Florida Court Rules Against Insurance Company for Wrongfully Refusing Appraisal

Posted by Annie Dike | Jan 21, 2019 | 0 Comments

Has your insurance company demanded an appraisal of your loss from Hurricane Michael?  Many homeowners in the Mexico Beach and Panama City area are dealing with their insurance companies now over policy provisions and damage assessments.  Often, their insurance company will ask them to produce hundreds of irrelevant documents or sit for a statement under oath.  Insurance companies frequently try to use fine print obligations like these to deny your claim.  We want to educate you to be on the lookout for games like this that insurance companies try to play.  In this recent Florida opinion, the court ruled against an insurance company that denied a claim by refusing to complete a loss appraisal until the homeowner met its unreasonable demands for documents and information. 

insurance company attorney denial of claim


The Appraisal Process in Gomez

Many insurance policies contain an appraisal provision.  Meaning, if there is a dispute as to the amount of the loss on an insurance claim, either the homeowner or the insurance company can demand an appraisal of the loss under the policy. This is what happened in a recent opinion out of the 3rd DCA in Florida. See Safepoint Insurance Company v. Gomez, Case No. 3D18-1366 (3rd DCA, Jan. 16, 2019)

While Safepoint Insurance Company paid an initial amount on the claim, the Gomezes did not believe it was enough to cover the damage and demanded more.  Safepoint invoked the appraisal process under the policy and an appraiser was selected and an appraisal scheduled.  However, Safepoint stopped the appraisal process before it was complete and denied the homeowners' claim based on an accusation that the homeowners failed to meet certain obligations under the policy.

The Insurance Company's Demands 

While most insurance policies require the homeowner to produce certain documents and sit for an examination under oath (commonly referred to as an “EUO”), in Gomez, the insurance company sent a demand, after the appraisal process had begun, for: 1) a Sworn Proof of Loss; 2) twenty-four categories of documents; 3) and an EUO of each insured covering twenty-five areas of inquiry.  When the homeowners did not meet these demands, Safepoint Insurance Company stopped the appraisal process and denied the claim, forcing the Gomezes to sue to recover under their policy.

Court Found the Demands Unreasonable

Thankfully, on appeal, the appellate court agreed with the trial court and found Safepoint's refusal to continue with the appraisal based on the homeowners' failure to produce documents was unreasonable.  The 3rd DCA concluded the production of documents and an examination under oath was not a condition precedent for completion of the appraisal and ordered Safepoint to continue with the appraisal process.

Do Not Let an Insurance Company Use Their Fine Print Against You

We are proud of the court for finding in favor of the homeowners in this case and protecting policyholder rights.  Insurance companies often try to use fine print obligations in your policy like this against you to place unreasonable demands on you and deny your claim if you fail to meet them.  While you do have certain obligations under your policy that you must fulfill in order to get paid on your claim, it is best to seek the advice of an experienced insurance dispute attorney to learn what these are before you accept an insurance company's underhanded tactics or denial of your claim.  If you have questions about an insurance dispute or your obligations under your policy, there is no fee, cost, or obligation to learn your rights. Contact us for a free policy and coverage review today. 

View the full opinion here -- Safepoint Insurance Company v. Gomez, Case No. 3D18-1366 (3rd DCA, Jan. 16, 2019).

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