PEOPLE'S TRUST INSURANCE CO. v. ANDREA TRACEY and JAMES TRACEY, 251 So. 3d 931

Homeowners Andrea and James Tracey reported tornado-related wind damage to their roof and interior to People's Trust Insurance Company.
The insurer acknowledged coverage for interior damage but concluded the roof damage resulted from wear and tear (an excluded cause) and therefore excluded roof repairs; insurer offered $4,354 for interior repairs (less deductible).
The insureds submitted a proof of loss and estimates (one > $55k, one > $43k) that included roof repairs and sued for breach of contract when the insurer refused to pay for the roof.
The insurer demanded appraisal to resolve whether wind (covered) or wear and tear (excluded) caused the roof damage, asserting causation goes to the amount of loss for appraisal.
The trial court denied the insurer’s motion to compel appraisal, concluding the insurer had effectively denied coverage for the roof and thus causation was a coverage issue for the court.
The Fourth District reversed, holding that because the insurer admitted coverage for the claim as a whole (interior damage) and disputed the amount attributable to the roof, causation/amount-of-loss issues belong to appraisal.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether appraisal must be compelled to resolve causation/amount-of-loss for contested roof damage	Tracey: insurer’s letter effectively denied coverage for the roof; causation is a coverage question for the court	People’s Trust: insurer admitted coverage for interior damage and disputed the amount; causation falls within appraisal as an amount-of-loss issue	Appraisal compelled. Where insurer admits coverage for the loss as a whole but disputes amount (including whether roof damage is covered), appraisal decides causation/amount of loss.
Whether insurer waived appraisal rights	Tracey: insurer’s prior conduct and letter show waiver or forfeiture of appraisal right	People’s Trust: timely requested appraisal in response letter and sought appraisal promptly after suit; did not act inconsistently with appraisal rights	No waiver. Requesting appraisal in the claims response and moving to compel promptly preserved appraisal rights.

Johnson v. Nationwide Mut. Ins. Co., 828 So. 2d 1021 (Fla. 2002) (distinguishes coverage-vs-amount-of-loss: coverage questions if insurer wholly denies covered loss; appraisal for amount disputes when coverage admitted)
Kendall Lakes Townhomes Developers, Inc. v. Agric. Excess & Surplus Lines Ins. Co., 916 So. 2d 12 (Fla. 3d DCA 2005) (appraisal appropriate where insurer did not deny entire claim and disputed amount attributable to roof vs. interior)
Fla. Ins. Guar. Ass’n v. Castilla, 18 So. 3d 703 (Fla. 4th DCA 2009) (appellate review is de novo for legal questions about appraisal scope)
Fla. Ins. Guar. Ass’n v. Branco, 148 So. 3d 488 (Fla. 5th DCA 2014) (waiver of appraisal turns on whether insurer acted inconsistently with appraisal rights)