Analysis and Interpretation by Michael A. Cassel

On February 8, 2017, the Fourth District Court of Appeals in and for the State of Florida (hereinafter the “4th DCA”) released their decision in State Farm Fla. Ins. Co. v. Figueroa, No. 4D15-2698, 2017 Fla. App. LEXIS 1548 (4th DCA 2017) (hereinafter “Figueroa”).  The Figueroa opinion discusses the standard and burden of compliance with post-loss conditions but, more importantly, the Figueroa decision establishes the relevancy of testimony regarding the insured’s health being presented as an excuse for the non-compliance with post-loss conditions.


On October 24, 2005, in a tale seemingly as old as time in the State of Florida, Dina Figueroa sustained property damage to her home as a result of Hurricane Wilma and filed a claim with her insurer within a week of the storm.  State Farm sent an adjuster to Ms. Figueroa’s property and initially determined that the monetary value of the 29 damaged roof tiles fell below the applicable policy deductible.  State Farm further advised the insured that she was free to obtain her own estimate for the alleged damages and submit same for consideration.  Ms. Figueroa initially contacted roofers but none accepted the job.  Subsequently, in January 2006, the insured was distracted from her claim when she began dealing with a serious medical condition. 

It was not until the end of 2008 when Ms. Figueroa obtained a contractor’s estimate which included full replacement of the roof.  In early 2009, she presented her newly acquired estimate to State Farm and requested that her claim be reopened for further consideration.  State Farm then sent another adjuster to Ms. Figueroa’s property who reached a conclusion in line with the original adjustment of the claim.  Subsequently, State Farm sent a reservation of rights letter outlining the insured’s post-loss conditions under the subject policy.  Said correspondence specifically included, in pertinent part, the requirement to make the reasonable repairs to protect the property from further damage and the requirement to submit a sworn proof of loss (hereinafter “SPOL”) within 60 days of the loss. 

On June 8, 2009, Ms. Figueroa presented her SPOL with the supporting contractor’s estimate.  In late 2009, counsel for State Farm advised Ms. Figueroa that the proof of loss did not comply with the conditions in the subject policy.  In March 2010, State Farm provided a form SPOL to the insured and, on June 10, 2010, Ms. Figueroa sent the second SPOL to State Farm.  Ultimately, on June 22, 2010, State Farm denied Ms. Figueroa’s supplemental claim due to her failure to timely submit a SPOL.  Ms. Figueroa initiated her civil action in the following month.

During the ensuing litigation, State Farm moved for summary judgment with regards to the insured’s failure to comply with post-loss conditions.  Said motion was denied due to the presentation of evidence that the insured substantially complied with her post-loss conditions by furnishing a SPOL regardless of the timeliness.  This argument was also raised through motions for directed verdict and denied on the same grounds.  Additionally, State Farm moved to limit Ms. Figueroa’s ability to introduce evidence pertaining to her health issues on the grounds that the testimony would be irrelevant and highly prejudicial.  This motion in limine was denied based on the insured’s argument that introduction of this evidence was necessary to explain the three (3) year gap between her initial claim and her supplemental claim.  Eventually, this matter proceeded to trial and the jury found in the insured’s favor.  The instant appeal followed.

4th DCA Opinion

Upon review, the 4th DCA opined that the trial court correctly denied the motions for summary judgment and directed verdict in line with the long held maxims that, “where an insured cooperates [with post-loss conditions] to some extent, a fact question remains as to whether the [post-loss] condition is breached…”  See Figueroa at 5 quoting Solano v. State Farm Fla. Ins. Co., 155 So. 3d 367, 370 (Fla. 4th DCA 2014).  Similarly, prejudice to an insurer due to untimely, albeit partial, compliance with a post-loss condition remains a question of fact to be decided by a jury.  See Figueroa at 7; see also Kramer v. State Farm Fla. Ins. Co., 95 So. 3d 303, 306 (Fla. 4th DCA 2012). 

Additionally, the 4th DCA opined that the trial court erred in denying State Farm’s motion in limine on the grounds that “the insured’s health was not relevant to any issue in the case.”  Figueroa at 7.  Furthermore, it was determined that the references to the insured’s health may have served to confuse the jury into considering that the insured’s health was a mitigating factor to be considered in a failure to comply with post-loss conditions.  Figueroa at 8-9.  Based on the improper introduction of the irrelevant testimony regarding the insured’s health, the 4th DCA remanded the matter back to the lower court for a new trial.

Analysis, Impact, and Effect

It is decently common in first-party property insurance claims to assert a failure to comply with post-loss conditions as a defense to coverage and, as such, there is a plethora of existing case law which discusses same.  As such, the Figueroa opinion does not provide any innovative perspective regarding compliance with same. 

It has been long held in Florida that a total failure to comply with a policy provision amounts to a breach of the policy precluding recovery.  Haiman v. Federal Insurance Co., 798 So.2d 811 (Fla. 4th DCA 2001).  See also  Starling v. Allstate Floridian Ins. Co., 956 So. 2d 511, 513 (Fla. 5th DCA 2007) (“[a] material breach of an insured's duty to comply with a policy's conditions precedent relieves the insurer of its obligations under the contract.”).  “If, however, the insured cooperates to some degree or provides an explanation for its noncompliance, a fact question is presented for resolution by a jury.”  Haiman at 812 quoting Diamonds & Denims, Inc. v. First of Georgia Ins. Co., 417 S.E.2d 440, 441–42 (Ga.Ct.App.1992); see also Solano v. State Farm Fla. Ins. Co., supra.  It must be noted, however, that it is proper for an insurer to obtain a partial summary judgment granting the presumption of prejudice at trial when proof of untimely compliance with a post-loss condition is undisputable.  See Kramer v. State Farm Fla. Ins. Co., supra; see also LoBello v. State Farm Fla. Ins. Co., 152 So. 3d 595, 596 (Fla. 2d DCA 2014).  As such, while the trial court was correct in denying the motion for summary judgment and motion for directed verdict as full and final dispositive motions, the trial court should have considered granting a rebuttable presumption of prejudice to State Farm which would be incorporated into the final jury instructions or potentially read as preliminary instructions prior to opening statements.

The more novel aspect of the Figueroa opinion pertains to the relevancy of the insured’s testimony regarding her health as an excuse for a lack of timely compliance with her post-loss conditions.  Relevant evidence is defined as “evidence tending to prove or disprove a material fact.” Fla. Stat. § 90.401 (2015).  Furthermore, “[r]elevant evidence is inadmissible if its probative value is substantially outweighed by the danger of unfair prejudice, confusion of issues, misleading the jury, or needless presentation of cumulative evidence…”  Fla. Stat. § 90.403 (2015).  Well established Florida law holds that the injection of improper and irrelevant information such as “religion, character [or] occupation even if not calculated to, can undoubtedly [have] influence upon the jury.”  Gluck v. State, 62 So.2d 71, 73 (Fla. 1952). 

The Figueroa court reasoned that “[b]ecause no provision in the policy allowed illness to excuse noncompliance or untimely compliance with the insured’s obligations, evidence of the insured’s health did not tend to prove or disprove that she substantially complied with the policy obligations or that State Farm was not prejudiced by her untimely compliance.”  Figueroa at 8.  Instead, the 4th DCA concluded that “[e]vidence of the insured’s medical condition improperly injected the potential for a sympathy verdict in the case…” and that testimony regarding that the testimony regarding the insured’s illness “could only have suggested that the jury make a decision on an improper basis.”  Figueroa at 9.  As such, the prejudice of the introduction of evidence pertaining to the insured’s health was held to far outweigh the probative value of same with regards to compliance with contractual provisions/conditions.  Accordingly, the Figueroa decision embellishes upon the tenets of Gluck and provides better guidelines for the admissibility of extrinsic evidence used to combat a failure to comply with post-loss conditions.