When I wrote my first blog on this site in 2009, I discussed proofs of loss at length. Since Hurricane Michael, these blogs have received a lot of traffic and discussion from people trying to navigate their way through the claims process. An issue that keeps coming up is whether a policyholder must comply with a proof of loss request after the insurer has admitted coverage and made payment.
As I said almost ten years ago, each situation is different. Sometimes it may be advisable to file a proof of loss even if the requirement has been waived. Other times it may not be. But, generally speaking, Florida case law has held that the proof of loss requirement has been waived once the insurer admits coverage and pays the undisputed amounts owed.
In 1939 the Florida Supreme Court reviewed a lawsuit over a pair of fires at a commercial building in Pensacola.1 The first fire was resolved quickly with the insurer paying an agreed upon amount for the damages. The second fire caused a small amount of additional damage, the amount of which was ultimately disputed by the carrier.
An issue arose as to whether the policyholder had complied with the proof of loss requirement on the second fire. Finding that the insurer had waived the proof of loss requirement, the court stated:
It is our view that the insurer admitted liability in some unagreed amount immediately after the second fire sufficiently to waive the formal proof of loss. . .
Nearly 40 years later, Florida’s Third District Court of Appeal cited Bear as binding precedent in American Bankers Ins. Co. v. Terry, 277 So.2d 563 (Fla. 3rd DCA 1973). The court stated:
In Bear it was held that upon the insurer admitting liability in some agreed amount, such was sufficient to waive the formal proof of loss. . .
The court went on to state,
The subsequent filing of a proof of loss by an insured does not operate to set aside the previous waiver of proof of loss by the insurer. . . . Once the insurer waives the giving of proof of loss, such waiver is irrevocable.
Under this line of cases, an insurer would waive its right to a proof of loss if it has already admitted coverage and made partial payments towards the amounts owed. But again, this analysis can change depending on the circumstances. So before refusing a proof of loss request you should always contact an experienced professional to determine what is best for your specific situation.
1 Bear v. New Jersey Ins. Co., 189 So. 252 (Fla. 1938).