DeCosta v. Allstate Insurance Co.
2013 U.S. App. LEXIS 19400
| 1st Cir. | 2013Background
- Flood loss at DeCosta’s Warwick, RI property March 31, 2010; SFIP issued by Allstate via FEMA; Allstate paid some claims and DeCosta sued for remaining covered losses; two initial proofs of loss were for building damages and depreciation; a separate 16-page adjuster estimate of $212,071.32 was not sworn by DeCosta; Allstate paid $102,659.03 and DeCosta accepted that payment; later additional building damages were claimed but untimely; FEMA waived the sixty-day limit for the second set of proofs of loss, but waiver was not sought for the unsigned estimate; court treated SFIP proof-of-loss strict compliance as a condition to recovery and to suit.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether DeCosta complied with the SFIP proof-of-loss requirement | DeCosta signed and submitted Allstate's proofs of loss with 'undisputed' notes and attached adjuster estimate | Unsigned adjuster estimate cannot satisfy the signed-and-sworn requirement for all claimed sums | No; strict compliance required; unsigned estimate fails |
| Whether the appraisal clause could resolve disputes about coverage or only value | Dispute concerned scope of coverage, not just value | Dispute fell outside appraisal scope | Appraisal not properly invoked; coverage issue unresolved |
| Whether waiver by FEMA could bar recovery for additional sums | Allstate paid on properly filed claims; equitable waiver could apply | Waiver requires express written consent; not present for unsigned estimate | Waiver not established; recovery barred by strict compliance |
Key Cases Cited
- McGair v. Am. Bankers Ins. Co. of Fl., 693 F.3d 94 (1st Cir. 2012) (strict compliance with SFIP provisions the governing rule)
- Mancini v. Redland Ins. Co., 248 F.3d 729 (8th Cir. 2001) (unsigned proof-of-loss not sworn defeats compliance)
- Phelps v. Federal Emergency Management Agency, 785 F.2d 13 (1st Cir. 1986) (sovereign immunity and waiver considerations constrain noncompliance defenses)
- Jacobson v. Metro. Property & Cas. Ins. Co., 672 F.3d 171 (2d Cir. 2012) (uniform strict SFIP interpretation; enforce proof-of-loss requirements)
- Flick v. Liberty Mut. Fire Ins. Co., 205 F.3d 386 (9th Cir. 2000) (Appropriations Clause requires precise compliance for federal flood claims)