Opinion ID: 2812344
Heading Depth: 2
Heading Rank: 2

Heading: QBE Denies 200 Leslie’s 2010 Claim

Text: While its lawsuit was pending, 200 Leslie provided QBE with a sworn Statement in Proof of Loss (the “proof of loss”) on a form supplied by QBE. The proof of loss was executed by Richard Vilain, a member of 200 Leslie’s board of directors. In the proof of Loss, 200 Leslie stated that its “whole loss and damage” 5 Case: 13-15228 Date Filed: 06/26/2015 Page: 6 of 16 from Hurricane Wilma was $10,934,677.49. However, 200 Leslie attached cost estimates for roof and window replacements, which totaled $10,934,677.49 and $7,907,404.43, respectively. 200 Leslie altered the proof of loss form supplied by QBE. The proof of loss form supplied by QBE also included a statement that “no articles are mentioned herein or in the annexed schedules but such as were destroyed or damaged at the time of said loss” (emphasis added). Counsel Golant struck a line through that language, and Vilain placed his initials next to the marking. Golant struck the language because he believed that it was not an accurate description of the benefits under the policy given that, based on his interpretation of the policy, 200 Leslie was entitled to certain benefits beyond the replacement value of items that were directly damaged by the hurricane. Specifically, Golant concluded that it was not possible to give a figure for 200 Leslie’s “whole loss and damage” while also stating that the figure included only damaged property. After 200 Leslie submitted the altered proof of loss, QBE’s third-party managing agent requested that 200 Leslie provide an inventory of damaged and undamaged property, pursuant to the policy’s terms. By the time of the bench trial in the district court, QBE had not received from 200 Leslie the inventory of damage and undamaged property that it had requested. Furthermore, the attachments to the proof of loss do not specify which windows were damaged and 6 Case: 13-15228 Date Filed: 06/26/2015 Page: 7 of 16 which were not. Indeed, nobody associated with 200 Leslie knew which windows or sliding doors were damaged and which were not damaged. This impacted the work of Andrew Bertucci, the claims adjuster working for QBE’s third-party managing agent in 2010. QBE also sent 200 Leslie a letter demanding an examination under oath of the 200 Leslie representative with the most knowledge of (1) the quantum of loss; (2) the cause of the loss; (3) the maintenance history of the buildings; (4) the preparation of the claim; (5) any repairs of the damaged property and any estimates for repair; and (6) whether 200 Leslie or the owners of individual units are responsible for repairing or replacing windows and sliding glass doors that provide access to single units. In response, 200 Leslie produced Vilain, who was then the president of 200 Leslie’s board, for an examination under oath. In his only preparation for the examination, Vilain met with Golant and reviewed the proof of loss for approximately five minutes. As a result, Vilain did not know the answers to many of the questions asked at the examination. On September 21, 2012, while 200 Leslie’s Third Amended Complaint was pending in the district court, QBE sent to 200 Leslie a letter denying its claim in the entirety. QBE based its decision on, inter alia, its conclusion that 200 Leslie failed to comply with its post-loss obligations. 7 Case: 13-15228 Date Filed: 06/26/2015 Page: 8 of 16