Florida Hurricane/Storm Damage Insurance Claims – How Long Do I Have to Provide Notice to My Insurer Under My Insurance Policy?

Right now down here in South Florida, we are in the middle of Hurricane season, thankfully dodging a bullet down here in Miami with Tropical Storm Isaac.  Nevertheless, we were not so lucky with regards to the 2005 season, wherein Hurricane Katrina and Wilma decided to make a visit, and the 2004 season, wherein Hurricanes Frances and Jeanne decided to strike Florida.  Many homeowners throughout the Miami-Dade, Fort Lauderdale and  Palm Beach areas sustained some form of water, wind or flood damage from these storms, most notably roof and window damage.   As a result, many South Florida homeowners have sought the assistance of a Hurricane/storm damage or homeowners insurance claim lawyer to assist them in recovering moneys to fix their property (given the potential for an insurance company’s low damage estimate), or assist them in an insurance claim dispute regarding coverage under their policy.

A couple of the issues that arise quite frequently and which a homeowner should be aware of, are the notice and sworn proof of loss provisions contained within a property damage insurance policy.   Whether it is a flood, wind or homeowners insurance policy, there typically will be some type of language within the policy that states the insured shall give immediate notice to the insurance company after a loss has been incurred, and that the insured shall submit a sworn proof of loss within a certain amount of days of the loss, say 60 days.  These provisions are typically considered  “post-loss condition precedents,”  given that another provision in the policy will usually say that no action can be brought against the insurance company unless there was compliance with the policy provisions.  Given that the notice and sworn proof of loss provisions must be complied with, in cases where they are not, an insurance company may consider this a material breach of the policy by the insured, thereby allowing the insurance company to deny coverage under the policy.

Several cases have recently been decided which lend some clarity as to the amount of time an insured actually has to provide notice to their insurance company regarding a Hurricane damage claim (per the insurance policy provisions), after they have been the victim of a property damage loss.  In Kroener v. Florida Ins. Guar. Ass’n, 63 So.3d 914 (Fla. 4th DCA 2011), the Fourth District Court of Appeal held on June 22, 2011, that a homeowner who sustained interior and exterior damage (roof leak) from Hurricane Wilma and who notified their insurance company two years and two months after the loss, that this was not “prompt notice” as a matter of law (per the notice requirement in the insurance policy) and therefore barred their claims.

Then on July 18, 2012, the Fourth District decided Kramer v. State Farm Florida Ins. Co., 2012 WL 2913189 (Fla 4th DCA 2012), where a homeowner who sustained roof damage in 2004 from Hurricane Frances and Hurricane Jeanne, didn’t make a claim to their insurance company until May 2009, almost five years from the dates of loss.  The insureds did not immediately notify State Farm of the loss, nor did they submit a sworn proof of loss within 60 days of the loss (per the policy provisions).  State farm denied coverage, and the insured sued them for breach of contract under the insurance policy.  The Court noted that despite the fact that a notice of loss and a sworn proof of loss are conditions precedent to suit (because the policy also included a provision that said no action shall be brought unless there has been compliance with the policy provisions), if the insured breaches the notice provision[s], prejudice to the insurer will be presumed, but may be rebutted by a showing that the insurer has not been prejudiced by the lack of notice.  In this case, the insured was unable to rebut the presumption of prejudice, as the insured submitted an affidavit from an engineer that essentially said he could not determine the cause of the damage, whether it was from a hurricane or some other cause.  The Kramer court thus dismissed the insureds claim.  Of note, the Kramer court noted their prior decision in Kroener, stating that holding was based upon a record similar to this case, where the insurer argued that it was prejudiced by the insureds’ untimely pre-suit notice of the alleged loss, and the insureds did not come forward with counter-evidence sufficient to reveal a genuine issue as to whether the insurer was prejudiced, ie., one must still go through the analysis of whether the insurance company was prejudiced (ie., unable to determine the cause of loss) by such late notice from their insured.

Then on July 25, 2012, the Fourth District decided Soronson v. State Farm Florida Ins. Co., 2012 WL 3022349 (Fla 4th DCA 2012), where a homeowner sustained roof damage from Hurricane Wilma in 2005, yet did not notify State Farm until February 2009 (3 years 4 months) of the loss, when they filed a lawsuit against them for failing to pay benefits under their insurance policy.  The Court went through the same analysis as in the Kramer case, noting that although the homeowner failed to comply with their pre-suit notice requirements under the policy (both the immediate notice and submitting of the sworn proof of loss within 60 days of the loss), this merely created a presumption of prejudice against the insurer, but may be rebutted by a showing that the insurer has not been prejudiced by the lack of notice.  The homeowner submitted an affidavit that attached “unsworn” engineer reports.  The Court felt these documents were not sufficient to rebut the presumption of prejudice against State Farm in being unable to investigate the loss due to the late notice.  Again, the Soronson court noted their prior decision in Kroener, stating that holding was based upon a record similar to this case, where the was prejudiced by the insureds’ untimely pre-suit notice of the alleged loss, and the insureds did not come forward with counter-evidence sufficient to reveal a genuine issue as to whether the insurer was prejudiced.

Most recently, on August 1, 2012, the Fourth District decided Leben v. State Farm Florida Ins. Co., 2012 WL 3101336 (Fla. 4th DCA 2012), where a homeowner sustained roof damage from Hurricane Wilma in 2005, yet did not notify State Farm until February 2009 (3 years 4 months) of the loss, when they filed a lawsuit against them for failing to pay benefits under their insurance policy.  The Court went through the same analysis as in the Kramer and Soronson cases, noting that although the homeowner failed to comply with their pre-suit notice requirements under the policy (duty to provide  immediate notice), they were able to create an issue of fact as to the rebuttable presumption of prejudice against the insurance company. The homeowner submitted two reports, one from a leak detection company and another from a roofing company, both reports stating they could unequivocally say damage was caused by Hurricane Wilma despite the fact the homeowner made repairs after the storm. The Court felt these documents were sufficient to rebut the presumption of prejudice against State Farm in being unable to investigate the loss due to the late notice, thereby allowing them to go to trial and let a jury determine whether the late notice prejudiced State Farm’s ability to investigate the loss.

All homeowners should note that these cases above are related to Hurricane Wilma losses or before.  For analysis of statute of limitations and statutory notice requirements related to property damage and Hurricane/windstorm losses after May 17, 2011, see my previous post regarding the changes in Florida law in 2011.

Moral of the Story: Whether you are a homeowner that lives in Hollywood, Dania, Weston, Plantation, Aventura, Miami Beach, Bal Harbour, Coral Gables, Kendall, Pinecrest or another area within Miami, Fort Lauderdale or Palm Beach, after a Hurricane or windstorm, make sure to have your property inspected to determine if any damage was caused by the storm, especially the roof and windows.  That way, you will be able to comply with the notice requirements under your insurance policy and hopefully avoid an insurance claim dispute as referenced in the cases above.

Florida Homeowners Insurance Claims – HO-2 v. HO-3 v. HO-4 v. HO-6 v. HO-8, Insurance Policies Oh My

When living in South Florida, it is more important than ever for a homeowner or renter/tenant to secure insurance for the many different hazards that may affect one’s property.  After all, we are especially susceptible to tropical storms and Hurricanes in the Miami, Fort Lauderdale and Palm Beach areas.  Yet, even though we have not experienced a Hurricane in quite some time, having homeowners or renters  insurance can provide peace of mind given the many other perils which may occur and that can destroy one’s property, including fires, electrical surges, floods, sinkholes, tornadoes, lightning strikes, vandalism, theft, and/or sudden water losses from a burst pipe, faulty/broken plumbing or a failed seal in a water heater.

Whether your a single family homeowner that may have an HO-2, HO-3 (also know as an “All Risks” policy) or HO-8 policy, a condo owner that has an HO-6 policy, or a tenant/renter that has a an HO-4 policy, if you sustain a property loss (structure and/or personal property) and require a Miami, Florida, Hurricane or property damage insurance claim lawyer, there are legal issues an insurance company may raise depending on the type of policy you have,  and that you scratch your head and say, what is that.  Some of these issues may include the following:

    1. Actual Cash Value:  if a policy provides for actual cash value as opposed to replacement cost, this would be the amount of money it would  cost to purchase a similar item in like condition and quality in today’s market place, ie, the market value of the property that takes into consideration depreciation.  An example of depreciation is say carpet or other types of flooring that has a useful life of say 10 years but at the time of loss was 5 years old, the market value of the carpet would be less than the replacement cost, as the market value would take into consideration this wear and tear over the years and reduce the value of the property.
    2. Replacement Cost: if a policy provides for the replacement cost of damaged property, this would be the amount of money it would take to purchase the same type of property of like kind and quality in today’s market place.
    3. Alternative Living Expenses: also known as ALE, alternative living expenses may include the reasonable expenses incurred to relocate for the time it takes to repair an uninhabitable property, such as staying in a hotel for days or weeks,  excess food expenses above what one normally would spend, transportation expenses in case you need to travel greater distances than normal, and storage expenses, just to name a few.  It is important to save your receipts in order to prove that these expenses were actually incurred.
    4. Loss of Use: an interchangeable term with alternative living expenses (ALE) on a Miami, Florida, homeowners insurance policy, loss of use damages are paid when a homeowner incurs excess expenses during the time it takes to repair an uninhabitable property.
    5. Deductible: the amount of money the policy holder must pay out of pocket before the insurance company will start paying from your insurance coverage.  For instance, a Miami, Florida, homeowner may have a $5,000 deductible on a windstorm policy, and when a Hurricane damage insurance claim is made, if the property damage claim is adjusted at $15,000, the insurance company will pay you a net of $10,000, ie., minus the $5,000 deductible.
    6. Exclusion: within a homeowner’s policy, there will be certain provisions called exclusions that an insurance company may cite to in order to deny a claim.  Common exclusions cited in a homeowner’s insurance policy could include mold (given that is it something that grows over time), flood (you would need to purchase a separate flood policy), landslides/sinkholes (ie, earth movement), neglect/wear and tear (policies cover water damage caused by sudden and unexpected losses, such as a burst pipe or a water heater that explodes), a sewer backup, loss caused by intentional destruction, and ordinance/law (such as construction to bring a house up to code), just to name a few.  However, insurance companies typically offer a homeowner the opportunity to purchase coverage that normally would be excluded.

As you can see, whether you are a homeowner/tenant in Coral Springs, Cooper City, Hallandale, Boca Raton, Homestead, Key Biscayne, Weston, Pompano Beach, Tamarac, Wilton Manners, Hialeah or another area within Miami, Fort Lauderdale or Palm Beach, there is a lot to think about when it comes to your insurance policy and potential property damage disputes and claims that may occur.