State Farm Florida Ins. Co. v. Hernandez, No. 3D13—2263, 2015 WL 3757773 (Fla. 3d DCA June 17, 2015)
The court held that an insured homeowner must be insufficient compliance with all post-loss policy obligations before the court may exercise its discretion to compel an appraisal.
After Hurricane Wilma struck Miami on October 24, 2005, and insured homeowner filed a claim for the repair of property damage to his house. About one month later, the insurance company, State Farm Florida Insurance Company, paid the insured $36,858.80 to cover the repairs, including $27,865 for a full replacement of the roof. The insured did not complete the roof repair until almost a year later, in 2006, because he was unable to acquire the proper roof tiling.
Sometime after State Farm’s initial payment, the insured noticed additional damage allegedly caused by Hurricane Wilma, including water stains, damage to the wiring and walls, and leaking in the roof. Based on these additional damages, the insured made extensive renovations to his house, replacing tiles, sinks, tubs, toilets, faucets, light fixtures, cabinets, appliances, and windows, and repainting various areas around the house. These repairs were completed in early 2007. The insured did not notify State Farm before, during, or after making these repairs.
In 2010, five years after the original loss, the insured filed a supplemental claim for the alleged additional damages caused by Hurricane Wilma. The amount the insured claimed for the supplemental loss changed over time. First, the insured signed a proof of loss in the amount of $201,038.84. Later, the insured signed the second proof of loss and reduced the amount claimed to $168,346.12. The amount claimed was reduced after he realized that the prior amount included monies already paid by State Farm to replace the roof. Then, in May 2011, while testifying at his examination under oath, the insured once again reduced the amount claimed, stating that he spent $65,000 to make additional repairs, rather than the $201,038.84 he claimed in his first proof of loss.
In October 2011 State Farm paid an additional $1,300, instead of the amount claimed of $65,000. In response, the insured sued and moved to compel appraisal. State Farm objected because the insured had failed to comply with his post-loss obligations. It argued that the insured failed to provide timely notice of the supplemental claim, failed to cooperate, failed to produce supporting documents for the loss and that the insured had breached the concealment or fraud provision regarding the supplemental claim.
The trial court found that, although the insured did not fully comply with post-loss obligations, he had sufficiently complied with post-loss obligations and entered an order compelling appraisal.
The issue addressed by the court was whether the trial court erred in compelling an appraisal.
The court explained that an insured must comply with all post-loss obligations before the appraisal clause can be triggered. The court noted that “sufficient compliance” requires all post-loss obligations to be satisfied.
The insured did not comply with “several” of his post-loss obligations. The Third DCA explained that “[t]hese breaches [were] both substantial and material.” Specifically, the insured: