Appraisal and coverage disputes

A disagreement about the cost of repairs and a disagreement about whether the policy covers a loss can require different responses. Read the insurer’s actual decision and the full appraisal provision before deciding what to do next.

What the Florida Supreme Court decided in 2002

In Johnson v. Nationwide Mutual Insurance Co., 828 So. 2d 1021 (Fla. 2002), the court considered two disputes in which the insurers denied that any covered loss had occurred. It distinguished those cases from a claim where the insurer admits a covered loss but disputes its amount.

The opinion explains that causation is a coverage question for the court when the insurer wholly denies a covered loss. When coverage is admitted and the amount is disputed, evaluating causation can be part of the appraisal panel’s amount-of-loss work. The decision does not turn an appraisal panel into a court with authority to resolve every policy dispute. Read the September 26, 2002 opinion.

What to gather before responding to an appraisal demand

• The policy and all endorsements in effect on the loss date.
• The insurer’s coverage letters, estimates and written appraisal demand.
• Your damage photographs, inspections, repair proposals and proof-of-loss documents.
• A timeline of reporting, inspections, payments and correspondence.

A Florida attorney should evaluate whether appraisal can be compelled, what questions remain for a court, and whether later decisions affect your circumstances. This historical case summary is not a prediction of your claim’s outcome.

Continue with our appraisal and mediation guide and the 2018 People’s Trust v. Tracey example. A public adjuster can help organize and evaluate the damage evidence within the scope of the license; litigation and legal interpretation require counsel.