172 So. 3d 473
Fla. Dist. Ct. App.2015Background
- Hurricane Wilma (Oct. 24, 2005) damaged Hernandez’s home; State Farm paid an initial claim shortly after the storm, including $27,800 for a full roof replacement.
- Hernandez completed the roof replacement in 2006 and, over 2006–2007, renovated much of the home without notifying State Farm or permitting inspections; many repairs were sparsely documented and allegedly paid in cash.
- In 2010 Hernandez retained a public adjuster and submitted a supplemental claim; his first sworn proof of loss sought $201,038.84 (including a $53,000 roof line-item that contradicted prior payments), later reduced to $168,346.12, and later testified repair costs were nearer $65,000.
- State Farm requested sworn proof of loss and documentation; it paid a small additional roof amount ($1,300) but denied the remainder and objected to appraisal based on Hernandez’s failure to comply with post-loss policy obligations and alleged misstatements.
- The trial court held an evidentiary hearing, found Hernandez had “sufficiently” complied, and compelled appraisal; State Farm appealed.
- The appellate court reversed, holding appraisal cannot be compelled where the insured has not fully complied with contractual post-loss obligations that affect coverage/insurer investigation.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether appraisal can be compelled before resolving coverage/noncompliance with post-loss duties | Hernandez: appraisal clause applies because amount of loss is disputed and he has sufficiently complied with post-loss duties | State Farm: Hernandez failed to comply with notice, cooperation, documentation, and submitted inconsistent sworn proofs of loss, preventing meaningful investigation | Court: Appraisal cannot be compelled until insured fully complies with all post-loss obligations; trial court erred in compelling appraisal here |
| Standard for triggering appraisal when post-loss compliance is contested | Hernandez: “sufficient compliance” permits appraisal even if some obligations not fully met | State Farm: “sufficient compliance” requires full satisfaction of post-loss duties before appraisal | Court: “Sufficient compliance” still requires satisfaction of all post-loss obligations before appraisal is triggered |
| Prejudice from delayed notice/poor documentation | Hernandez: late supplemental claim and sparse records do not bar appraisal | State Farm: delay and sparse/contradictory documentation deny insurer meaningful opportunity to investigate causation/amount | Court: Delay and inconsistent sworn statements materially prejudiced State Farm’s ability to investigate; appraisal barred until compliance remedied |
| Effect of inconsistent sworn proofs of loss on entitlement | Hernandez: later corrections and EUO testimony explain differences | State Farm: inconsistent sworn statements undermine credibility and may indicate fraud, justifying denial or resisting appraisal | Court: Inconsistencies are material; could preclude recovery and support refusal to proceed to appraisal until resolved |
Key Cases Cited
- Citizens Prop. Ins. Corp. v. Mango Hill # 6 Condo. Ass’n, 117 So. 3d 1226 (Fla. 2013) (distinguishes coverage questions from appraisalable amount disputes)
- U.S. Fid. & Guar. Co. v. Romay, 744 So. 2d 467 (Fla. 3d DCA 1999) (insured must comply with policy post-loss obligations before appraisal is triggered)
- State Farm Fire & Cas. Co. v. Licea, 685 So. 2d 1285 (Fla. 1996) (insurer may contest coverage when policy conditions like fraud or lack of notice exist)
- Citizens Prop. Ins. Corp. v. Mango Hill Condominium Ass’n 12 Inc., 54 So. 3d 578 (Fla. 3d DCA 2011) (appraisal cannot be compelled absent compliance with post-loss duties)
- State Farm Fla. Ins. Co. v. Cardelles, 159 So. 3d 239 (Fla. 3d DCA 2015) (reaffirms full compliance requirement; “sufficient compliance” means all post-loss obligations satisfied)
- Citizens Prop. Ins. Corp. v. Galeria Villas Condominium Ass’n, 48 So. 3d 188 (Fla. 3d DCA 2010) (no disagreement for appraisal until insurer had reasonable opportunity to investigate)
- Sunshine State Ins. Co. v. Corridori, 28 So. 3d 129 (Fla. 4th DCA 2010) (contrasting view from Fourth DCA about sequencing coverage before appraisal)
- First Home Ins. Co. v. Fleurimond, 36 So. 3d 172 (Fla. 3d DCA 2010) (citing Romay: insured must comply with post-loss obligations before appraisal)