In the recent case of Rainforest Chocolate, LLC v. Sentinel Insurance Company, Ltd.,1 the Supreme Court of Vermont found coverage for Rainforest where Sentinel’s “false pretense” exclusion turned out to be ambiguous as there were at least two reasonable interpretations of what constituted “physical loss or physical damages.”2
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In October 2016, Guillermo Acosta and Laura Pirela (the “Insureds”) suffered a water loss at their home and filed an insurance claim.1 The insurer inspected the property and then invoked the ‘elect to repair provision’ under the policy that stated as follows:

If a peril causing a loss and related damage are covered (other than sinkhole loss) and repairs are necessary to protect covered property from further damage, [the Insureds] must notify [the Insurer] before authorizing or commencing repairs so [the Insurer], at [its] option, may select Rapid Response Team, LLC™ to make the covered Reasonable Repairs.

* * * * *

If [the Insureds] and [the Insurer] fail to agree on the amount of loss, which includes the scope of repairs, either may demand an appraisal as to the amount of loss and the scope of repairs.

* * * * *

The scope of repairs shall establish the work to be performed and completed by Rapid Response Team, LLC™. Such repair is in lieu of issuing any loss payment to [the Insureds] that otherwise would be due under the policy.


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Being that FAPIA falls on the cusp of Halloween this year, there will be lots of fun themed events to look forward to. On Saturday night, October 27, Venture Construction Group will be hosting a Scary Insurance Claims Cocktail Party. Venture will also be sponsoring brunch on Sunday October 28. Be sure to throw some hairspray in your bag because on Sunday evening, October 28, FAPIA is putting on a Public Adjusters Rock Concert featuring Titans of Rock, a Journey and Bon Jovi Tribute Band.
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In December of last year, my colleague Ashley Harris discussed Security First Insurance Co. v. Florida Office of Insurance Regulation,1 where the Florida Fifth District Court of Appeal (Fifth DCA) upheld the Office of Insurance Regulation (“OIR”) prohibition of proposed language in an insurance policy that would require “all insureds, all additional insureds and all mortgagees” named on a policy to consent to any post-loss assignment of benefits (“AOBs”) to a third party.
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Florida’s Federal Middle District believes it can.1 After Hurricane Irma struck its commercial building in Port Charlotte, Florida, building owners Etcetera, Etc, Inc., filed an insurance claim under their policy with Evanston Insurance Company (“Evanston”). Evanston began its investigation, and as that was underway Charlotte County also inspected the building and issued a “Notice of Unsafe Building” stating the building “was in danger of collapse.”
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This past week, I had the pleasure of attending the Florida Association of Public Adjusters (“FAPIA”) conference in Ft. Myers, Florida. FAPIA President, Jimmy Farach did a wonderful job spearheading the event, along with the help of Nancy Dominguez and many others. They also did a great job selecting the venue; the Sanibel Harbour Marriott Resort and Spa was lovely and I had a great experience with their management and staff.
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Generally, in Florida, when there is a difference of opinions between each party’s expert, the jury gets to decide who’s right, not the judge. But there has been a trend by insurance companies in the first-party property context of taking their expert’s report before the judge and arguing, in essence, “our expert’s right, the insured’s is wrong, so find in favor of the insurance company as a matter of law.”
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In Arizona, the statute of limitations for a cause of action for insurance benefits will begin to run from the date the insurer committed a breach, unless the policy states otherwise (i.e., from the “inception of” or “date of” loss). Typically, this means from the date the insurer denies claim benefits to its insured.1
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