When homeowners experience a loss after faithfully fulfilling their obligation to make premium payments, they should be able to presume that their insurance carrier will cover a loss when disaster strikes. Unfortunately, many claims are denied or underpaid when policyholders lack legal representation. Sometimes policyholders notify their insurance company of a claim and presume it is being resolved only to discover that they have run afoul of some policy term or condition. There are other times that an insured does not pursue a claim because it does not appear that the claim is covered. An experienced Miami insurance claims attorney will carefully analyze the policy language and may be able to develop a persuasive argument for coverage.
The case of Rodrigo v. State Farm Florida Insurance provides a compelling example of how easy it is for an insured to make a mistake in pursuing a claim when unrepresented. The insured made a claim for property damage to her condominium, the property within the condo, and related expenses. While she never filed a sworn proof of loss, she did supply invoices and a list of specific damages. An adjuster for the insurance company directed a contractor to inspect the policyholder’s condo. The insurer tendered payment to the insured who rejected the payment because it did not cover the personal property damage.
Failure to Provide a Proof of Claim
The language of the policy specifically provided in pertinent part:
“Loss Payment. We will adjust all losses with you. . . . Loss will be payable 60 days after we receive your proof of loss and:
- reach agreement with you;
- there is an entry of a final judgment; or
- there is a filing of an appraisal award with us.”
The appellate court upheld the trial court’s ruling that filing a sworn proof of loss was a condition precedent to payment of the claim under the policy. The policyholder contended that the insurer waived the proof of loss prerequisite for payment of a claim by tendering payment. However, the court noted that an insurance company does not waive any policy provision or defenses by investigating a claim or negotiating a potential settlement.
Because the insurance company did not waive the sworn proof of loss requirement, the insured had to rebut a presumption that the insurance company suffered prejudice. The policyholder did not present any evidence rebutting this presumption, so the court upheld the trial court’s ruling in favor of the insurance company because of the policyholder’s failure to provide the proof of loss.
While the policyholder’s belief that submission of invoices and other documents satisfied the notice requirement, this decision demonstrates the importance of careful compliance with all conditions and policy terms when pursuing a claim. When policyholders are represented by our experienced Florida homeowners insurance attorney, we can assist an insured in navigating the procedures necessary to obtain the full value of a claim.
Florida property insurance policies typically include a provision requiring the filing of a sworn proof of loss (POL). The accuracy and timeliness of the POL often become issues of contention if an insurance claim dispute must proceed to litigation. Insurance companies might use allegations of fraud or misrepresentation as a basis to deny a claim. The policy also will typically include a deadline for filing a proof of claim. While failure to comply with this deadline might be an obstacle that can be overcome, many policyholders lose in lawsuits disputing their insurer’s denial of coverage because they are delinquent in filing the claim.
Greenberg, Stone, & Urbano: Seeking Maximum Recovery for Policyholders from Their Homeowners Insurance Company
If your homeowners insurance carrier fails to properly resolve your claim, our experienced Miami homeowners insurance claims lawyers can protect your interests and counter unfair practices by your insurer. Greenberg, Stone & Urbano tenaciously pursues the full compensation our clients are entitled to under the law. For over 130 collective years, our firm has assisted homeowners with damage claims across South Florida. We seek to obtain compensation for your tangible and intangible damages. Our skill and dedication have 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.