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Failure to Timely File a Sworn Proof of Loss Could Impact Coverage

Pekar Law, P.A. June 23, 2014

A recent Florida controversy over property damage to a condominium resulting from an exploding corpse has come to a close. The plaintiff in this case was a condo owner and State Farm insured. Her upstairs neighbor died in the unit and was not found for weeks. Gases had built up in the body cavity causing it to rupture and the corpse was only found after neighbors complained about the smell. The rupture caused body fluids to leak into the walls and ceilings of the plaintiff’s apartment below. The condominium association did eventually renovate the unit to eliminate the odor and damage, but the effects of the situation were still present in the plaintiff’s unit.

The plaintiff filed a claim with her property insurance carrier for damage done to her unit, her personal property and living expenses. She argued that the rupturing of the body cavity was equal to an explosion and that an explosion was a covered peril under her policy. The court relied on past cases to direct them and decided that because terms must be taken in their plain meaning, the term explosion does not include the rupturing of a body cavity. Therefore, this event did not qualify as an explosion.

More importantly, this case may impact Florida law relating to policy conditions requiring a proof of loss. Although the insured provided invoices to prove the costs, the insured failed to submit a proof of loss as required by the policy. The court applied case law addressing late notice of a claim to the insured’s failure to provide a proof of loss. Florida law holds that once late notice is established, the insurer is presumed prejudiced by the late notice and the insured bears the burden of showing that the late notice did not adversely impact the insurer. The court similarly required the insured to show that the failure to provide the proof of loss did not prejudice the insurer, State Farm. The court held that the insured had not met that burden. The judge further held that the insurer, State Farm, did not waive the requirement to submit a proof of loss by negotiating the amount of the loss with the insured.

The decision in this case shows the importance of following technical details when filing an insurance claim. Call Pekar Law P.A. if you are looking for a careful and skilled attorney to handle your property insurance matter.