A recent opinion of Florida’s Fourth District Court of Appeals involving a Hurricane Wilma homeowner’s claim has a rather startling decision, and not a good one for the policyholder side. The case Hunt v. State Farm highlights the need for policyholders to pay close attention to their claim, their insurance policy language and any communication they receive from their insurance company. This is particularly true given the results of this case on the requirement to file a proof of loss.

As background, it has been my experience that most homeowner’s property policies in Florida require a policyholder to file a Proof of Loss (POL) ONLY WHEN REQUESTED by the insurance company. For the most part, a POL, if asked for at all, is taken to acknowledge a settlement. As an example, once the policyholder and the insurance company adjuster agree on the terms of the settlement, the insurance adjuster may ask the policyholder to sign a proof of loss.  Nothing wrong with this as it offers some protection to both sides since it memorializes the agreement or terms of the settlement as stated on the proof of loss form. Other times a demand for a POL is used to flush out a policyholder as to exactly what it is they are filing a claim for as well as the stated amount of their loss. Since the POL is a sworn statement, a person who files a statement of claim containing false, incomplete or misleading information, may be guilty of insurance fraud.

A proof of loss filing requirement in a National Flood Insurance Policy can be contrasted to private policy requirements in that a proof must be filed within 60 days after the flood event unless waived by an authorized official from FEMA.

While not all the facts are known about the Hunt case, clearly when a claim is filed years after the event (in this case close to five years after a hurricane) the insurance company certainly has a legitimate concern and a need to ask for information about the loss and damages. In this case a late filing was fatal to this policyholder. Under their policy, the Hunts were required to provide State Farm with immediate notice of any loss, and to submit a signed, sworn proof of loss “within [sixty] days after the loss.” Despite this requirement, the Hunts did not provide State Farm with a signed, sworn proof of loss until almost five years later, mere days before they filed suit against State Farm for breach of contract. The Hunts argued that their untimely pre-suit submission of a sworn proof of loss did not preclude them from recovery under the policy. The courts did not agree.

If the insurance company requests you file a POL or if, as in the Hunt case, the policy very specifically requires a proof within 60 days, a policyholder should pay very close attention to this requirement and comply.

Finally, under either requirement, (i.e., at our request, or file within 60 days) you can always ask the insurance company for an extension for the filing deadline date.  This should “always” be in writing and the approval to your request should be in writing from an authorized official having the authority to grant the requested extension.

In closing, if unsure of your status on your post loss requirements, proof of loss or otherwise, there are a number of consumer resources available you may want to consult which may include getting a legal opinion from a qualified lawyer based on the facts of your loss and your policy conditions and requirements. 

A proof of loss form and its request can be a benign insurance form or as in the Hunt case, a fatal blow to coverage for your loss and damages.

If you have questions regarding any property insurance claim related issues please call 800.321.4488 or contact us to submit a question to one of our public adjuster or insurance claim experts.