Ambrose v. United States

106 Fed. Cl. 152, 110 A.F.T.R.2d (RIA) 5564, 2012 U.S. Claims LEXIS 980, 2012 WL 3292905
CourtUnited States Court of Federal Claims
DecidedAugust 3, 2012
DocketNo. 11-64T
StatusPublished
Cited by4 cases

This text of 106 Fed. Cl. 152 (Ambrose v. United States) is published on Counsel Stack Legal Research, covering United States Court of Federal Claims primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ambrose v. United States, 106 Fed. Cl. 152, 110 A.F.T.R.2d (RIA) 5564, 2012 U.S. Claims LEXIS 980, 2012 WL 3292905 (uscfc 2012).

Opinion

OPINION

ALLEGRA, Judge:

In this tax refund suit, plaintiffs claimed a casualty loss deduction under section 165 of the Internal Revenue Code of 1986 (the Code) based on the loss of their home to a fire. Although their home was insured, plaintiffs failed to file, on a timely basis, documentation required by their policy, and coverage was denied. Plaintiffs challenged that denial in court, but lost. They then took the deduction in question on their Federal income tax return. At issue is whether plaintiffs’ failure to provide timely proof of then- loss to their insurer prohibited them from deducting their loss under section 165(h)(5)(E) of the Code, which limits the availability of deduction of a loss covered by insurance if the taxpayer fails to “file a timely insurance claim with respect to such loss.” Claiming that plaintiffs’ conduct triggered this limitation, defendant has moved to dismiss their complaint under RCFC 12(b)(6). Finding otherwise, the court DENIES defendant’s motion.

I. BACKGROUND1

In August of 2002, plaintiffs Mark and Jennifer Ambrose (plaintiffs or the Ambros-es), now divorced, took out a homeowners insurance policy with Farm Family Casualty Insurance Company (Farm Family) on their residence in Auburn, New York. That policy covered their home, other structures on the premises, personal property, and loss of use in the event of a fire or other “peril insured against” up to a limit of $216,000, subject to a $250 deductible. As is typical, this coverage was subject to a number of conditions. The policy, for example, did not cover an “intentional loss” arising out of an act committed “[b]y or at the direction of an ‘insured’; and/ ... [wjith the intent to cause a loss.” One of the policy provisions listed the insured’s “Duties After Loss,” and required, in pertinent part, that the policy holder: (i) “[g]ive prompt notice to us or our agent;” (ii) “[p]re-pare an inventory of damaged personal property,” and (iii) within 60 days of Farm Family’s request, supply various proof of loss.2 Finally, the policy was “void if, whether before or after a loss, an ‘insured’ has: (a) Intentionally concealed or misrepresented any material fact or circumstance; (b) Engaged in fraudulent conduct; or (c) Made false statements; relating to insurance.”

In November 2002, the Ambroses’ home was damaged by a dryer fire. In fulfillment of its obligations under the Ambroses’ homeowners policy, Farm Family contracted with Diamond’s Air Clean and Construction (Dia[154]*154mond) to repair the fire, smoke, and water damage, while the Ambroses temporarily relocated to a nearby motel. In the early hours of December 25, 2002, a second, more serious fire occurred in the Ambrose residence, totally destroying the home.

According to Farm Family’s business records, Mark Ambrose reported this loss to the company at 8:41 AM on December 26, 2002. The form reflecting this indicates that the “Person Reporting this Claim” is “Mark-Ambrose-Insured,” and lists various details regarding the claim, including a “Claim Number.” That same day, Farm Family generated a “Claim Report Sheet — Non Auto” that listed various details about the fire; this sheet listed the aforementioned “Claim Number” and a “Report Date” of December 26, 2002. On December 27, 2002, an adjuster met with plaintiffs and conducted an inspection of the property, as well as an interview. The record includes a “State of New York Standard Fire Claim Form,” which refers to the aforementioned “Claim No.” and contains various details that apparently were derived by the adjuster from his inspection and interview. This form was signed by Mr. Ambrose, as the “Claimant,” on that same day.

Plaintiffs allege that the second December fire was caused by Diamond’s negligent workmanship. On January 29, 2003, Farm Family sent plaintiffs a letter, via both certified and regular mail, indicating that the company’s “claim file that pertains to the destruction of your residence ... has been reviewed.” The letter noted that at the December 27, 2002, meeting, the adjuster requested that plaintiffs provide him with a “Personal Property Inventory” and indicated that at the time of the letter, Farm Family had “not received any documentation from you to present your personal property loss.” This letter quoted the provisions of the policy conditioning the payment of claims, including paragraph g. quoted above, and then stated—

We are also enclosing our Sworn Statement in Proof Loss form, and we are asking that, within 60 days of this written request, you submit to us your signed, sworn proof of loss which sets forth, to the best of your knowledge, the information requested by the policy, [sic] the enclosed blank Sworn Statement In Proof of loss form is to assist you in meeting the conditions of this section of your policy.

On or about February 4, 2003, plaintiffs retained an attorney, who contacted Farm Family inquiring whether anything else was required to process the Ambroses’ claim beyond the information previously taken. On March 26 and April 7, 2003, a Farm Family representative conducted an examination under oath of each of the plaintiffs. Plaintiffs assert that they never received either the certified or regular mail version of the January letter. They allege that Farm Family did not request the sworn proof of loss until the April 7, 2003, examination, and that their attorney timely returned the sworn proof of loss on April 23, 2003.

On June 12, 2003, Farm Family sent plaintiffs a letter denying coverage for the December 25th fire. The letter explained that plaintiffs were not entitled to insurance coverage for the loss of their home because the insurance company’s “investigation has revealed that it is highly probable that you intentionally and deliberately caused or procured that fire,” thereby triggering one of the listed coverage exclusions. Additionally, the letter indicated that Farm Family was denying coverage under the Concealment of Fraud condition in the policy because, “during the course of our investigation of the reported fire loss and your claim,” plaintiffs denied involvement in the fire and did not explain various cash advances debited against their credit cards. Finally, the letter indicated that—

We also find that you breached the above-quoted condition of the policy that required you to send to us your signed, sworn proof of loss within 60 days after our request. By letter dated January 29, 2003, Farm Family requested that you complete and submit within 60 days a signed, sworn proof of loss with respect to your fire loss of December 25, 2002. During the continuation of Mr. Ambrose’s examination under oath on April 7, 2003, Mr. Ambrose confirmed that he received that January 29, 2003 letter. During that ex-[155]*155animation under oath, it also became apparent that you also received the blank proof of loss form enclosed with that letter. Despite your having received that letter and form within days of January 29, 2003, you did not submit your signed, sworn proof of loss to us until April 23, 2003, more than 60 days after our request, in material breach of the above-quoted policy condition. For this additional but separate reason, Farm Family must decline to make payment to you for your loss of December 25, 2002.

Neither in this letter, nor at any other point time, did Farm Family ever indicate to plaintiffs that they had failed to file a timely claim or that any such failure was the basis for the denial of coverage.

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Cite This Page — Counsel Stack

Bluebook (online)
106 Fed. Cl. 152, 110 A.F.T.R.2d (RIA) 5564, 2012 U.S. Claims LEXIS 980, 2012 WL 3292905, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ambrose-v-united-states-uscfc-2012.