Kramer v. State Farm Florida Insurance Co., 95 So. 3d 303

In Sept. 2004, Hurricanes Frances and Jeanne allegedly damaged the insureds’ roof; the policy requires immediate notice after a loss and a sworn proof of loss within 60 days; no action may be brought unless policy provisions are complied with.
The insureds did not give immediate notice or submit a sworn proof of loss within 60 days and decided the roof damage was not within the policy.
In 2008, a roof leak occurred; again no notice or sworn proof of loss was provided; the insureds determined repair costs were below the deductible.
In May 2009, after being advised by a person inspecting the roof that Frances/Jeanne may have caused damage, the insureds filed a claim; the insurer investigated, including an inspection, and in July 2009 sent a letter listing policy violations and referencing the notice and proof provisions.
In August 2009, the insurer notified that coverage could not be extended; the insureds sued for breach; the circuit court granted summary judgment for the insurer on prejudice due to breach of conditions precedent; the insureds appealed.
The court held that the notice and proof provisions are conditions precedent to suit, and untimely compliance creates a presumption of prejudice that the insureds failed to rebut; the insurer prevailed on summary judgment.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Are notice and proof of loss conditions precedent to suit?	Insureds argue they are not strict conditions; prejudice should control.	Insurer argues they are plain conditions precedent; noncompliance bars suit.	Yes, they are conditions precedent.
Is prejudice presumed from untimely notice and proof of loss and may it be rebutted?	Presumption should be rebuttable; engineer affidavit supports rebuttal.	Presumption applies and was not rebutted by insureds.	Presumption applies and insureds failed to rebut.
Does the engineer affidavit create a genuine issue of material fact to rebut prejudice?	Engineer shows damage cause not clear; supports lack of prejudice.	Affidavit does not negate prejudice; report suggests insurer’s inability to determine causation.	No genuine issue; prejudice stands.

Bankers Insurance Co. v. Macias, 475 So.2d 1216 (Fla. 1985) (presumption of prejudice for failure to report; may be rebutted by showing no prejudice)
Goldman v. State Farm Fire General Insurance Co., 660 So.2d 300 (Fla. 4th DCA 1995) (notice provisions can be conditions precedent vs cooperation clause)
Starling v. Allstate Floridian Ins. Co., 956 So.2d 511 (Fla. 5th DCA 2007) (notice and proof of loss within 60 days can be a condition precedent to suit)
Kroener v. Florida Insurance Guaranty Ass'n, 63 So.3d 914 (Fla. 4th DCA 2011) (prejudice analysis framework applied to notice provisions)