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State Farm Florida Insurance Company v. Figueroa, No. 4D15—2698, 2017 WL 514361 (Fla. 4th DCA Feb. 8, 2017)
In this case, the insured homeowner did not submit a sworn proof of loss within 60 days of the loss, as required by the post-loss conditions set forth in the policy, but did submit one before filing suit against her insurer. Although the insured’s compliance with the post-loss condition was untimely, because the insured ultimately complied before filing suit, the court held the issue of whether compliance was substantial was a question of fact. In addition, although an insured’s untimely compliance with the post-loss condition was presumed to have prejudiced the insurer, the court stated the insured can overcome the presumption by showing the insurer was not prejudiced. Because substantial compliance and prejudice were both questions of fact, the court held the trial court did not err in denying the insurer’s summary judgment and directed verdict motions.
An insured filed a Hurricane Wilma claim in 2005. State Farm investigated and found the damage was below the deductible. State Farm informed the insured she was free to obtain her own estimate and to contact it if she obtained an estimate higher than the deductible. State Farm did not request a proof of loss.
In late 2008, a contractor estimated more than 25% of the insured’s roof tiles were loosened by wind and estimates over $43,000 in repairs. The insured then asked State Farm to reopen her claim and submitted the new estimate. State Farm advised the insured of her obligations under the policy, including the requirement of a sworn proof of loss within 60 days of the loss. The insured submitted a proof of loss approximately two months later. State Farm responded that the proof of loss did not comply with policy provisions and provided a new proof of loss form to the insured in March 2010. The insured finally completed and submitted the proof of loss in June 2010. State Farm informed the insured it was relieved of its obligations under the policy due to the untimely proof of loss and failure to protect the property from further damage, and the insured sued.
State Farm moved for summary judgment based upon the untimely proof of loss and failure of the insured to protect the property from further damage. The insured argued that she substantially complied with post-loss obligations, that State Farm was not prejudiced, and that she was unable to immediately dispute the 2005 below-deductible estimate because of health issues. The trial court denied the motion and the matter proceeded to trial. State Farm moved in limine to keep the insured from discussing her health issues but was denied. A jury found the insured substantially complied with post-loss obligations and awarded the full cost of replacing the insured’s roof. State Farm’s post-verdict motion for a new trial was denied. State Farm appealed to the Fourth DCA.
The court addressed three issues: 1) whether the trial court erred in denying the State Farm’s summary judgment and directed verdict motions on the issue of compliance with post-loss obligations; 2) whether the trial court erred in denying State Farm’s summary judgment and directed verdict motions on the issue of prejudice, and 3) whether the trial court erred in denying State Farm’s motion in limine directed at the relevance and prejudicial nature of the insured’s health.
The court held as follows: 1) No. Whether an insured substantially complied with post-loss obligations is a question of fact. 2) No. Whether an insurer is prejudiced by an insured’s untimely compliance is a question of fact because while prejudice is presumed, it is rebuttable. 3) Yes. The insured’s health was irrelevant to any issue of the case.
Because the insured’s untimely proof of loss was not a complete failure to comply with the proof of loss post-loss obligation, whether her compliance was substantial, and whether such untimely compliance was prejudicial to the insurer, were questions of fact. While prejudice is presumed by the untimely compliance, the presumption is rebuttable and the insured complied “to some extent” and did so before filing the lawsuit. This created questions for the factfinder.
In making its decision, the court rejected State Farm’s reliance on Goldman v. State Farm Fire Gen. Ins. Co., 660 So. 2d 300, 306 (Fla. 4th DCA 1995), which held the insured’s failure to comply with a post-loss obligation that is a condition precedent to suit would preclude action on the policy, regardless of prejudice. The court distinguished Goldman because in that case the insured completely failed to comply with the policy obligation (examination under oath) before bringing the lawsuit. In the present case, the insured had supplied proof of loss, albeit late, before filing suit.
Further, because no provision of the policy allowed illness as an excuse for noncompliance or untimely compliance with the post-loss conditions, evidence of her health to prove she substantially complied with post-loss obligations or lack of prejudice was irrelevant, injected the possibility of sympathy from the jury, and should have been excluded. The Fourth DCA, therefore, remanded for a new trial.
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