Insurance – Proof Of Loss

Filing a proof of loss as part of a claim is very basic to all insurance claims.  This issue was a topic in a recent Fifth Circuit opinion styled, Andre Yanez v. American Strategic Insurance Coporation; E-Ins., L.L.C.; FKS Insurance Services, L.L.C.

The lower court granted the insurers motion for summary judgment based on Yanez not submitting a proof-of loss form as required by the federal flood program policy.

This claim arose out of storm in 2016, causing flood damage to Yanez’s property.  Yanez filed a claim and adjusters were assigned to the claim.  Yanez completed a flood field survey and filed a proof-of-loss and was paid for the 2016 flood consistent with the proof-of-loss that was filed.

Yanez sought additional sums but did not file and additional proof-of-loss form.  As a result the claim for the additional loss was not paid.  Yanez lost at the administrative appeal and this lawsuit resulted.  Yanez now appeals the lower court summary judgment ruling.

This Court has made that “the provisions of an insurance policy issued pursuant to a federal program must be strictly construed and enforced.”  In this case, for Yanez to receive any additional benefits, he was required to submit a supplemental proof-of-loss form within 60 days of the flood.  It is undisputed that Yanez did not send the insurers the additional proof of loss within 60 days of the flood.  Yanez tried to argue that the paperwork he submitted contained all the relevant information.  While this may be true, this is insufficient.  He never submitted the required signed proof of loss for additional benefits.  Yanez’s argument that the insurer waived the 60 day submission period is meritless in that the insurer cannot waive federal regulations promulgated by FEMA.

Something to keep in mind is that this case dealt with federal law.  However, most all insurance policies have this same requirement.  One of a few ways to get around the requirement of filing a proof of loss is when the insurer denies the claim prior to there being a chance to submit the proof of loss.