Fourth District Explains When Appraisal Is Ripe

In Heritage Property & Casualty Insurance Company v. Wellington Place HOA, Inc., No. 4D2022-2749 (Fla. 4th DCA Sept. 13, 2023), the Fourth District Court of Appeal addressed the aforementioned question.

This appeal involves Hurricane Irma, which Struble, P.A. is quite familiar with.

Here, the Insured (a homeowner’s association) submitted a claim for roof damage. The insurer determined the roof damage was caused by Hurricane Irma, “for which the policy provides coverage,” but stated it would not be issuing payment because its adjuster had determined the amount of loss was less than the deductible. The insurer later provided a “revised” estimate and asked the insured to provide its adjuster’s estimate and supporting documentation “so we can address any disputes” after the insured hired its own adjuster and consulting company.

In April 2020, the insured submitted its adjuster’s estimate which included, for the first time, the cost to replace all the windows and sliding glass doors.

Following the Insurer’s failure to settle the claim, the insured filed suit. The trial court ultimately granted the insured’s motion to stay litigation and compel appraisal.

The insurer responded that the insured’s April 2020 submission of its adjuster’s estimate for damages to the windows and doors constituted a “supplemental” damage claim, not ripe for appraisal, because the insurer had yet to determine coverage, and that the letter seeking payment for additional roof damage constituted a “reopened” claim. It also responded no “amount-of-loss” issue existed because the insured had never disputed the cost to repair the initially reported roof damage. Nonetheless, the trial court ruled the insured’s claim was ripe for appraisal as to the “amount of loss” because the insurer had admitted a covered loss had occurred and had been given sufficient information to assess the claim. The trial court granted the insured’s motion, stayed the litigation, and compelled appraisal. The insurer appealed.

In affirming the trial court’s order, the Fourth DCA determined the insurer admitted coverage for the insured’s loss as a whole and determined the initially reported roof damage was covered; the claim was never settled and was still open when the insured subsequently reported additional roof damage and damage to its windows and doors; and that generally, it has been held a subsequent claim should be treated as part of the initial claim if the insurer has accepted coverage for the initial claim and the claim has not been settled. The Court agreed with the insured that the parties’ dispute regarding the additional roof damage and the damage to the windows and doors is an “amount of loss” or causation dispute on the initial claim, which is ripe for appraisal because the insurer admitted coverage. Therefore, the insured’s claim was ripe for appraisal because the insurer admitted coverage for the initial claim, and the claim remained open for adjustment when the insured reported additional damage pursuant to the policy, and the parties’ disagreement as to whether the insurer is required to pay for the additional damage is an “amount-of-loss” issue for appraisal to resolve, not a coverage issue.

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