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Adjusting Claims in Florida Following Hurricane Irma

Property & Casualty Insurance   |   September 25, 2017
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As the waters recede from Hurricane Irma, property insurers have many issues to consider as they adjust claims in Florida. This alert discusses a few of those issues.

Claims Reporting

The Florida Office of Insurance Regulation (Office) requested that all property insurers with direct insurance in force for listed lines of business in the state of Florida (see list below) provide claims reporting data related to Hurricane Irma on an individual company basis beginning as early as September 9, if data is available. The claims reporting system is live at http://irfs.fldfs.com. The first required filing was due September 11 at 5 pm.

Claims information is required to be reported for the following lines of business:

FIRE, ALLIED LINES, FARMOWNERS MULTI-PERIL, HOMEOWNERS MULTI-PERIL, COMMERCIAL MULTI-PERIL, OCEAN MARINE, INLAND MARINE, PPA PHYSICAL DAMAGE, COMMERCIAL AUTO PHYSICAL DAMAGE, AIRCRAFT, GLASS, BOILER AND MACHINERY, INDUSTRIAL FIRE, INDUSTRIAL EXTENDED COVERAGE, MOBILE HOME MULTI-PERIL, MOBILE HOME PHYSICAL DAMAGE, MULTI-PERIL CROP, and SURPLUS LINES PROPERTY & CASUALTY.

No filing is required for property and casualty insurers, risk retention groups, or surplus lines carriers with no direct insurance in force in the lines of business listed above.

Claims data to be reported includes the following data points: 

  1. Number of claims reported
  2. Number of claims closed with and without payment
  3. Number of open claims
  4. Percent of closed claims
  5. Dollar amount of paid losses
  6. Dollar amount of paid ALAE
  7. Dollar amount of case incurred losses

Attached is a notice issued by the Office regarding these reporting requirements. 

Coverage Issues

 

Assignment of Benefits

An assignment of benefits (AOB) is a legal tool that allows a third party to be paid for services performed for an insured property owner who would normally be reimbursed by the insurance company directly after making a claim. AOB is commonly used when a property owner experiences a loss and contacts a contractor for assistance. Most AOB agreements allow the contractor to stand in the shoes of the property owner for insurance collection purposes, and they are allowed and enforceable under Florida law. Bioscience West, Inc. a/a/o Elaine Gattus vs. Gulfstream Prop. & Cas. Ins. Co., 185 So. 3d 638 (Fla. 2d DCA 2016) (Anti-assignment clause of policy did not prohibit assignment of benefits to mitigation contractor. The court further found that post loss claims are freely assignable without the insurer’s consent.). 

Insurers adjusting Hurricane Irma losses should be aware of the issues raised when an assignment is involved, including the scope of any assignment and necessary scope of any corresponding claim release, and the extent to which the insured should be involved in the adjustment notwithstanding the assignment.

Causation and Exclusions

Property insurers are well aware of the challenges involved in assessing hurricane claims involving flood and wind damage, particularly when they combine to cause the damage, but one is excluded. Therefore, it is important to be aware that in December 2016, the Supreme Court of Florida ruled that if damage results from “concurrent causes” and, as between the concurrent causes, an “efficient proximate cause” cannot be determined, it is reasonable to find coverage for the entire loss under an all-risk policy, even if one of the causes is excluded from coverage. Sebo v. American Home Assurance Company, 208 So.3d 694 (Fla. 2016). As a result, Florida insurers whose policies do not contain anti-concurrent causation language in their exclusions may now be saddled with coverage for damage they intended to exclude.

The Florida Supreme Court’s ruling underscores the importance of anti-concurrent causation language in exclusions. However, the decision does not wholly preclude the possibility of applying the efficient proximate cause doctrine to a loss in Florida. The court held that the concurrent cause doctrine applies when there is no reasonable way to distinguish the proximate cause of a loss. Based on the court’s reasoning, in those instances where there is a clear proximate cause or sequence of events, it appears that the efficient proximate cause theory of liability would still apply.

Time Element: Widespread Economic Effects

A common business interruption claims issue is whether the loss measurement should take into account the post-hurricane economic conditions. At least one Florida court has held that the policyholder cannot rely on increased projected demands caused by a catastrophic event when calculating its business interruption losses. See, American Auto. Ins. Co. v. Fisherman's Paradise Boats, Inc., No. 93-2349CIVGRAHAM, 94-0014CIVGRAHAM, 1994 WL 1720238, at *4 (S.D. Fla. Oct. 3, 1994). In contrast, the same court held that a policyholder could include projected profits had its stores been open after Hurricane Andrew. See, Stamen v. Cigna Property & Casualty Insurance Co., No. 93-1005-CIV-DAVIS, 1994 U.S. Dist. LEXIS 21905, at *5 (S.D. Fla. June 13, 1994). 

Many policy forms have been modified over the years to address the widespread economic effects of a catastrophic weather event. Policy language will always be an important consideration when evaluating this issue. 

We are available to assist you in navigating Florida’s treacherous insurance coverage waters. Please contact us should you have any questions regarding the issues raised in this alert.


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