People often wonder why they would need an attorney for an insurance claim if they paid their premium and only want what is fair.  If you or someone you know in Panama City, Mexico Beach, or the Port St. Joe area has suffered damage from Hurricane Michael they may be dealing with the insurance company right now and unknowingly taking actions that will impair their ability to recover the full amount of their claim.  

The reason someone filing an insurance claim after Hurricane Michael would need an attorney is that many insurance companies simply do not play fair.  Some insurance companies use loopholes or fine print to avoid paying legitimate claims.  Did you know if you do not use the specific proof of loss required by the insurance company for filing your claim, they could try to argue you breached the policy and deny your claim entirely? 

In a recent case out of the Supreme Court of Florida that is precisely what the insurance company argued, and it was an argument that carried the day at the trial court level.  The trial court entered judgment in favor of the insurance company because the policyholders provided a sworn proof of loss prepared by their public adjuster, but it was not on the form the insurance company required.  We see this happen all of the time.

Many Insurance Companies Use Tricks Like This All the Time

Unfortunately, as attorneys who have represented policyholders for more than twenty-five years, we see insurance companies use tactics like this often to avoid paying legitimate claims.  Any fine print or loophole they can find in the policy (and, believe us, they know where to find them because they wrote the policy) they will use to try to avoid their obligation to you.  It is disheartening and frustrating, but a sad truth in our world.  This is why we practice the law that we do and represent policyholders only, never insurance companies.

Thankfully, these policyholders fought back.  They made the wise choice early on to bring an experienced insurance attorney on board to help them with their claim.  Even though the attorney made sure the insurance company was notified promptly of the loss and provided an opportunity to investigate, the insurance company refused to pay the claim.  Avatar Property & Casualty Insurance would not honor the claim until a different sworn proof of form was used and all parties involved in the repairs—from the policyholders, to the plumber, to the contractor—all sat down for an examination under oath. 

Do You Know Your Obligations Under Your Policy? 

Did you know most policyholders are required, under the terms of their policy, to submit to an examination under oath (sometimes referred to as an “EUO”) scheduled unilaterally by the insurance company?  This is an obligation under the policy that, if the policyholder fails to meet, allows the insurance company to deny the claim.  It is provisions like the EUO requirement, that most policyholders are unaware of because they do not read their policies carefully, that can cause policyholders to inadvertently take a very unfortunate misstep that can allow the insurance company to deny their claim entirely. 

What Happened In This Case

In this case, the policyholders suffered damage to their home when an air conditioner leaked. They worked quickly to mitigate damages by hiring a plumber to fix the leak and a contractor to remove the damaged flooring.  They notified their insurance company within two days of the loss and also brought in a public adjuster to assess their damages and prepare a sworn proof of loss which they submitted to the insurance company.  The insurance company deemed the proof of loss deficient (without providing any reason why) and refused to pay the claim until all parties sat for an EUO. Although the policyholders' attorney tried many times to reschedule the EUO and find out what was deficient about the submitted proof of loss, the insurance company refused to explain and refused to pay the claim. 

Why the Trial Court Ruled in Favor of the Insurance Company

Sadly, the trial court found the policyholders' conduct constituted a breach of the insurance policy and entered judgment in favor of the insurance company denying the claim entirely.  This can happen often to policyholders with legitimate claims who simply do not know the ins and outs of filing an insurance claim, because the insurance company knows all the tricks and they will try to utilize every one available to their advantage. 

Why the Supreme Court of Florida Reversed and Ruled in Favor of the Policyholders

We are proud to report the Supreme Court of Florida sided with the policyholders on appeal and reversed the trial court on all counts.  The Supreme Court advised whether the policyholders substantially complied with their policy obligations—by: 1) notifying the insurance company within two days of the loss; 2) providing the sworn proof of loss that they did; and 3) attempting to reschedule the EUO—was a question for the jury, not a judge on a motion for entry of judgment. 

The case will be sent back down to the trial court to be litigated further and (we hope) eventually brought to trial so more people can see the lengths insurance companies will go to to avoid paying legitimate claims.  However, it is important to remember this loss occurred in 2016 and will now be set for trial likely sometime in 2018 if not 2019, three years after the insurance company should have paid the claim.  It requires a lot of stamina and resources to fight an insurance company for that long.  That is what we do for policyholders, so they don't have to fight insurance companies alone.

Do Not Wait to Contact an Experienced Insurance Attorney

If you are preparing to file or have filed a claim from Hurricane Michael or any insurance claim, do not wait to consult with an attorney experienced in handling and litigating insurance claims.  Public adjusters and other professionals can be very helpful.  However, only an attorney can give you advice about your legal rights to help you to make sure you don't make inadvertent mistakes like this that can cost you your entire claim.  The attorneys at Taylor, Warren & Weidner are experienced insurance attorneys, designated by their peers as Super Lawyers in Insurance Coverage year after year, and are very familiar with the fine print and complicated obligations under your policy.  There is absolutely no fee, cost, or obligation to learn about your rights.  Contact us.  

Read the full opinion here — David Himmel v. Avatar Property & Casualty Insurance Co., Case Nos. 4D17-2724 and 4D18-0004 (Fla. 4th DCA, October 17, 2018).