Appraisal Goes Forward Even Though Insurer Has Yet to Determine Coverage on Additional Claims
The trial court's order granting the insured's motion to stay litigation and compel an appraisal was affirmed even though the insurer had not determined coverage on the insured's additional claims.Heritage Prop. & Cas. Ins. Co. v. Wellington Place HOA, 2023 Fla. App. LEXIS 6405 (Fla. Ct. App. Sept. 13, 2023).
The insured homeowner's association reported roof damage to its insurer, Heritage, after Hurrican Irma struck. Heritage agreed the damage was covered, but issued no payment because the amount of loss was less than the deductible.
The insured hired its own adjuster. The insured requested an extension of the policy's two year time limit to complete repairs because the claim was still in dispute and the insurer had not yet paid sufficient funds to allow necessary repairs. Heritage sent a revised estimate and asked the insured to send its adjuster's estimate in order to address any disputes. The insured submitted its adjuster's estimate of more than $6 million, including, for the first time, the cost to replace all the windows and sliding glass doors.
The insured demanded an appraisal. The record did not reflect whether Heritage ever responded. Nevertheless, the insured filed suit for breach of contract. After filing suit, the insured moved to stay the litigation and compel appraisal. Heritage responded that the estimate of damages to the windows and doors was a "supplemental" damage claim, not ripe for appraisal, because the insurer had yet to determine coverage. The trial court granted the insured's motion and found the claim was ripe for appraisal as to the amount of loss because the insurer admitted a covered loss had occurred and had been given sufficient information to assess the claim.
The appellate court agreed with the insured. This policy required a "reopened" or "supplemental" claim for hurricane damage to be reported to the insurer within three years after a hurricane. But the policy was silent as to whether a new coverage decision was required for a "reopened" or "supplemental" claim where the insurer had already admitted coverage for the initial claim. Heritage admitted coverage for the loss as a whole and determined the initially reported roof damage was covered. The claim was never settled and was still open when the insured subsequently reported additional roof damage and damage to its windows and doors.
Therefore, the insured's claim was ripe for appraisal. The parties' disagreement as to whether the insurer was required to pay for the additional damage was an "amount-of-loss" issue for appraisal to resolve, not a covered issue. The order staying the litigation and compelling appraisal was affirmed.
