Supplemental claims are becoming more common, especially on large projects where additional loss and damage may be discovered while completing the repairs or replacement. But what happens when the insurance company places conditions or limitations not contained within the policy upon the submission of a supplemental claim for additional or missed damages?


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On Wednesday, Florida’s Third District Court of Appeal issued an opinion affirming a trial court’s order compelling appraisal of a homeowners’ supplemental Hurricane Katrina claim.1 The insureds, the Cardelles, had filed claims with State Farm after Hurricanes Katrina and Wilma in 2005. After each hurricane the insureds reported property damage to State Farm. They obtained estimates from a contractor and their public adjuster and submitted sworn proofs of loss for each claim.


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Before you agree to settle your insurance claim, make sure that you have no additional or supplemental claims stemming from the original you want to collect on.

A federal court recently ruled in favor of the carrier on a motion for summary judgment on the issue of whether an insured could assert an additional claim based on an amended proof of loss after the insured had agreed to a settlement. The case, State Automobile Property & Casualty Company v. There is Hope Community Church,1 involved a church building damaged by fire.
 


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In response to my previous post, The Time to Hesitate is Through – Superstorm Sandy Proofs of Loss are Due April 28, 2014, a reader commented and asked the following question:

Can the Insured file a supplemental [Proof of Loss (POL)] or are they stuck with the amount the Insurer may have already paid in response to their initial POL?

After receiving the comment, I decided it would be better to have a full post instead of just a simple response in the comments section, as many readers might have the same question.


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How often do insurance companies get it right the first time? If they don’t, whose responsibility is it to correct them and give them a second chance? As demonstrated through litigation on many hurricane claims, the insurance companies may tell you it is the policyholder’s responsibility to notify them of newfound damage after a claim has already been resolved. Recently, Judge Robert N. Scola, Jr., of the United States District Court for the Southern District of Florida, disagreed with that logic, holding that a policyholder did not have to give the insurance company a second chance before suing it.


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Continuing on with last week’s post on late notice claims, this week I want to expand on Shaun’s post from last week about the difference between supplemental and reopen claims. Blurring the distinction between the two is an easy way to confuse the issues that may result in the denial of an otherwise valid claim. That is why it is so important to keep the two separate.


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Continuing with our discussion regarding late notice and prejudice defenses asserted by insurers, when is a re-opened hurricane claim a “supplemental claim?” This issue often presents itself in the context of a demand for appraisal by the policyholder on a re-opened hurricane claim. Insurance carriers treat the re-opened claim as a “supplemental claim” because a certain amount of time has passed since its claim determination. What would the time criteria for a “supplemental claim” be: one month; one year; two years; three years; four years? The issue of time is not a factor in the test of whether a re-opened claim is in fact “supplemental.”


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