Shaun Marker – Property Insurance Coverage Law – September 2, 2014
Florida’s 4th District Court of Appeals (“4th DCA”), recently issued an opinion relating to compliance with post-loss duties in a property insurance case.1 The issue centered on whether the policyholder breached their duties under the insurance contract by not timely submitting a sworn proof of loss. The trial court decided that the policyholder could not recover under the policy because of their untimely submission of a sworn proof of loss. The policyholder appealed that ruling. The 4th DCA affirmed the trial court. We will discuss the reasoning behind the decision.
The Hunt case involved a Hurricane Wilma claim. Under the policy they had with State Farm, the Hunts were to provide State Farm with a signed sworn proof of loss “within [sixty] days after the loss.” The policyholders did not provide the sworn proof of loss to State Farm until almost five years after Hurricane Wilma; just days before they filed suit against State Farm. State Farm moved for summary judgment and argued the policyholder materially breached the policy duties by not timely submitting the proof of loss. The trial court agreed with State Farm and held that the policyholders breached a condition precedent to coverage and introduced no evidence to rebut that State Farm was prejudiced by their breach.
On appeal, the 4th DCA stated that it is well settled in Florida that submission of a proof of loss is a condition precedent to coverage. The court notes that if a policyholder fails to comply with a condition precedent before filing suit, its breach is deemed material, and the insurance company is relieved of its coverage obligations under the policy. The court also explains that if the policyholder complies with the policy conditions before filing suit, albeit in an untimely manner, the insurance company is only relieved of its coverage obligations if it was prejudiced by the breach.
In the Hunt opinion, the 4th DCA cites to Starling v. Allstate Floridian Insurance Company.2 However, in Starling, the policyholder did not submit the proof of loss until several months after they filed suit. In Starling, the 5th DCA noted that:
[A] total failure to comply with policy provisions made a prerequisite to suit under the policy may constitute a breach precluding recovery from the insurer as a matter of law. If, however, the insured cooperates to some degree or provides an explanation for its noncompliance, a fact question is presented for resolution by a jury.
In Hunt, the proof of loss was submitted before suit was filed. So, while the compliance with the policy condition to submit the proof of loss was late, it was met before suit was filed. I wonder why this part of the analysis was not discussed in Hunt.
The 4th DCA stated in Hunt that the policyholder did not offer any evidence rebutting the presumed prejudice to State Farm. That must have been part of the court’s reasoning why there was not a fact question presented for the jury to decide whether the delay in submission of the proof of loss really prejudiced State Farm.
1 Hunt v. State Farm Florida Ins. Co., 2014 WL 4083205 (Fla. 4th DCA August 20, 2014).
2 Starling v. Allstate Floridian Ins. Co., 956 So.2d 511 (Fla. 5th DCA 2007).