Tag Archives: Conditions Precedent

Legal Action Against Us Clause

While the timeframe to file a legal action is generally defined under the Statute of Limitations, in some states an insurance policy can contractually establish a shorter period to file a legal action. In a recent California case, Keller v. Federal Insurance Company,1 the Ninth Circuit upheld a Legal Action Against Us clause, finding the … Continue Reading

Compliance with Policy Conditions After a Denial of Coverage

In Florida, an insurer’s denial of coverage constitutes a waiver of its right to require an insured to comply with policy conditions before filing suit.1 But, what if insured requests an insurer to reconsider its coverage denial before filing suit? Does the request to reconsider nullify the insurer’s previous denial of coverage requiring the insured … Continue Reading

Is Substantial Compliance with a Proof of Loss Enough?

The purpose of a sworn proof of loss is to enable the insurer to properly investigate the circumstances of a loss while the occurrence is fresh in the minds of the witnesses, to prevent fraud, and to enable it to form an intelligent estimate of its rights and liabilities so it may adequately prepare to … Continue Reading

Court Upholds Policy Suit Limitations Provision and Holds Appraisal Award Unenforceable for Failure to File a Timely Lawsuit

This blog has often discussed the importance of carefully reading your insurance policy. It is imperative to know of your rights should your insurance claim become problematic. It is crucial to know the policy’s suit limitation clause as well as your state’s statute of limitations, so you don’t miss the filing deadline. Once this period … Continue Reading

Proof of Loss: Can an Insurer Deny Coverage and Later Argue the Claim is Barred Because the Insured Did Not Comply with the Proof of Loss Condition?

Insurers on occasion deny coverage or make claim decisions based on one ground, and then later, during litigation, seek to avoid liability based upon an entirely new defense theory. Although coverage decision letters regularly throw in boilerplate language seeking to avoid waiving coverage defenses, I was recently asked whether an insurer can deny coverage or … Continue Reading

Insurance Company Has to Have Reasonable Requests Pursuant to the Policy

When submitting a claim to an insurance company, a policyholder has certain obligations that must be followed. The insurance policy contract lists the obligations. The policy document was written by the insurance company and approved (most of the time) by the insurance regulatory agency for the state where the property is located. Insurance contracts are … Continue Reading

Recent Florida Case on Submission of Proof of Loss – Why is There Not a Fact Question for the Jury to Decide?

Florida’s 4th District Court of Appeals (“4th DCA”), recently issued an opinion relating to compliance with post-loss duties in a property insurance case.1 The issue centered on whether the policyholder breached their duties under the insurance contract by not timely submitting a sworn proof of loss. The trial court decided that the policyholder could not … Continue Reading

Six Month Delay in Reporting Property Damage Claim was not “Prompt Notice” According to Eleventh Circuit

If an insured fails to provide prompt notice of its property loss, it can often be grounds for denial of coverage. Most policies have a provision that notice be given promptly, immediately, or as soon as practicable. The question then becomes what is “prompt notice”? In PDQ Coolidge Formad, LLC v. Landmark American Insurance Company,1 … Continue Reading

Compliance With Examinations Under Oath – Supreme Court of Florida Authority Hot Off The Press

Many moons ago (on October 26, 2012, to be precise), I blogged about compliance with examination conditions. That blog noted conflicting views as to what is required of a policyholder under the policy’s condition for examination under oath (in the property insurance context) or compulsory medical examination (in the health, disability, or long-term care insurance … Continue Reading

Carolina Coverage – Producing records Can Mean Physical Delivery

Last week, my post, Carolina Coverage – Are All These Documents Really Necessary, highlighted the Chavis case, in which the North Carolina Supreme Court ruled the Plaintiffs were justified as a matter of law in refusing to sign an overly broad release for records. But when it comes to producing documents requested by an insurance … Continue Reading

Consequences of Failing to Comply with Request for Examination Under Oath and Submission of Insufficient Proof of Loss in Texas

While working on a case for recovery after hail pummeled a homeowner’s roof, I found a recent case that discussed Texas law regarding Examinations Under Oath (EUO). In this case, the insurer demanded that the EUO be videotaped. When the insured refused to submit to a videotaped EUO, the issue of failing to comply with … Continue Reading

Insurance Policy Conditions (a/k/a/ Land Mines): Part 26 – EUOs Continued …Who Can Be Present At Which EUO?

It is not uncommon these days to see an Examination Under Oath (“EUO”) provision (usually by way of endorsement) that reads along these lines: You, an ‘insured’ seeking coverage, must submit to recorded statements and examinations under oath, while not in the presence of any other ‘insured’, and sign the same. Also, your representative, including … Continue Reading

Insurance Policy Conditions (a/k/a/ Land Mines): Part 7 – Damage Inspection

Most policies contain a post-loss condition requiring the insured to show the insurer damaged property “as often as [the insurer] reasonably require[s].” It is rare to find a policyholder bothered by the fact that an insurance company over-inspected damages during claim adjustment. Sure, sometimes insurers request one inspection after another in an effort to exhaust … Continue Reading

Insurance Policy Conditions (a/k/a/ Land Mines): Part 2 – Compliance With Examination Conditions

In my October 13, 2012, blog post, I gave an overview of what will be an ongoing blog topic – post-claim / pre-suit insurance policy conditions. Today’s topic is compliance with examination requests. It is clear from the case law that examination policy conditions (e.g., Examination Under Oath (“EUO”) and Compulsory Medical Examination (“CME”) policy … Continue Reading

Late Notice–When is Late Too Late?

A case issued yesterday shows when late notice is simply far too late. The policyholders lost in Kramer v. State Farm Florida Insurance Company,1 because they had no proof that the insurer was not prejudiced by the late notice of the loss. There should be an asterisk to this post because the lesson is that if … Continue Reading

Has The True Purpose Of An EUO Been Lost In The Recent “Cottage Industry Of EUO Litigation” In Florida Courts?

According to a recent Florida appellate court, it has. What a great description of the strategic basis for the increasing litigation in Florida regarding compliance with examinations under oath. Attorneys, adjusters and others involved in the first-party property insurance claims industry are likely aware of the tactics some insurers use to pull the rug out … Continue Reading

What Constitutes a Sufficient Request for an Examination Under Oath?

During litigation, whether insureds complied with their duties to submit to requested Examinations Under Oath (EUO) can become a major issue. One way to combat an insurer’s accusation of non compliance is to research the actual “request” and determine whether it was sufficient. The sufficiency of the request will depend on the exact language in … Continue Reading