Migliaro v. Fidelity National Indemnity Insurance Co.

880 F.3d 660
CourtCourt of Appeals for the Third Circuit
DecidedJanuary 29, 2018
Docket17-1434
StatusPublished
Cited by18 cases

This text of 880 F.3d 660 (Migliaro v. Fidelity National Indemnity Insurance Co.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Third Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Migliaro v. Fidelity National Indemnity Insurance Co., 880 F.3d 660 (3d Cir. 2018).

Opinion

*662 OPINION

RENDELL, Circuit Judge:

The issue 'in this case is whether the rejection of a policyholder’s proof of loss constituted a “written denial of all or part of the claim,” thereby triggering the one-year statute of limitations that is set forth in every Standard Flood Insurance Policy (“SFIP”). After receiving a payment from Fidelity National Indemnity Insurance Company, based on an adjuster’s assessment of the damage to his property caused by Hurricane Sandy, Anthony Migliaro submitted a sworn proof of loss seeking additional compensation. Fidelity sent Migliaro a letter rejecting his proof of loss, and he filed suit. The District Court found that the letter rejecting Migliaro’s proof of loss was a “written denial of all or part of the claim.” Since Migliaro filed his complaint almost two years after he received the letter, the District Court dismissed the suit as time-barred. We affirm the District Court’s order. Although the rejection of a proof of loss is not per se a denial of the claim in whole or in part, it does constitute a denial of the claim if, as here, the policyholder treats it as such by filing suit against the carrier.

I. Background 1

A. The National Flood Insurance Program

Congress authorized the creation of the National Flood Insurance Program (“NFIP”) to “enable interested persons to purchase insurance against loss resulting from physical-damage, to-or loss of ... property ... arising from any flood occurring in the United States.” 42 U.S.C. § 4011 (a). The NFIP is administered by the Federal Emergency Management Agency (“FEMA”). Id. .Under FEMA’s Write Your Own program, individuals may purchase SFIPs from private insurance carriers (“WYO carriers”). 44 C-F.R. § 62.23 .

The national flood insurance system is an unusual hybrid of government and private insurance, but it is essentially a government program. WYO carriers are “fiscal agents” of the United States. 42 U.S.C. § 4071 (a)(1). SFIP policyholders pay premiums to" WYO carriers and WYO carriers service the policies. 44 C.F.R. § 62.23 (d). However, the United States government ultimately pays all SFIP claims. Van Holt v. Liberty Mut. Fire Ins. Co., 163 F.3d 161 , 166 (3d Cir. 1998) (“[A]n insured’s flood insurance claims are ultimately paid by FEMA.”). 2 In addition, álthough WYO carriers are also responsible for defending lawsuits arising under SFIPs, the United States government reimburses the cost of defending such claims. 44 C.F.R. § 62.23 (i)(6); Van Holt, 163 F.3d at 165 (“Although WYO companies have the responsibility of defending against claims, FEMA reimburses the WYO companies for their defense costs.”). Because SFIP claims are ultimately paid by the United States government, all SFIPs must be *663 identical to the form codified at 44 C.F.R. pt. 61, app. A(l). 3 Every-SFIP contains the following statute-of-limitations provision:

You may not sue us to recover money under this policy unless you have complied with all the requirements of the policy. If you do sue, you must start the suit within one year after the date of the written denial of all or paft of the claim[.] ... This requirement applies to any claim that you may have under this policy and to any dispute that you may have arising out of the handling of any claim under the policy. ■

44 C.F.R. pt. 61, app. A(l), art VII(R) (emphasis added).

The SFIP and corresponding FEMA bulletins describe the SFIP claims process. After an SFIP policyholder suffers a loss, the WYO carrier sends an insurance adjuster to assess the damages. FEMA Bulletin W-12092a (Nov. 9, 2012). The adjuster then makes a recommendation as to the amount of money the policyholder is entitled to recover under the policy. Id. The WYO carrier typically adopts the adjuster’s recommendation and pays the policyholder the recommended amount. Id. If the policyholder’s coverage limits have not been exhausted and he believes he is entitled to recover more, he must send the carrier a proof of loss no later than a year and a half from the date of the loss. FEMA Bulletin W-13060a (Oct. 1, 2013). 4 A proof of loss is the policyholder’s signed and sworn estimate of the additional covered damages. 44 C.F.R. pt. 61, app. A(l), art. VII(J)(4). The SFIP’s Loss-.Payment provision sets forth the options available to the policyholder if. the proof of. loss is rejected. See 44 C.F.R. pt. 61, app. A(l), art. VII(M)(2). •

B. Factual Background

Migliaro purchased an SFIP from WYO carrier Fidelity for his New Jersey proper-' ty. The property sustained flood damage in October 2012 as a result of Hurricane Sandy. Fidelity sent an independent adjuster to assess the damage. The adjuster recommended a payment of $90,499,11. Fidelity adopted the adjuster’s recommendation and sent Migliaro a check for the recommended amount. 5

Five months later, Migliaro submitted a proof of loss, claiming an additional $236,702.57 in damages. On July 15, ,2013, Fidelity sent Migliaro a letter titled “Rejection of Proof of Loss.”-A189. The letter read, in pertinent part:

The Proof of Loss cannot be accepted under the terms and conditions of the insurance policy for the following reason:

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880 F.3d 660, Counsel Stack Legal Research, https://law.counselstack.com/opinion/migliaro-v-fidelity-national-indemnity-insurance-co-ca3-2018.