October 26, 2021

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Be Mindful of Differing Policy Terms and Definitions

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An insured should be mindful that the same term in one homeowners insurance policy can have a different interpretation in another homeowner’s insurance policy. Goldberg v. Universal Property is a prime example of such a case.1

In Goldberg, after an insured sustained hurricane damage to his condominium unit, he filed a homeowners insurance claim asserting interior damage, which included damage to his personal property. The carrier then inspected his home but only issued coverage for the insured’s dwelling (Coverage A) and denied that any of his personal property was covered under the policy (Coverage C).

In response, the insured alleged that he had a proposal showing damages to his dwelling exceeded the carrier’s estimate. Here, the relevant policy provision stated:

You must give notice of a claim, a supplemental claim, or reopened claim for loss or damage caused by the peril of windstorm or hurricane, with us in accordance with the terms of this policy and within three years after the hurricane first made landfall or the windstorm caused the covered damage. For purposes of this Section, the term “supplemental claim” or “reopened claim” means any additional claim for recovery from us for losses from the same hurricane or windstorm which we have previously adjusted pursuant to the initial claim.…2

Despite the carrier asking him to provide more information under this policy language, the insured never provided a competing proposal showing additional damages to his dwelling and never provided an inventory list describing his damaged personal property.

The insured then obtained legal counsel who requested various categories of documents from the carrier. His counsel also did not submit any competing estimate showing damage to the insured’s dwelling or to his personal property. When the carrier failed to respond to the insured’s request for documents, the insured filed a one-count Complaint alleging that the carrier breached its contract by failing to pay for all benefits due and owing under the policy. During litigation, the carrier moved for summary judgment alleging that the insured failed to submit an estimate or a supplemental claim before filing suit. After review of the parties’ arguments, the trial court granted the carrier’s motion for summary judgment.

An appeal before the Fourth District Court of Appeal followed. One issue before the appellate court was whether the insured was required to submit a supplemental claim before he filed suit for the additional payment for the loss to the dwelling under Coverage A. In analyzing the positions of both parties, the appellate court noted the varying interpretations of the term “supplemental claim” that existed among different homeowners insurance policies but found the “no action” clause at issue in this case required that the insured file a supplemental claim for damages to the dwelling before filing suit. The court’s opinion stated:

The policy, in this case, states that one of the insured’s duties after loss is to notify Universal of a “supplemental claim” caused by the peril of windstorm or hurricane within three years of the storm making landfall. The policy defines a “supplemental claim” for the purpose of this section as “any additional claim for recovery from us for losses from the same hurricane or windstorm which we have previously adjusted pursuant to the initial claim.”3

Regarding the insured’s requirement to submit a supplemental claim for his personal property damage, the appellate court reached a different result. The court found that because the carrier failed to pay any amount for the insured’s personal property loss, those actions constituted a denial of coverage and a waiver of its right to insist the insured’s compliance with policy requirements.

In all, the court’s holdings demonstrate the need for insureds to be mindful of the relevant language in their policy, and the importance of not assuming that every policy term will be interpreted the same way in all circumstances.
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1 Goldberg v. Universal Prop. & Cas. Ins. Co., 302 So. 3d 919, 925 (Fla. 4th DCA 2020).
2 Goldberg, 302 So. 3d at 920-21(emphasis added).
3 Goldberg, 302 So. 3d at 923.

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