DISTRICT COURT OF APPEAL OF THE STATE OF FLORIDA

FOURTH DISTRICT

PEOPLE'S TRUST INSURANCE COMPANY,

Appellant,

v.

ANDREA TRACEY and JAMES TRACEY,

Appellees.

No. 4D17-3945

[July 25, 2018]

Appeal of non-final order from the Circuit Court for the Fifteenth 

Judicial Circuit, Palm Beach County; Jeffrey Dana Gillen, Judge; L.T. Case 

No. 502017CA005429XXXXMB.

Raoul G. Cantero, Ryan A. Ulloa and Iesha S. Nunes of White & Case 

LLP, Miami, and Jonathan Sabghir and Brett R. Frankel, Deerfield Beach, 

for appellant.

Juan Ramirez Jr., of ADR Miami LLC, Coral Gables and Alberto M. 

Regueyra of Regueyra & Llerandi, P.L., South Miami, for appellees.

MAY, J.

An insurer challenges a trial court order denying its motion to compel 

an appraisal. We reverse the order because causation and the “amount of 

loss” are issues to be determined by an appraisal where the insurer has 

not “wholly denied” there is a covered loss.

The insureds sustained damage to their roof and their home’s interior. 

They filed a claim with their insurer for all the damage caused by wind 

from a tornado. The insurer investigated the claim and sent a letter to the 

insureds confirming coverage, but limiting the “amount of loss.” The letter 

contained the following:

THERE IS COVERAGE UNDER THE POLICY FOR THIS LOSS 

AS A WHOLE; HOWEVER, THE SCOPE OF DAMAGES 

COVERED BY YOUR POLICY INCLUDES ONLY THE 

INTERIOR DAMAGES BUT DOES NOT INCLUDE YOUR 

ROOF. 
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We have completed our investigation of your claim, and based 

upon what we were provided and what you reported, and 

additionally, based upon our claim investigation, there is 

generally coverage for your loss as a whole. However, and 

more specifically, our investigation revealed that the roof leak 

you reported stemmed from age-related wear and tear and 

deterioration; general mechanical breakdown or latent defect; 

and/or faulty, inadequate or defective maintenance of the 

roofing system - none of which are covered causes of loss. 

Therefore, in our opinion, the scope of covered damages would 

not include your roofing system because those damages were 

caused by uncovered or excluded causes, but would provide 

coverage for resulting ensuing damages to the interior of your 

home. Therefore, we believe our obligation is to repair only 

those damages to the interior of the home. If you are not in 

agreement with that assessment, the question of whether the 

scope of repairs should include the roof, can be resolved in 

appraisal (see below). 

The letter included a proposed scope of repairs for the interior totaling 

$4,354 (less a $2,500 deductible). The insureds disagreed with the 

insurer’s position and submitted a proof of loss. They obtained two 

estimates, one totaling $55,718.85 and the other totaling $43,507.77. 

Both estimates included the roof repairs.

In response, the insurer demanded an appraisal to determine whether 

the roof damage was caused by wind (a covered cause) or wear and tear 

(an uncovered cause). 

The insureds filed a breach of contract action against the insurer. The 

insurer moved to compel an appraisal. It argued that the issue of 

causation is for the appraisal panel because it goes to the amount of loss. 

The insureds replied that the cause of the roof damage was a coverage 

issue to be determined by the trial court.

The trial court concluded that, because the insurer made a 

“predetermination” that the roof was not covered, the issue could not be 

submitted to appraisal. 

All right. I’m going to deny the motion to abate and deny the 

motion to compel appraisal without prejudice. You may think

this is a clear case but it is not at all clear to me because it 

does seem very – and if it’s a form letter, it’s problematic, it 

seems to be, but it seems pretty clear from the April 11, 2017 
3

letter that the – there is some question – well, quite frankly, 

that the defendant People’s Trust has denied coverage with 

respect to the leaky roof even though they have accepted –

acknowledged coverage with respect to the damage that the 

leaky roof has caused on the interior of the home. So, to me, 

that is not clear and if there had not been that 

predetermination, I might otherwise had compelled appraisal, 

but under these circumstances, I won’t. 

And the reason – well, as I said, I’m making this determination 

without prejudice. If it’s determined later on down the road 

after some discovery has taken place that an appraisal is 

warranted, then, by all means, I will order. 

The trial court entered an order denying the insurer’s motion to compel 

appraisal. It is from this order that the insurer appeals.

We have de novo review as the issue is a legal one. Fla. Ins. Guar. Ass’n 

v. Castilla, 18 So. 3d 703, 704 (Fla. 4th DCA 2009). 

“[C]ausation is a coverage question for the court when an insurer 

wholly denies that there is a covered loss and an amount-of-loss question 

for the appraisal panel when an insurer admits that there is covered loss, 

the amount of which is disputed.” Johnson v. Nationwide Mut. Ins. Co., 

828 So. 2d 1021, 1022 (Fla. 2002) (emphasis added). In other words, when 

an insurer admits coverage and disputes the amount of loss, causation is 

to be determined by an appraisal panel. See Kendall Lakes Townhomes 

Developers, Inc. v. Agric. Excess & Surplus Lines Ins. Co., 916 So. 2d 12, 

15-16 (Fla. 3d DCA 2005). 

In Kendall Lakes, the insured asserted that Hurricane Irene caused 

both interior water damage to a building, and damage to the roof tiles. Id. 

at 13. The insurer’s investigation concluded that the interior water 

damage was not caused by a covered loss, but that the roof tiles were 

covered. Id. at 14. The insured claimed over $700,000, but the insurer 

agreed to pay only $1,000. Id. The Third District concluded that the issue 

was an “amount of loss” and not a coverage issue because the insurer did

not deny the whole claim. Id. at 16. The court held the dispute was 

appropriate for the appraisal process. Id. 

Similarly, here, the insurer admitted coverage for the interior damage,

but declined to repair the roof. In short, the insurer did not “wholly deny” 

coverage. There is only one claim, and it includes both the roof and the 

interior of the same home. It is unlike cases which involved separate 
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buildings or separate claims. See, e.g., Pernas v. Scottsdale Ins. Co., 1:15-

CV-21506-KMM, 2016 WL 471949 (S.D. Fla. Feb. 8, 2016) (a single claim 

for damage to two separate buildings); Sunshine State Ins. Co. v. Corridori, 

28 So. 3d 129 (Fla. 4th DCA 2010) (involving an original claim and a 

“supplemental claim” filed two years after the original claim was paid and 

closed).

The insureds’ waiver argument lacks merit. The insurer requested an 

appraisal in its response letter to the claim and filed a motion to compel 

appraisal upon answering the insured’s complaint. See Fla. Ins. Guar. 

Ass’n v. Branco, 148 So. 3d 488, 493 (Fla. 5th DCA 2014) (“[T]he question 

of waiver of appraisal is not solely about the length of time the case is 

pending or the number of filings the appraisal-seeking party made. 

Instead, the primary focus is whether the[y] acted inconsistently with their 

appraisal rights.”). 

We therefore reverse and remand the case to the trial court to compel 

an appraisal.

Reversed and Remanded.

WARNER and GROSS, JJ., concur.

* * *

Not final until disposition of timely filed motion for rehearing.