Flood Insurance Coverage Dispute
December 1, 2014
This case pertains to a motion by the insurer for summary judgment. The dispute is over a flood insurance claim. This case is Lusco v. Allstate Ins. Co., No. 13-66342014, WL 3796423 (E.D. La July 30, 2014).
The Standard Fire Insurance Company, a participant in the Federal Emergency Management Agency's Write Your Own Flood Insurance Program, issued a standard flood policy to Lusco. When Hurricane Isaac hit on August 29, 2012, Lusco suffered property damage.
An independent adjuster inspected the property, and Lusco requested an advance payment of $15,000 for the covered building damage and a $5,000 advance payment for covered contents damage. Standard Fire approved these payments. In October 2012, Lusco submitted a signed and sworn proof of loss to Standard, contending that his building and contents losses totaled $75,076.12. Standard approved this payment.
When FEMA extended the proof of loss submission deadline for Hurricane Isaac-related claims to April 28, 2013, Lusco did not submit any additional proof of loss. However, on December 12, 2013, Lusco sued Standard Fire and his windstorm insurer (Allstate Insurance Company). On June 26, 2014, Lusco submitted an additional estimate of flood-related damage. Standard Fire filed a summary judgment motion seeking a dismissal of Lusco's claims, alleging that Lusco failed to submit a timely signed and sworn proof of loss to support his supplemental claim.
The United States District Court for the Eastern District of Louisiana noted that the Standard policy mandates that an insured who suffers flood loss to his property send the insurer a proof of loss within sixty days after the loss. The policy also declares that the insured may not sue the insurer to recover money under the policy unless the insured has complied with all the requirements of the policy.
The court also noted that courts interpret and enforce such provisions strictly; several rulings from the Fifth Circuit were quoted in support of this stance. Foremost among these rulings is the fact that the insured must provide a signed and sworn proof of loss within sixty days after the loss, or within any extension authorized by FEMA. The failure to submit a complete sworn proof of loss with supporting documentation is fatal to a claim for flood damage. In this instance, FEMA extended the proof of loss submission deadline to April 28, 2013. Lusco had until this date to submit a proof of loss for the additional sums he claims he is owed. He did not do so.
Standard Fire alleges that Lusco failed to submit a timely proof of loss for any additional amounts he seeks to recover beyond those provided in the October 20, 2012 proof of loss, which was paid in full by Standard. Lusco countered that by submitting the October 20, 2012, proof of loss which he later supplemented on June 26, 2014, with a detailed itemized estimate of the damage, he substantially complied with the proof of loss requirements. The court was not impressed with Lusco's position.
The court said that in strictly enforcing the applicable regulations, the Fifth Circuit has foreclosed Lusco's arguments that he need not submit a timely, signed, and sworn proof of loss when he seeks additional payments, as well as his argument that he substantially complied with the proof of loss requirements. The court found that the rule barring recovery absent submission of a timely sworn proof of loss applies regardless of whether it is an initial claim by an insured or a supplemental claim. In this case, Lusco failed to submit a timely, signed, and sworn proof of loss for the supplemental claim he makes, and this failure is fatal to his claim.
Standard Fire's motion for summary judgment was granted, and Lusco's claims were dismissed.
Editor's Note: This case is an example of the old saying "rules are rules." The insured had a definite deadline to submit his sworn proof of loss; he failed to do so; his claim was dismissed.
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