final until disposition of timely filed motion for rehearing.
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.
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.
Ramirez Jr., of ADR Miami LLC, Coral Gables and Alberto M.
Regueyra of Regueyra & Llerandi, P.L., South Miami, for
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.
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).
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.
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).
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.
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, ...