Overview | Blog Posts, Court Decisions | Related | Print | Share
Rodrigo v. State Farm Fla. Ins. Co., 39 Fla. L. Weekly D838, 2014 WL 1612494 (Fla. 4th DCA Apr. 23, 2014).
The Fourth District affirmed a summary judgment entered in favor of a homeowner’s insurer in a case involving an insured’s first-party claim for damage to her condominium, its contents, and related expenses allegedly caused by bodily fluids that leaked from a decomposing body in an adjoining condominium unit. The court held the insured was not entitled to payment because: (1) the insured failed to rebut the presumption that her failure to submit a sworn proof of loss prejudiced the insurer, (2) the insurer did not waive the sworn proof of loss requirement by tendering payment on the building damage claim, and (3) the policy’s coverage for personal property damage caused by an “explosion” does not include coverage for damage caused by a decomposing body’s cells explosively expanding and causing leakage of bodily fluids. The case is particularly significant because the court attempts to clarify case law and statutory provisions in the area of property coverage.
The insured in this case, Judy Rodrigo, owned a condominium unit she insured through State Farm. Her next-door neighbor died and the body went undiscovered for a number of days. Fluids seeped from the body and eventually infiltrated the walls into Rodrigo’s adjoining unit.
The insured made a claim upon State Farm for the damage, requesting coverage for building damage, personal property damage, and alternative living expenses. State Farm retained a contractor, who inspected the property and signed an appraisal award. State Farm tendered that amount but denied Rodrigo’s personal property damage claim outright. The insurance contract was a “named perils” policy to the extent of personal property damage, and State Farm deemed that a decomposing body was not one of the named perils.
Rodrigo filed suit against State Farm, claiming the appraisal award was invalid and State Farm breached the contract. State Farm moved for summary judgment on several bases, two of which were addressed in this opinion.
First, State Farm argued Rodrigo failed to satisfy a condition precedent by failing to provide a proof of loss—which the policy required before payment was owed. Rodrigo replied that State Farm waived the proof-of-loss requirement by making a payment on the building damage claim. Second, State Farm argued that the policy did not provide personal property coverage for damage caused by a decomposing body. Rodrigo argued that a decomposing body fell under the named peril, “explosion,” and submitted a licensed physician’s affidavit stating that ” the internal contents of [the deceased’s] body explosively expanded and leaked.”
The trial court found for State Farm on both arguments and entered summary judgment. Rodrigo appealed.
The court held that under section 627.426(1)(c), Florida Statutes (2007) (the claims administration statute), State Farm’s tendering of payment did not waive its right to a proof of loss. Therefore, it was the insured’s burden to rebut a presumption that her failure to submit a proof of loss was prejudicial to State Farm, and she failed to rebut that presumption.
Additionally, the court held there was no “explosion,” as the term is used in the policy. The court stated, “The plain meaning of the term ‘explosion’ does not include a decomposing body’s cells explosively expanding, causing leakage of bodily fluids.”
Based on these holdings, the appellate court affirmed the summary judgment for State Farm.
The court distinguished the Florida Supreme Court’s recent decision in State Farm Mut. Auto. Ins. Co. v. Curran, 2014 WL 1010658 (Fla. Mar. 13, 2014), where the court held that the compulsory medical examination (“CME”) provision in an automobile insurance policy providing uninsured motorists (“UM”) coverage was a condition subsequent, not a condition precedent and that the insured’s breach of the CME provision could not result in a post-occurrence forfeiture of insurance coverage without a showing of prejudice to the insurer. The Fourth District noted that Curran is a plurality decision that, to the extent of its authoritative value, is limited to “the unique subject of uninsured motorist coverage and compulsory medical exams.”
Based on these holdings, the appellate court affirmed the summary judgment for the insurer.
Since this opinion issued, Rodrigo has moved for and received an extension of time to file a motion for rehearing. Therefore, this opinion is not yet final.