Source: https://insuranceclaimsbadfaith.typepad.com/insurance_claims_badfaith/proof-of-loss/
Timestamp: 2019-04-25 11:54:10+00:00

Document:
WIND 2019: THE 20th ANNUAL CONFERENCE ENRICHES THE DISCUSSION.
Photograph by Dennis J. Wall.
The Annual Conference of the Windstorm Insurance Network, or WIND, turned 20 this year. The 20th Anniversary WIND Annual Conference was held at Walt Disney World. Some 1,200 people attended. The Annual Conference attendees, like the members of WIND, are professionals in the property insurance claim process. At the WIND Annual Conference they present the policyholder sides and the insurance company sides of major property insurance issues.
WIND picks its speakers and its session topics through the work of its Speakers Committee. This group of about ten people has the charge of staying on top of speakers and current issues for the Annual Conference and, from what I saw myself this year, they do their job well.
For example, one current issue or "hot topic" of discussion in property insurance circles is clearly what explains the handling of catastrophe claims resulting from the 2017 Hurricanes and other catastrophes then and since. As one presenter explained, first of all we had not had a catastrophe for a number of years.
Taking Hurricanes in Florida as an example, the last major Hurricanes to hit Florida came in 2004 and 2005, named Charlie, Frances, Ivan and Jeanne in 2004, and named Katrina and Wilma in 2005. So it had been awhile before Hurricanes Harvey, Irma and Maria struck Texas, Florida, and Puerto Rico the hardest, in 2017.
All panelists were in agreement on the central ingredient for success in handling catastrophe claims (as well as other kinds of claims): Communication. If you say that you are going to call the policyholder every Friday to update her on the status of her claim, for example, then make the telephone call that you said that you would make, even if all you have to tell her that week is that there is nothing new but that you will call again when there's been a development.
Notice is a big issue in recent Catastrophe Claims handling. Panelists conjectured about the reasons for the increase in such issues in recent years. One suggestion was that higher deductibles may be contributing to late notice to insurance companies, because policyholders with the higher deductibles may conclude that the claim could not reasonably exceed the amounts of their deductibles, but of course the amounts of the claims resulting from catastrophes usually present a second catastrophe, the first being the loss itself, and the second being the amount of indemnity that is required as a result of the loss.
Tying into the idea of high deductibles generally being a cause of late notice, other presenters suggested that late notice of claims after recent catastrophes may have been caused at least in part by the implementation of high Hurricane deductibles. Many of the high Hurricane deductibles, they pointed out, took effect just before Hurricane Harvey in 2017.
Another suggestion came out of the nature of the catastrophes such as Hurricane Irma, in which the catastrophe claims were apparently largely based on wind-driven rain which causes damage that does not show up until later.
Countering these suggestions was the basic and simple notion that it doesn't cost anything to report a claim (not even the cost of a stamp, I might add, since the advent of Fax and email, although keeping a paper copy of a letter put in the mail is still probably a very sure way of incontestably giving notice).
Another current issue is the evidentiary effect, if any, of insurance companies' pre-catastrophe inspection reports.
Managed repair was a popular topic. Once coverage is accepted by an insurance company for even a part of the loss -- such as coverage for repair of the damaged property -- then, according to the discussion at another panel, the policyholder would have the right to an appraisal, even in a repair situation.
Whatever the state of coverage that might exist in that situation, once again the idea is current and under discussion by those involved in property insurance claims and will come as no surprise to the attendees of this year's 20th Anniversary WIND Annual Conference.
WIND 2019: THE 20th ANNUAL CONFERENCE CONTINUES THE CONVERSATION.
WIND, which stands in for Windstorm Insurance Network, blew into Walt Disney World for its 20th Annual Conference recently. WIND has grown from an initial membership of some 350 people into a roll call of about 1,300. They come from 36 States, and from other countries including Singapore, France, and Germany.
About 1,200 people attended the Annual Conference in 2019. WIND members and the people who tend to attend the Annual Conference as well, are all professionals representing policyholder and insurance company sides of property insurance disputes, in basic and simple terms.
The sessions I attended this year generally proved the WIND format, which is not unique to WIND but works everywhere it is used to present insurance issues as far as I can see: A panel of four presenters, for example, would have one policyholder lawyer, one policyholder public adjuster, one insurance company representative or independent adjuster, and one defense attorney to present points of view.
The panel presenting Commercial Policies and Claims followed this model. Like every other session I attended, the panel that presented this topic emphasized the long-standing truth that the insurance policy is the starting point for the answer to every insurance coverage question.
Whether presenters said that "the insurance policy is king," or compared purchasing a policy to going to the store where what you come out with depends on what you get, the central idea behind every issue is always what the policy says.
Besides expressing eternal truths, as it were, the panelists at WIND raised cutting-edge questions in property insurance for all participants to consider. An example of current questions is whether there is coverage under property insurance policies for experts' assistance to policyholders in adjusting or presenting claims under their policies? The suggestion was raised that perhaps good arguments in favor of coverage for that assistance would be available under coverage for Adjustment Expenses, whatever the coverage might be called in a given policy.
Another suggestion was that perhaps there is such coverage available under Extra Expense coverage. Whatever the source of coverage there might be for that particular expense, the idea is new and current and will come as no surprise to the attendees of this year's 20th Anniversary WIND Annual Conference.
Coverage, if any, Before Appraisal; Evidence Sometimes Required First.
Policyholders' alleged breach of Proof of Loss requirements in their Homeowner's Insurance Policy resulted in reversal of an Order to Appraise their Hurricane Wilma Damage Claims, until the Coverage Issue of Proof of Loss compliance was determined, in Download Sunshine State Insurance Co. v. Corridori (Fla. 4th DCA Case No. 4D09.2502, Opinion Filed February 3, 2010), attached Official Slipsheet Opinion at 1, also reported as Sunshine State Insurance Co. v. Corridori, 2010 WL 366599 *1 (Fla. 4th DCA February 3, 2010)(subscription required to access Westlaw).
The Policyholders in that case had previously presented a Hurricane Wilma Damage Claim under their same Homeowner's Insurance Policy, which the Homeowner's Insurance Company paid and resolved. "Two years later," they filed what was denominated "a supplemental claim" for additional Damages. In response to the supplemental claim, the Homeowner's Insurance Company requested a Proof of Loss as required by the Policy and also requested Examinations Under Oath. The Policyholders returned an allegedly "incomplete and inaccurate" Proof of Loss after the time for doing so had passed, and apparently their EUOs were not scheduled although this is not clear from the Court's opinion.
The Homeowner's Insurance Company denied the supplemental claim. The Policyholders filed a petition to compel Appraisal of their supplemental claim. The Trial Court ordered Appraisal, concluding "[w]ithout taking any evidence," that the original claim and the supplemental claim were different and that the Policyholders had not breached their Homeowner's Policy. Download Sunshine State Insurance Co. v. Corridori (Fla. 4th DCA Case No. 4D09.2502, Opinion Filed February 3, 2010), at 1; Sunshine State Insurance Co. v. Corridori, 2010 WL 366599 *1 (Fla. 4th DCA February 3, 2010).
The Florida Appellate Court reversed. In Florida as in most if not all jurisdictions, it is generally held that Insurance Coverage issues must be resolved before there can be an Appraisal of the amount of a loss. Insurance Coverage issues, moreover, must be determined by a Court in Florida, not by a panel of Appraisers. Since the Policyholders argued that they complied with Policy conditions including for Proof of Loss and that their breach, if any, of the Insurance Policy was not material, the case presented a Question of Fact as to the degree of the Policyholders' compliance with the Policy requirements. "The trial court, without taking any evidence, did not resolve this dispute of fact with competent evidence to support its determination of coverage." Download Sunshine State Insurance Co. v. Corridori (Fla. 4th DCA Case No. 4D09.2502, Opinion Filed February 3, 2010), at 1-2; Sunshine State Insurance Co. v. Corridori, 2010 WL 366599 *1-*2 (Fla. 4th DCA February 3, 2010).
Various Cases dealing with Appraisals under First-Party Policies, as in Corridori, are examined in Dennis J. Wall, "Litigation and Prevention of Insurer Bad Faith" § 11:2 (Second Edition, Shepard's/McGraw-Hill; 2009 Supplement West Publishing Company). Examinations Under Oath are the subject of discussion in id. § 11:8, and Proofs of Loss are mainly addressed in id. § 11:9, among other Sections.
Waiver of First-Party Policy Conditions, And No "Do Over"!
A Proof of Loss requirement in a First-Party Insurance Policy is a condition precedent to successfully pursuing Coverage under that Policy. A Proof of Loss requirement can also be waived.
Llerena v. Lumbermens Mutual Casualty Co., 379 So. 2d 166, 167 (Fla. 3d DCA 1980)(subscription required to access Westlaw or Southern Second), not available on the Florida Third District Court of Appeal's web site where archived Online Opinions at this time only go back to July 18, 2001.
Further, once the waiver has been established, the Florida Courts have held that it is irrevocable. "Once the insurer waives the giving of proof of loss, such waiver is irrevocable." American Bankers Insurance Co. v. Terry, 277 So. 2d 563, 564 (Fla. 3d DCA 1973).
Attention must be paid to Proof of Loss requirements, both by Counsel for the Policyholders and Insureds, and by Counsel for the Insurer.
There is a post on Insurance Claims and Issues Web Log, on April 1, 2010, about a case in which Proof of Loss provisions were construed earlier this year.

References: v. 
 v. 
 v. 
 v. 
 v. 
 v. 
 § 11
 § 11
 § 11
 v. 
 v.