was not provided in a timely manner.  When you work with a knowledgeable Miami Homeowner’s Insurance Claims Lawyer, your legal counsel can anticipate and preempt these types of contentions raised by insurers looking to avoid paying claims.

The attorney in this case asserted a creative argument that demonstrates the ways an experienced attorney can assist you in successfully overcoming insurance company strategies for denying claim.  The insured condominium unit was damaged by a decomposing body in the adjacent unit.  Predictably, the policy did not provide coverage for decomposing bodies as a peril, but medical records submitted to the insurance carrier indicated that the body “explosively” expanded and leaked fluids causing the damage.   The insurer’s attorney used this evidence to argue that “explosions” constituted a covered peril.

Although this contention was unsuccessful in this case, this lawsuit amounts to a cautionary tale regarding the importance of legal representation when taking on insurance companies in claims disputes.  Our Miami Homeowner’s Claims Lawyers carefully investigate relevant policy language, correspondence with the insurer, and damage to the subject property, so we can present the most compelling position in support of our client’s insurance claim.  This approach might involve more common insurance company defenses, such as failure to mitigate damages and non-compliance with the proof of loss requirement, or novel legal theories like using a medical report attesting to an “exploding body” as a covered “explosion” under a policy.

Greenberg Stone and Urbano:  Seeking Maximum Recovery for Policyholders from Homeowner’s Insurance Companies

If your homeowner’s insurance carrier denies, delays, or lowballs your claim, our Miami Homeowner’s Insurance Attorneys at Greenberg Stone and Urbano will tenaciously pursue the full compensation you deserve.  For over 130 collective years, our firm has assisted accident victims in personal injury and wrongful death actions across South Florida.  We seek to obtain compensation for your tangible and intangible damages, including medical bills, lost wages, pain and suffering, and more.  Our skill and dedication has earned us an AV rating from Martindale Hubbell and recognition as one of South Florida’s top firms by the Miami Herald.   Call us at (888) 499-9700 or (305) 595-2400 or visit our website to schedule your initial consultation.


Rodrigo v. State Farm Insurance, Case No. 4D12-3410 (4th Dist. 2014)

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