Caselaw Wednesday – What if you only comply with a portion of your duties under an insurance policy?

We have previously discussed the importance of complying with post obligations here and here. We have also discussed why an insured MUST comply with a sworn proof of loss request in a prior post. In short, if you have an insurance claim for your home or business in Florida, you need to make sure you follow all post-loss conditions in the policy, including submitting a sworn proof of loss to the insurer, in a timely fashion. Otherwise, your claim could be denied. But what if the insurance company says that you have not fully complied and denied your claim as a result?

Florida’s Fourth District Court of Appeals recently handed down a decision that dealt with this issue. In Huertas v. Avatar Prop. & Cas. Ins. Co., Mr. & Mrs. Huertas suffered water damage to their property as a result of a plumbing leak. They filed a claim with Avatar, who requested an inspection and a sworn proof of loss. Avatar initially informed the Huertas that the loss was covered but after two months informed the insureds that the sworn proof of loss was insufficient and requested an examination under oath (EUO). Avatar then denied the claim citing the insureds inability to answer certain questions during an EUO and that the sworn proof of loss was not complete.

The Huertas sued, and Avatar moved for summary judgment because the Huertas did not satisfy all conditions precedent to recover under the policy namely the failure to answer questions at the EUO and the deficient sworn proof of loss. Summary judgment was granted on this issue to Avatar and the case went to the Fourth District Court Appeals.

The Court held that full compliance with all post-loss provisions is not necessary to recover under an insurance contract, only substantial compliance, or performance so nearly equivalent to what was bargained for that it would be unreasonable to deny’ the other party the benefit of the bargain. The summary judgment was reversed as there was questions of fact for a jury to decide. 

This case further highlights the importance of complying with your duties after a loss under an insurance policy. As this case highlights, as long as the compliance is substantial or nearly complete, a complete forfeiture of coverage should not occur. So, if you file an insurance claim in Florida, make sure you timely submit your sworn proof of loss and any other required documentation in a timely fashion and as complete as possible. If you need assistance complying with your policy obligations, contact the attorneys at Alvarez Law Group for a free claim review and to determine your rights.

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