Policyholder blocked repairs, now can't recover damages from insurer
A Florida Appeals Court upheld that an insured cannot recover damages from an insurance company if they failed to comply with the policy and failed to allow the insurer to make the necessary repairs.
Florida’s Third District Court of Appeal upheld without comment a Miami-Dade Circuit Court decision from 2020, that an insured cannot recover damages from an insurance company if they failed to comply with the policy and failed to allow the insurer to make the necessary repairs. The case is Rose v. Fla. Peninsula Ins. Co., No. 3D21-435, 2022 Fla. App. LEXIS 5183 (Dist. Ct. App. July 27, 2022).
The claim began almost a decade ago, in 2013, when the Roses said their home suffered water damage from a leak. The property was inspected on the day the damage occurred, and less than two weeks later, Florida Peninsula notified the Roses that it was exercising its option to repair, in keeping with the policy. The letter included a proof of loss form but specifically noted that Florida Peninsula was not requiring the Roses to complete the form. Between the date when Florida Peninsula invoked the right to repair and present, the insurer was never allowed to repair the Plaintiff’s property, despite its requests and a stay issued by a prior judge in the case.
In October 2013, the insurer said the claim would ultimately be denied if the repair work did not begin within 14 days. Despite that, the homeowners would still not allow the repairs, and their attorney alleged that the insurer invoking the repair clause was improper “for reasons left unstated,” and then requested copies of all estimates, communications, emails, and invoices between Florida Peninsula and its contractor.
In the complaint, the Roses argued that they had actually allowed access to the property and the insurance company had improperly denied the claim.
The judge found that the uncontested facts showed that Florida Peninsula exercised the option to repair the damage at the plaintiffs property consistent with the policy’s option to repair provision. According to the opinion, “[d]despite Florida Peninsula’s request and a court order, the plaintiffs failed and/or refused to allow the repairs to commence. Instead, they used threats and unsupported conditions to prevent the repairs from commencing. This was in violation of Florida law and the policy.”
Editor’s Note: One of the key components of any insurance policy is the insured’s obligation to comply with the policy provisions. One of the first policy provisions in a standard homeowners policy is that the insurer will provide the insurance described in the policy in return for premium and compliance with all policy provisions. Then in the Conditions section, the Duties After Loss provision outlines specific steps an insured is to comply with when a loss occurs, from promptly notifying the company or its representative to cooperating in the investigation of a claim and other duties. The policy language clearly states that failure to comply with the duties is prejudicial to the insurer, and that there is no duty to provide coverage if the insured fails to comply with the duties. In this case, the insureds refused to allow the insurer to repair the property; if an insured will not work with the insurer to have the damaged property repaired, then an insurer is no longer obligated to provide coverage for the loss.