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People's Trust Insurance Co. v. Tracey

Florida Court of Appeals, Fourth District

July 25, 2018

PEOPLE'S TRUST INSURANCE COMPANY, Appellant,
v.
ANDREA TRACEY and JAMES TRACEY, Appellees.

         Not final until disposition of timely filed motion for rehearing.

          Appeal of non-final order from the Circuit Court for the Fifteenth Judicial Circuit, Palm Beach County; Jeffrey Dana Gillen, Judge; L.T. Case No. 502017CA005429XXXXMB.

          Raoul G. Cantero, Ryan A. Ulloa and Iesha S. Nunes of White & Case LLP, Miami, and Jonathan Sabghir and Brett R. Frankel, Deerfield Beach, for appellant.

          Juan Ramirez Jr., of ADR Miami LLC, Coral Gables and Alberto M. Regueyra of Regueyra & Llerandi, P.L., South Miami, for appellees.

          May, J.

         An insurer challenges a trial court order denying its motion to compel an appraisal. We reverse the order because causation and the "amount of loss" are issues to be determined by an appraisal where the insurer has not "wholly denied" there is a covered loss.

         The insureds sustained damage to their roof and their home's interior. They filed a claim with their insurer for all the damage caused by wind from a tornado. The insurer investigated the claim and sent a letter to the insureds confirming coverage, but limiting the "amount of loss." The letter contained the following:

THERE IS COVERAGE UNDER THE POLICY FOR THIS LOSS AS A WHOLE; HOWEVER, THE SCOPE OF DAMAGES COVERED BY YOUR POLICY INCLUDES ONLY THE INTERIOR DAMAGES BUT DOES NOT INCLUDE YOUR ROOF.
We have completed our investigation of your claim, and based upon what we were provided and what you reported, and additionally, based upon our claim investigation, there is generally coverage for your loss as a whole. However, and more specifically, our investigation revealed that the roof leak you reported stemmed from age-related wear and tear and deterioration; general mechanical breakdown or latent defect; and/or faulty, inadequate or defective maintenance of the roofing system - none of which are covered causes of loss. Therefore, in our opinion, the scope of covered damages would not include your roofing system because those damages were caused by uncovered or excluded causes, but would provide coverage for resulting ensuing damages to the interior of your home. Therefore, we believe our obligation is to repair only those damages to the interior of the home. If you are not in agreement with that assessment, the question of whether the scope of repairs should include the roof, can be resolved in appraisal (see below).

         The letter included a proposed scope of repairs for the interior totaling $4, 354 (less a $2, 500 deductible). The insureds disagreed with the insurer's position and submitted a proof of loss. They obtained two estimates, one totaling $55, 718.85 and the other totaling $43, 507.77. Both estimates included the roof repairs.

         In response, the insurer demanded an appraisal to determine whether the roof damage was caused by wind (a covered cause) or wear and tear (an uncovered cause).

         The insureds filed a breach of contract action against the insurer. The insurer moved to compel an appraisal. It argued that the issue of causation is for the appraisal panel because it goes to the amount of loss. The insureds replied that the cause of the roof damage was a coverage issue to be determined by the trial court.

         The trial court concluded that, because the insurer made a "predetermination" that the roof was not covered, the issue could not be submitted to appraisal.

All right. I'm going to deny the motion to abate and deny the motion to compel appraisal without prejudice. You may think this is a clear case but it is not at all clear to me because it does seem very - and if it's a form letter, it's problematic, it seems to be, but it seems pretty clear from the April 11, 2017 letter that the - there is some question - well, quite frankly, that the defendant People's Trust has denied coverage with respect to the leaky roof even though they have accepted - acknowledged coverage with respect to the damage that the leaky roof has caused on the interior of the home. So, to me, ...

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