EDDRIN MARTINEZ AND CARMEN MARTINEZ vs UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY

• Court: District Court of Appeal of Florida
• Decided: February 9, 2023
• Docket: 21-3016
• Status: Published

Opinion

IN THE DISTRICT COURT OF APPEAL OF THE STATE OF FLORIDA FIFTH DISTRICT

NOT FINAL UNTIL TIME EXPIRES TO FILE MOTION FOR REHEARING AND DISPOSITION THEREOF IF FILED

EDDRIN MARTINEZ AND CARMEN MARTINEZ,

Appellants, Case No. 5D21-3016 v. LT Case No. 2016-CA-1296

UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY,

Appellee.

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Opinion filed February 9, 2023

Appeal from the Circuit Court for Hernando County, Donald Scaglione, Judge.

Melissa A. Giasi, and Erin M. Berger, of Giasi Law, P.A., Tampa, for Appellant.

Paulo R. Lima, and Elizabeth K. Russo, of Russo Appellate Firm, P.A., Miami, for Appellee.

EVANDER, J. In this homeowners’ insurance case, Eddrin and Carmen Martinez

(“Insureds”) appeal a summary final judgment entered in favor of Universal

Property & Casualty Insurance Company (“Universal”). The summary

judgment was granted on the grounds that Insureds failed to file a sworn proof

of loss prior to filing suit against Universal. We reverse. The timeline

stipulated to by the parties at the summary judgment hearing reflects that

Universal denied coverage prior to the date on which Insureds were required

to submit the sworn proof of loss. Consequently, the trial court erred in

granting summary judgment in favor of Universal.

In their operative complaint, 1 Insureds alleged that they suffered

damage covered under their insurance policy with Universal as a result of two

separate plumbing leaks. A plumbing leak in the bathroom was alleged to

have occurred on November 6, 2015, and a plumbing leak in the kitchen was

alleged to have occurred on November 23, 2015. Written notice of the claims

was provided to Universal on December 16, 2015, and Universal inspected

the property on January 13, 2016. On January 20, 2016, Universal requested

Insureds to provide a sworn proof of loss and other documentation within sixty

days. However, prior to the expiration of the sixty-day period, Universal

1 Insureds filed separate actions on their two claims. The two cases were subsequently consolidated.

2 denied coverage on both claims on the grounds of Insureds’ “repeated lack

of cooperation, failure to comply with . . . post-loss obligations, and failure to

provide requested documents.” Subsequent to its denial of Insureds’ claims,

Universal did tender a payment on one of the two claims. However, Insureds

rejected that tender and subsequently filed suit. It is undisputed that Insureds

did not provide a sworn proof of loss to Universal prior to commencing the

actions below.

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.” “[A] policy provision requiring an

insured to submit a sworn proof of loss is a condition precedent to a suit

against an insurer.” Bryant v. GeoVera Specialty Ins. Co., 271 So. 3d 1013,

1021 (Fla. 4th DCA 2019). However, “[w]hen 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.” Keel v. Indep. Life & Accid. Ins. Co., 99 So. 2d

225, 227 (Fla. 1957); see also Goldberg v. Universal Prop. & Cas. Ins. Co.,

302 So. 3d 919, 925 (Fla. 4th DCA 2020) (“An insurer’s repudiation of

3 coverage waives the insurer’s right to insist upon the insured’s compliance

with policy conditions, such as filing a proof of loss.”). Here, Universal denied

coverage prior to the expiration of the time period in which Insureds were

required to submit a proof of loss, thereby relieving Insureds of their obligation

to do so prior to filing suit.

Furthermore, an insured’s failure to provide a proof of loss does not

automatically result in a forfeiture of coverage. An insured may avoid

forfeiture resulting from a breach of a proof of loss condition by proving that

the insurer was not prejudiced. See Allstate Fla. Ins. Co. v. Farmer, 104 So.

3d 1242, 1249 (Fla. 5th DCA 2012) (“Thus, even in proof of loss cases,

prejudice is an issue in determining whether forfeiture results from an

insured’s breach.”). Here, Universal’s “premature” denial of coverage letter

constituted evidence that it was not prejudiced by Insureds’ failure to provide

a sworn proof of loss. As we observed in Farmer, the purpose of a proof of

loss provision “is to inform the insurer of facts surrounding the loss, and to

afford the insurer an adequate opportunity to investigate, prevent fraud, and

form an intelligent estimate of its rights and liabilities before it is obliged to

pay.” Id. at 1246. Universal’s decision to deny coverage before the time

period for the submittal of a sworn proof of loss had expired supports a

4 determination that it was not hampered in its investigation of Insureds’ claims

by a lack of a proof of loss form.

For the reasons set forth above, we conclude that the trial court erred

in granting summary judgment in favor of Universal.

REVERSED and REMANDED.

EDWARDS and HARRIS, JJ., concur.