Jean-Paul Rudd | Adams & Adams
Disputes often arise between insurers and policyholders regarding the value of insured property. Some of these disputes are resolved with little difficulty, as the value can be relatively easily established. For example, in cases where a storm causes partial damage to a home and its contents, the insured property remains assessable. However, other disputes are more challenging, especially when a home and its contents have been completely destroyed, such as by a hurricane or fire. In these instances, an appraiser is often required to determine the value of the insured property.
To complicate things further, insurance policies often have limits on coverage amounts for specific types of property or damage. These limits can result in situations where the actual cost of repairs or replacement exceeds the maximum payout defined in the policy.
US Case Study
An example of the complexities arising from policy limits can be seen in a recent case in Florida, USA, following Hurricane Ian. The U.S. District Court for the Middle District of Florida was called upon to resolve a property dispute in the case of Wood v. GeoVera Specialty Insurance Company.
In the aftermath of Hurricane Ian, Nancy and John Wood filed an insurance claim with GeoVera Specialty Insurance Company. Disagreements over the valuation of damage led to the involvement of an appraiser. The appraisal revealed damages that exceeded the policy’s limits for specific items. Although GeoVera paid the maximum allowable under the policy, they refused to cover the additional amounts indicated by the appraisal. As a result, the Woods initiated legal action against their insurer to recover the difference.
The difference in certain items was substantial. For example, the damage to the pool enclosure was appraised at $12,695.00, while the policy limit was only $5,000.00. The court ruled that GeoVera was not obligated to pay more than the policy limit, even if the damage exceeded that amount.
Disputes can also centre on the cause of the damage, not just its extent. In the Woods’ case, the interior damage was appraised at $52,282.00. While their policy limited water damage coverage to $10,000.00 under a water damage endorsement, there was no specific limit for wind damage. According to the court, it was unclear whether the appraisal attributed the interior damage to water or wind. Consequently, the court postponed its decision on this aspect to allow for further evidence to be led on the cause of the damage.
Takeaway
While appraisals assist in determining the extent of the loss, they do not override unambiguous policy limits.
When one of your cases is in need of a construction expert, estimates, insurance appraisal or umpire services in defect or insurance disputes – please call Advise & Consult, Inc. at 888.684.8305, or email experts@adviseandconsult.net.