Louisiana Court Finds in Favor of Flood Insurer Where Insured Submitted an Incomplete Proof of Loss


Roussell v. Allstate Insurance Company, 2014 U.S. Dist. LEXIS 82319 (E.D. La. June 17, 2014) involved a dispute over insurance coverage related to the damage caused to the plaintiff’s property by Hurricane Isaac on August 29, 2012. The property was covered by a Standard Flood Insurance Policy issued by Allstate under the National Flood Insurance Program (the “Allstate Policy”). The Allstate Policy contained a provision that required the submission of a signed, sworn Proof of Loss to the insurer for the amount of benefits claimed as a condition precedent to filing suit. Plaintiff originally submitted a Proof of Loss in the amount of $51,279.86 and a signed and sworn Building Replacement Proof of Loss in the amount of $2,447.48. Upon receipt of these Proofs of Loss, Allstate paid the plaintiff the $53,727.34 due.

Thereafter, the plaintiff enlisted an adjuster to handle the insurance claim with Allstate. The adjuster forwarded a supplemental estimate of damages on December 6, 2012. The adjuster also submitted a Proof of Loss document that was signed by the adjuster, dated December 12, 2012. The plaintiff submitted a signed and dated proof of loss, but nothing else on the form was filled out, including the policy number, policy term, the amount of coverage at the time of loss, when the loss occurred, or the amount of the loss. On May 23, 2013, Allstate denied coverage for the supplemental claim. The Plaintiff filed an appeal with FEMA. After not receiving a response from FEMA within 60 days, the plaintiff filed suit in federal court to recover the amounts detailed in its supplemental estimate of damages.

In its motion for summary judgment, Allstate argued that the plaintiff failed to comply with statutory regulations of filing a supplemental Proof of Loss at the time of filing a claim for supplemental damages. Allstate argued in its motion that even if it were inclined to waive the requirement of a signed, sworn Proof of Loss for the amount of damages sought, it could not do so because all flood loss claims under Standard Flood Insurance Policies are paid with U.S. Treasury funds, and thus, strict adherence to the conditions precedent for payment of a claim is required.

The plaintiff argued that submission of the itemized estimate prepared by its public adjuster and submitted to Allstate served as a supplemental proof of loss. The plaintiff argued that submitting the signed Proof of Loss form along with documentation of the additional damages was at least sufficient to allow the plaintiff to survive summary judgment. The plaintiff further argued that the “proof of loss” does not consist of a single form, but constitutes all forms, estimates and other documentation that can be used to evaluate the claim. The plaintiff claimed that based upon this standard, Allstate had more than adequate information to evaluate the plaintiff’s claim, including a sworn proof of loss and an itemized estimate of damage.

In its analysis, the court cited case law stating that the requirements to recover for flood loss under the National Flood Insurance Program (“NFIP”) are strictly enforced, and that a NFIP participant cannot file a lawsuit seeking benefits under a Standard Flood Insurance Policy unless the participant can show prior compliance with all policy requirements. The court also cited additional case law that previously held that an insured’s failure to file a complete, sworn proof of loss statement relieves the insurer’s obligation to pay what otherwise might be a valid claim. Ultimately, the court found that the signed, but otherwise blank proof of loss was not complete, as required by the policy, and that the itemized estimate and documentation did not fulfill the Proof of Loss requirement. Correspondingly, the court entered summary judgment in favor of Allstate.


DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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