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**File size:** 92.28 KB

FEMA Flood Insurance Appeal Decision #D1

BUILDING COVERAGE: $25,000PERS. PROPERTY COVERAGE: $17,000DATE OF LOSS: September 2022DATE OF DENIAL: March 2023APPEAL SUBMISSION DATE: March 2023APPEAL ELIGIBILITY DATE: April 2023PROPERTY DESCRIPTION: Single-family unit in a two-story condominium building.POLICYHOLDER’S APPEAL: The policyholder appeals the insurer’s denial and seeks payment for condominium loss assessments. [1]Result: Concur with DenialBASIS FOR DECISION UNDER THE STANDARD FLOOD INSURANCE POLICY (SFIP): [2]The SFIP will pay up to the Coverage A limit of liability, the policyholder’s share of loss assessments charged against them by the condominium association in accordance with the condominium association’s articles of association, declarations, and the deed. The assessment must be made because of direct physical loss by or from flood during the policy term, to the unit or common elements of the National Flood Insurance Program (NFIP) insured condominium building in which the unit is located. (See SFIP (III)(C)(3)(a)).The SFIP will not pay any loss assessment that results from a deductible under the insurance purchased by the condominium association insuring common elements. (See SFIP (III)(C)(3)(b)(2)).The SFIP covers a condominium association’s loss assessments to an insured property for direct physical damage by flood. This does not include an assessment from the condominium association for property not covered by the SFIP, such as the cleanup of debris, sand, landscape lighting, repairs to parking lots, decks, sidewalks, and pools. [3]FEMA reviewed the policyholder’s assessment letter submitted on appeal. The assessment letter states it is for uninsured losses for property damages from Hurricane Ian. However, the letter does not provide any details as to what the uninsured losses are.In case of a loss or request for payment, the SFIP requires the policyholder to provide a signed and sworn-to proof of loss with the documentation that supports the loss and dollar amount requested. (See SFIP (VII)(G)(3)-(5)). If the policyholder can obtain a more detailed breakdown of the loss assessment(s), the policyholder should submit it directly to the insurer for review.For these reasons, the insurer properly denied coverage for the condominium loss assessment, as the policyholder has not proven the assessment is for damages due to direct physical loss by or from flood.*Delivery of this Appeal Decision concludes your appeal. 44 C.F.R. § 62.20(f)(3). If you do not agree with this decision, please refer to the SFIP for options for further action. The appeals process does not extend the one-year period to file suit against the flood insurer that began when the insurer first denied your claim in writing. 44 C.F.R. § 62.20(f)(4).**You may request a phone discussion with a FEMA flood insurance expert regarding this Appeal Decision by emailing FEMA-FI-Appeals@fema.dhs.gov and referencing the FEMA Appeal Decision number. Such discussions are for informational purposes only. FEMA will not reopen the appeal or consider new information during any phone discussion.*
[1] 44 C.F.R. § 62.20. All appeal-related documents are on file with FEMA [hereinafter “Appeal File”].[2] *See*44 C.F.R. § 61.13 (2016); Dwelling Form available at 44 C.F.R. pt. 61 App. A(1).[3] *See* FEMA’s NFIP Claims Manual, Section 1: SFIP Forms – Dwelling Form (Oct. 1, 2021).
  
      
            Related Resources
Appealing Your Flood Insurance Claim (fema.gov)
NFIP Claims Manual, October 2021 (fema.gov)
Flood Smart Glossary
Flood Smart | How to Appeal a Flood Insurance Claim Payment





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