Martinez v. Universal Property & Casualty Insurance Company

Fifth DCA

Martinez v. Universal Property & Casualty Insurance Company—(J. Evander; 5DCA; 2/9/23).

This is a homeowner’s insurance case. I have largely stopped summarizing these, but this one has an issue that could pop up in any plaintiff-vs.-insurer case. The insurer denied the insured’s claim because the insured failed to file a sworn proof of loss prior to filing suit against Universal. The insurance policy at issue provided that in case of a loss to covered property, Insureds were required to send Universal “within 60 days after [Universal’s] request,” a sworn proof of loss. The policy further stated that no action could be brought against Universal under the policy “unless the policy provisions have been complied with.”

Because the Insured never sent a sworn proof of loss before filing suit, the trial court granted summary judgment for the insurer. The insured appealed. The DCA reversed. While the insurer did not perform a condition precedent to filing suit, Universal actually denied the claim prior to the date upon which the insureds were required to submit that proof of loss. When an insurer denies in advance that it has any liability under the policy coverage, the formal filing of a proof of loss becomes, in the eyes of the law, a useless and unnecessary thing that would accomplish nothing. An Insured may avoid forfeiture resulting from a breach of a proof of loss condition by proving that the insurer was not prejudiced, and here the fact that Universal did not wait for the condition to be satisfied and moved straight to denying the claim shows that they were not prejudiced. Reversed and remanded.

Terry P. Roberts
Director of Appellate Practice Fischer Redavid PLLC
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