Insurance Company and Insurance Agent Were Deemed Same Entity Regarding Notice Requirements

In Siguenza v. Citizens Prop. Ins. Corp. (Fla. 3d DCA 2013), the insurer, Citizens, denied a claim based on late notice and insured sued for breach of contract, testifying that she gave prompt notice directly to insurance company.

Citizens contradicted testimony through affidavit, prompting insured to file affidavit clarifying that she gave prompt notice to insurance agent. The court granted summary judgment in insurer’s favor, finding the insured’s subsequent affidavit in contradiction with her testimony. Appellate court reversed, ruling a material question of fact existed regarding timeliness of loss since insured considered the insurance company and the insurance agent to be the same entity and since the policy provided that prompt notice could be given to either one.

Insured’s Failure to Comply With EUO Requirements Was a Breach of the Policy’s Cooperation Clause

Citizens Prop. Ins. Corp. v. Ifergane (Fla. 3d DCA 2012)

This case involved a coverage dispute with regard to a wind-only dwelling policy issued by Citizens Property Insurance Corporation. The policy was issued solely to Alexandra Ifergane and provided coverage with respect to a house in which Alexandra resided with her then-husband, Haim.

In October of 2005 the house sustained damages during Hurricane Wilma. The following month Alexandra and Haim divorced and Alexandra thereafter executed a quit claim deed to Haim, assigning him all of her rights and interests in the home. When a tender was made to Citizens for the 2005 damages, Citizens sought to take examinations under oath of Haim and Alexandra. Alexandra declined to comply with the requests, asserting that she was not obligated to sit for an EUO since she had assigned to Haim all of her rights and interests in the property.

In response, Citizens filed an action for declaratory judgment against the Iferganes, seeking a determination regarding its coverage obligations. Citizens sought, inter alia, a determination as to the validity of the quit claim assignment, a declaration that Alexandra is obligated to appear for an EUO (examination under oath) and to comply with other policy conditions, and a determination that Alexandra’s failure or refusal to comply with the EUO request and policy conditions constituted a breach of contract precluding recovery under the policy as a matter of law. Alexandra moved to dismiss the complaint and Haim, in turn, filed a cross-motion insisting that Alexandra’s alleged failures could not be imputed to him because he was an innocent resident spouse co-insured under the policy.

Ultimately, the proceedings led to the entry of three distinct orders which were all at issue on appeal before the Third District. First, was an order granting, with prejudice, Alexandra’s motion to be dismissed as a party. The Third District ruled that this order was properly entered since, by virtue of the valid assignment, Alexandra no longer had an “actual, present, adverse and antagonistic interest in the subject matter of the amended complaint ….” There were two other orders reviewed: an order of final judgment and an order granting Haim’s motion for partial summary judgment as to coverage. The court reversed both, ruling that these orders were erroneously entered. The two reasons provided were, first, because there were genuine issues of material fact as to whether Haim was entitled to coverage as a resident spouse on the date of loss and, second, because the assignment from Alexandra to Haim did not relieve Alexandra of her post-loss obligations (as opposed to rights) as a named insured under the policy.

Insurer Was Not Required to Participate in Appraisal Where the Insured Failed to Comply With Appraisal Requirements

Citizens Prop. Ins. Co. v. Casar (Fla. 3d DCA 2013)

The Casars, insured with Citizens under a homeowners’ policy, filed a claim for water damage alleged to have been caused by a refrigerator line leak. After two inspections, Citizens concluded that the damage to only some of the items claimed were caused by the leak. Because Citizens also valuated the damages at a disagreeable amount, the Casars sent a written demand for appraisal of the entire claim.

In response, Citizens forwarded an appraisal agreement that listed for appraisal only those items all parties agreed were damaged by the water. Because Citizens excluded from appraisal any of the items determined not to have been damaged by the leak, the Casars refused to sign the agreement and Citizens, in turn, declined to proceed with appraisal.

The trial court granted the Casars’ ensuing motion to compel appraisal, but the third district reversed on appeal. The court’s rationale was grounded in contract law: “The appraisal provision of the Citizens’ policy unambiguously requires a written request for appraisal and a written agreement between the parties in order for appraisal to take place. …. Citizens complied with the appraisal provisions of the Policy [by] forward[ing] an Agreement for Appraisal. The Casars would not agree to the terms. Therefore, appraisal could not take place. Citizens complied with the policy provisions and, as such, the trial court had no basis to compel Citizens to appraisal.”