The insured's claim for flood coverage was denied when the insurer refused to accept an adjuster's report submitted without a proof of loss. Jackson v. Fid. Nat'l Ins. Co., 2015 U.S. Dist. LEXIS 66589 (E.D. La. May 21, 2015).
Plaintiff's property was damaged by Hurricane Isaac. Defendant Fidelity provided flood coverage for the property through the National Flood Insurance Program (NFIP). After plaintiff submitted a flood claim, she executed a proof of loss for $53,803.02. A second proof of loss for contents was submitted in the amount of $26,556.13. Fidelity paid both these claims.
Thereafter, an adjuster's estimate of plaintiff's damages, totaling $284,332.91, was submitted to Fidelity. Plaintiff did not submit a supplemental proof of loss for this claim. Fidelity refused to pay the claim and plaintiff filed suit.
Fidelity's motion for summary judgment was granted because plaintiff never submitted a proof of loss for any amount beyond what she was paid. A regulation governing the NFIP stated that the insurer "may accept the adjuster's report of loss instead of your proof of loss." Fidelity could have waived the proof of loss requirement, but plaintiff offered no evidence that Fidelity exercised its discretion and waived the requirement. Further, the adjuster's estimate sent to Fidelity did not bear plaintiff's signature.
Plaintiff next contended that the adjuster's report coupled with the initial verified proof of loss satisfied the proof of loss requirement. Again, the court disagreed. There was no genuine issue of material fact that plaintiff did not satisfy the proof of loss requirement when she submitted an adjuster's report for additional damages without an accompanying signed and sworn proof of loss.
This is yet another case enforcing that requirements for coverage under the NFIP are strictly construed.