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How Far Will An Insurance Company Go To Avoid Paying My Claim?

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Insurance companies are quick to deny property damage claims based on some alleged failure of the policyholder to comply with the terms of the policy.  Indeed, even when the policyholder can show they followed the rules, the insurance company may still contend it is not responsible for paying you owed insurance benefits.  Ultimately, such wrongful defiance leads to litigation.

Appeals Court: Homeowner Entitled to New Hearing After Insurer Misrepresented Facts to Trial Court

Take this recent decision from the Florida Fifth District Court of Appeals, Lopez v. Avatar Property & Casualty Insurance Co., 313 So.3d 230 (Fla. 5th DCA 2021).  The plaintiff in this case insured her home with the defendant. During the term of the policy, the plaintiff’s home sustained water damage during two separate incidents, one in 2015 and the other in 2016.

When the plaintiff filed claims for both losses, the defendant sent a letter asking her to submit “proof of loss” statements within 60 days. The letter was dated April 5, 2016. The plaintiff said she provided the required statements on June 7, 2016, which was prior to the 60-day deadline. The defendant, however, claimed it did not receive the forms until June 14, which was 9 days past the deadline.  On that basis, the defendant denied both insurance claims.

Litigation followed.  In response to the plaintiff’s lawsuit, the defendant asked a Florida circuit court to grant it summary judgment on the basis that it was “undisputed” the plaintiff did not file her proof of loss on time.  The defendant also represented to the court that the forms they did receive from the plaintiff were for “some other company, made by some other insured, under some other policy, for who knows what kind of loss, under who knows what type of coverage.”

That turned out not to be true.  In fact, the plaintiff did submit forms that correctly identified her losses and policy with the defendant.  The defendant then argued that the proof of loss forms were incomplete since they did not contain any “repair estimates.”  As the Fifth District noted in its opinion, the insurer repeated this specific point “nine times” during a hearing on its summary judgment motion.

The trial court ultimately granted defendant summary judgment.  The plaintiff asked for a new hearing, however, after the defendant’s own attorneys admitted they misrepresented the facts. The truth was that the plaintiff had submitted the supposedly missing repair estimates.  Despite this concession, the defendant opposed rehearing the summary judgment motion, and the judge declined to reconsider their prior decision.

The Fifth District said that was a legal error. The evidence clearly established that summary judgment was not appropriate in this case. The plaintiff was therefore entitled to proceed with her lawsuit.

Speak with a Florida Property Insurance Claims Attorney Today

Insurance companies will never stop attempting to reduce the amount of the claim pay out, or find some unreasonable basis to deny the claim even when the law does not support their position. As a policyholder, you should never be afraid to assert your own rights as well. A qualified Florida insurance claims lawyer can present your case to a judge in a skilled and professional manner.  Contact Older Lundy Alvarez & Koch today to schedule a consultation with a member of our team.

Source:

scholar.google.com/scholar_case?case=3979296775489245174

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