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So when you say ‘explosion,’ what exactly does that mean? p2

Tue May 13th, 2014 on     Insurance Claims,    

An insurance company has prevailed in an unusual dispute with a Florida condominium owner. The woman filed a claim with State Farm Florida Insurance Co. after an unpleasant incident in the unit above hers. Her upstairs neighbor died, and the body was not discovered for a couple of weeks. By that time, the body had decomposed to the point that the abdomen had ruptured, allowing bodily fluids to escape.

The stench permeated everything, including the ceiling and walls of the apartment below, the unit owned by the plaintiff in this case. The homeowners association apparently refused to pay for the repairs to the plaintiff’s apartment, so she was forced to pay for them herself. She filed a claim with State Farm to recover the costs of repairs as well as personal property damaged in the incident.

After an inspection and appraisal (paid for by State Farm), the insurer offered to pay for the repairs but denied liability for the plaintiff’s personal property. She refused the offer and sued.

The lower court found for State Farm, as did the Fourth District Court of Appeals in its recent decision. The appellate court focused on two primary issues: the definition of “explosion” and the procedure for filing claims.

The homeowners policy dictates that the insured file a sworn proof of loss within 60 days of filing the claim. While the plaintiff had sent copies of invoices with a list of damages, she never filed the proof of loss. State Farm would have paid the claim within 60 days of receiving that proof of loss had any of the following been true:

  • The insurance company and the claimant had reached an agreement on the amount of the claim.
  • A court had entered a final judgment in the matter.
  • An appraisal award was filed.

The court was not persuaded that the inspection and appraisal conducted earlier constituted any of these circumstances. Remember, the plaintiff refused the initial offer to cover only the repairs to her apartment; the parties did not agree on what the claim was worth. Her lawsuit failed on this argument.

We’ll discuss the explosion debate in our next post.

Sources: 

Insurance Journal, “Florida Court: ‘Exploding Corpse’ Not Covered Under Property Policy,” Michael Adams, May 8, 2014

Courthouse News Service, “The Case of the Exploding Corpse,” Izzy Kapnick, Nov. 24, 2009

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