What Can Be Appraised
Submitted by Robert Gregory on 04 Feb, 2019
In a recent case out of the Third District Court of Appeals here in Florida, the court was tasked with determining which aspects of a homeowner’s claim would fall under the Appraisal provision.
The case, Garcia v. People’s Trust Insurance Company, centered around a roof leak at the insured residence in October 2016. People’s Trust elected to repair the damages noting that “… there is generally coverage for your loss as a whole. However… the scope of covered damages would not include [the] roofing system because those damages were caused by uncovered or excluded causes…” Ms. Garcia disputed the amount, as well as, the scope of damages to be repaired. People’s Trust then demanded appraisal per the terms of the policy, to which Ms. Garcia responded by filing suit.
People’s Trust then moved the trial court to stay the case and compel Ms. Garcia to comply with the appraisal process as outlined in the insurance policy. The trial court ultimately determined that the issue in the case is one of coverage (to be decided in litigation), not amount-of-loss (an issue that could be resolved in appraisal).
The Third DCA reversed finding that, because People’s Trust had not “wholly denied coverage,” the cause of loss still encompassed the amount-of-loss, which is a determination to be made by an appraisal panel. The Third DCA utilized the findings in Johnson v. Nationwide Mutual Insurance Co., 828 So.2d 1021 (Fla. 2002), to support their position.
In Johnson, the Florida Supreme Court held that if an insurer has not wholly and outright denied coverage, causation is an amount of loss issue that can be resolved in appraisal. This was an adaptation of the reasoning in Gonzalez v. State Farm Fire & Insurance Co., 805 So.2d 814 (Fla. 3d DCA 2000), wherein it was held that when an insurance carrier admits the loss is covered, but the amount to be paid is in dispute, the appraisers are to inspect and sort out the covered versus uncovered damages.
Based on the Third’s ruling in Garcia, we expect a number of challenges to be made under appraisal for cases that involve disputed claims both relating to scope and monetary value.