Florida Appeals Court Affirms Lower Court Decision in Insurance Claim Case

In a recent case, the Third District Court of Appeals in Florida issued an opinion in an appeal involving an insurance claim between the Appellants, the plaintiff, and the Appellee, Citizens Property Insurance Corporation (Citizens). The plaintiff sued Citizens after a claim for hurricane damage he filed was denied by Citizens due to late notice. Citizens moved for summary judgment on the basis that the plaintiff failed to promptly report his claim. The trial court granted summary judgment, and the plaintiff appealed.

The plaintiff was issued a homeowners policy by Citizens. The policy expressly barred any hurricane claims filed outside of a three-year window. Additionally, the policy requires claimants to give prompt notice of damages for claims. In the aftermath of Hurricane Irma, the plaintiff’s home sustained interior and exterior damage to his residence. He retained a public adjuster, and two years and seven months after the storm, he reported a claim to Citizens. Citizens responded by denying the claim, stating that due to the length of time that had passed between the date of the loss and the date the loss was reported, Citizens considers the loss to be a late report claim. Citizens then assigned a field adjuster. According to the field adjuster’s report, due to the passage of time, he was unable to determine if the exterior or interior damages were the result of Hurricane Irma. Citizens requested photographs and documentary evidence from the public adjuster, without success, though the plaintiff did tender a written proof of loss. Citizens denied the claim, asserting late notice.

At trial, the plaintiff testified that he noticed leaks throughout his residence the day after the storm struck. He stated that he observed roof leaks and attempted to effectuate repairs using tar approximately one month after the hurricane. The next year, the plaintiff made more roof repairs, including tile replacement, but did not report damages to Citizen. The plaintiff cited a lack of fluency with the terms of his policy as the reason why he did not report the damage at the time.

On appeal, the plaintiff challenged the final summary judgment rendered in favor of Citizens, claiming that the trial court erred in entering summary judgment on the basis that the plaintiff failed to overcome the presumption that Citizen was prejudiced as the result of his failure to timely report his claim. The appellate decision laid out a two-step analysis to be applied in such cases. (1) whether the notice was timely given, and (2), if the notice was untimely, then prejudice to the insurer is presumed, but that presumption may be rebutted if the insured demonstrates the insurer had not been prejudiced by the untimely notice. In this case, the appeals court found that the plaintiff failed to act with reasonable dispatch and within a reasonable time and failed to adequately counter the presumption of prejudice. The plaintiff also claimed that the policy was ambiguous and thus should be construed in favor of the insured. The appeals court agreed that ambiguities should be construed in favor of the insured, but pointed out that policy provisions should be harmonized whenever feasible, with ambiguities only construed in favor of the insured when that is not possible. Here, they found that the clauses required the insured to provide prompt notice, affirming the lower court decision in full.

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