Professional Documents
Culture Documents
FIRST DISTRICT
STATE OF FLORIDA
Appellant,
Appellee.
__________________________________/
_____________________________________________________________
Appeal of Non-Final Order from the Circuit Court (Hugh A. Carithers, J.)
of the Fourth Judicial Circuit in and for Duval County, Florida
_____________________________________________________________
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I. TABLE OF CONTENTS
Page
ISSUES
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Table of Contents (cont.)
Page
III. THE TRIAL COURT ERRED IN CONFUSING
TIMELINESS OF A DEMAND FOR APPRAISAL
WITH WAIVER BY INCONSISTENT ACTS ………. 25
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II. TABLE OF CITATIONS
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Cases Cited Page(s)
Gonzalez v. State Farm Fire & Cas. Co., …………………………… 22, 32, 44
805 So. 2d 814 (Fla. 3d DCA 2000)
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Cases Cited Page(s)
Miller Constr. Co., Inc. v. First Baptist Church of Live Oak, Inc., ….. 21
396 So. 2d 281 (Fla. 1st DCA 1981)
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Cases Cited Page(s)
SR Int’l Bus. Ins. Co., Ltd. v. World Trade Center Props., LLC, ……… 24
2003 U.S. Dist. LEXIS 3881 (S.D.N.Y. Mar. 18, 2003)
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Cases Cited Page(s)
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III. STATEMENT OF THE CASE AND OF THE FACTS
Preliminary Statement
buildings and 21 garage buildings. (App. C, Ex. A). The insurance policy
(App. C, Ex. A). This form is separately indexed at Appendix B for ease of
reference.
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On June 1, 2008, a microburst hail storm caused damages to
Representative for Appellant, accepted that there was coverage for the
regarding the roof damage was that possibly 4 of the 34 roofs might be in
Roofing) believed that all 34 roofs needed to be replaced, Mr. Kull sent
2008, and advising Appellee that if there was a dispute, Appellant might hire
On July 22, 2008, Mr. Kull and Mr. Gildenmeister met with Reliable
Roofing employees and discussed the damages to the roof systems, but could
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not come to a consensus regarding the roof damage. Mr. Kull made
provided by Appellee for repairs and costs which Appellee had already paid.
estimate prepared by Mr. Gildenmeister based upon the Haag report for what
Ex. 4). On October 22, 2008, Appellant tendered to Appellee a check for
tender, refused to provide the sworn proofs of loss, identified damages that
was presenting for the first time, and made a counter-offer to Appellant for its
other damages unrelated to the roof claims. (App. O, p. 2, Ex. B). One week
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damages and invoked appraisal pursuant to the terms of the policy, infra, in
order to establish the actual amount of loss, and named its appraiser. (App.
provided Appellant with a copy of the Complaint it had filed six (6) days
earlier on December 23, 2008 and advised Appellant that it was “not
interested” in participating in the appraisal process set forth under the policy.
Procedural History
counts for breach of contract and declaratory judgment, and propounded its
First Set of Interrogatories and First Request to Produce which are not
D).
alleging counts for breach of contract and declaratory judgment. (App. E).
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On February 5, 2009, Appellant filed a Motion for Protective Order
and for Extension of Time to Respond to Discovery based upon the pendency
of its Motion to Dismiss and to preserve its demand for appraisal. (App. G).
Motion for Protective Order and Motion for Extension of Time to Respond to
Discovery, alleging inter alia that Appellant had waived its right to refuse to
Compel Appraisal for hearing to occur on May 14, 2009. (App. J).
the independent adjuster hired by Appellant (App. L). On April 24, 2009,
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Appellee also filed a Motion for Partial Summary Judgment (App. M) along
with supporting affidavits (which are not included in the appendix) for
Kull (App. N) on April 30, 2009, a supplemental affidavit of Mr. Kull (App.
individuals which are irrelevant to this analysis and are not included in the
Appendix.
held and transcribed. (App. S). At the hearing, Appellee provided the trial
court with numerous exhibits and copies of the affidavits and documents
discussed at the depositions. The trial court orally ruled that the insurance
provision of the October 3, 2008 estimate and that it had waived its right to
33). The trial court also found that Appellant’s submission of the October 3,
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2008 estimate waived its right to request a sworn proof of loss from
Appellee. (App. S, p. 29-30). The trial court further found that under the
insurance policy, Appellant then had 30 days from the date it “waived” its
appraisal was made on November 18, 2008, the trial court found that it was
“untimely” and therefore appraisal was waived for those damages. (App. S,
p. 28). The trial court found that for damages presented by Appellee in its
(App. T).
On June 1, 2009, the trial court entered its order partially denying and
(App. A). The order specifically found that policy sections E4a(3) and E4c
provided that Appellant had 30 days from October 3, 2008 within which to
demand appraisal. (App. A, p. 5). The order also found that by providing
Appellee with the estimate on October 3, 2008, and the subsequent tender on
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believed to be the total amount of Appellee’s claimed damages, Appellant
“admitted liability and coverage for all items addressed or listed in Mr.
A, pp. 4-5). The order further held that Appellant “failed to timely assert its
2008.” (App. A, p. 5). The order solely relied upon the cases of American
Bankers Ins. Co. of Fla. v. Terry, 277 So. 2d 563 (Fla. 3d DCA 1973),
Llerena v. Lumberman’s Mutual Casualty Co., 379 So. 2d 166 (Fla. 3d DCA
1980), Bear v. New Jersey Ins. Co., 189 So. 252 (Fla. 1939) and Cincinnati
Ins. Co. v. Palmer, 297 So. 2d 96 (Fla. 4th DCA 1974). (App. A, pp. 3-4).
On June 5, 2009, Appellant timely filed its Notice of Appeal with this
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IV. SUMMARY OF THE ARGUMENT
insurer as to the amount of loss. Appellant accepted that there was coverage
for damages that were properly claimed and payable. Appellant conducted an
demanded appraisal of the claim under the policy in light of the dispute as to
damages. Five weeks later, Appellee filed suit and refused to participate in
the appraisal process. Appellant’s first response to Appellee’s lawsuit was its
honored. The trial court, however, found that Appellant had waived its right
offer.
The trial court erred in ruling that Appellant had waived its right to
demand appraisal. The trial court failed to apply the correct law when
precedent from this Court and the Florida Supreme Court, and failed to
resolve all doubts in favor of arbitration and appraisal. When faced with
Appellant’s Motion to Compel Appraisal, the trial court should have confined
acceptance of the judicial forum. Other courts have clarified that only
negotiations and October 22, 2008 good faith offer (which was rejected by
contrary to this Court’s opinion in U.S. Fire Ins. Co. v. Franko and despite
the fact both parties still disputed the amount of loss. The trial court
disregarded this Court’s holding that when an insurer accepts coverage, the
extent of repair of a roof is not a coverage issue, but an amount of loss issue,
and whether an insured is entitled to be paid on a claim and if so, the amount
constituting waiver. This Court has expressly held that when the facts of the
case suggest only delay, a waiver analysis is improper, and that questions of
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The trial court erred in applying anomalous and distinguishable cases
while ignoring recent and directly on-point case authorities. The four cases
distinguishable on their facts. Case law holds that the instant appraisal
provision is optional for the parties, has no time frame within which a
dissimilar in that appraisal was mandatory if there was a dispute (Bear and
The trial court erred in finding that the post-loss obligations under the
policy affected the right to demand appraisal. Under the policy, Appellant
damages. The 30-day requirement that the Appellant advise Appellee of its
intentions after receipt of a sworn proof of loss referenced the four options as
to how the claim was going to be evaluated, i.e., (1) pay the value of the
property, (2) pay the cost to repair or replace the property, (3) take all or any
replace the property with like kind and quality property. Contrary to the trial
court’s holding, the provision did not require the appraisal process to be
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demanded within that 30 day period nor was any time limit imposed for
The trial court failed to apply the correct law and its rulings are not
supported by the evidence. Neither the Appellee nor the trial court
asserted its right to appraisal as its initial response to Appellee’s lawsuit. The
parties agreed there was a valid appraisal agreement and that there was an
The trial court should have compelled the entire matter to appraisal pursuant
to applicable case law. Appellant requests that this Court reverse that portion
the matter back to the trial court with directions to compel all issues
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V. STANDARD OF REVIEW
policies are construed in the same manner as arbitration provisions. See U.S.
Fire Ins. Co. v. Franko, 443 So. 2d 170, 171-72 (Fla. 1st DCA 1983); Fla.
Farm Bureau Cas. Ins. Co. v. Sheaffer, 687 So. 2d 1331, 1332 (Fla. 1st DCA
1997). This Court recently held, “This court reviews de novo a trial court’s
Sales, Inc., 846 So. 2d 1238, 1240 (Fla. 1st DCA 2003) (citing Florida Title
Loans, Inc. v. Christie, 770 So. 2d 750, 751 (Fla. 1st DCA 2000)). Under a de
purely one of law, and [this Court is] not constrained by more deferential
standards from substituting [its] judgment for that of the lower tribunal.”
Dixon v. City of Jacksonville, 774 So. 2d 763, 765 (Fla. 1st DCA 2000).
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VI. ARGUMENT
Compel using the incorrect law and found that Appellant had waived its right
manner as arbitration provisions. See U.S. Fire Ins. Co. v. Franko, 443 So.
2d 170 (Fla. 1st DCA 1983); Fla. Farm Bureau Cas. Ins. Co. v. Sheaffer, 687
So. 2d 1331, 1332 (Fla. 1st DCA 1997). Thus, opinions addressing arbitration
confine its inquiry to three succinct issues: (1) whether a valid written
arbitrable issue exists; and (3) whether the right to arbitrate has been waived.
See O’Keefe Architects, Inc. v. CED Constr. Partners, Ltd., 944 So. 2d 181,
185 (Fla. 2006) (emphasis added); see also Piercy v. Sch. Bd. of Washington
County, 576 So. 2d 806, 807 (Fla. 1st DCA 1991); Phillips v. Gen. Acc. Ins.
Co. of Am., 685 So. 2d 27, 29 (Fla. 3d DCA 1996); Kaplan v. Kimball Hill
Homes Fla., Inc., 915 So. 2d 755, 758 n.1 (Fla. 2d DCA 2005). Although the
trial court stated at the hearing on Appellant’s Motion to Compel that it had
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read Appellant’s motion and supporting memo, (App. S, pp. 3-4) and
construed in favor of arbitration [and appraisal] rather than against it.” The
Hillier Group, Inc. v. Torcon, Inc., 932 So. 2d 449, 456 (Fla. 2d DCA
2006)(quoting Doctors Assocs., Inc. v. Thomas, 898 So. 2d 159, 162 (Fla. 4th
Benedict v. Pensacola Motor Sales, Inc., 846 So. 2d 1238, 1240 (Fla. 1st DCA
2003); see also U.S. Fire Ins. Co. v. Franko, 443 So. 2d 170, 171-72 (Fla. 1st
DCA 1983).
The first two issues the trial court was to address were uncontested.
The parties never disputed that a valid agreement existed containing the
arose at that meeting as to the amount of loss,” and reiterates the same at
paragraph 23. (App. E, pp. 3-4). Thus, as appraisal requires a dispute as to the
During his deposition and in his affidavits, Bill Kull, Appellant’s Senior
Claims Representative, testified that coverage for the damages, including the
roof, has never been denied, just the extent and the amount of the loss needed
between the parties is the extent of roof that needs to be repaired or replaced.
(App. O, p. 2). Thus, the amount of loss to the roof was an appraisable issue.
This Court has held that the determination of the extent of a roof repair
(as in the instant case) is not a coverage dispute, such as would be within the
purview of the Court and not the appraisal panel, but rather is precisely the
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type of dispute intended to be resolved in the appraisal process. See Fla. Farm
Bureau Cas. Ins. Co. v. Sheaffer, 687 1331, 1334 (Fla. 1st DCA 1997),
overruled on other grounds Allstate Ins. Co. v. Suarez, 833 762 (Fla. 2002).
was a coverage question, the insurer argued that because it conceded that the
insurance policy covers the damage to the insured’s home and it would be
bound by the appraisers' determination that replacement of the entire roof was
dispute regarding the amount of the loss. 687 So. 2d at 1332. This Court
agreed with the insurer that the dispute “concerns only the amount of loss.”
Id. at 1334. Whether the insured is entitled under the facts to be paid on a
claim and if so, the precise amount to which the insured is entitled, is a
question reserved for the appraiser. Id. The identical position is made by the
Appellant here, that coverage is present for the roof damage, but that the
18, 2008 letter where he inadvertently omitted the word “not” before the
word “agree” such that the sentence should have read: “We have reviewed
the various estimates submitted [in your November 11, 2008 letter] and do
not agree with what has been submitted by your office as to the amount of
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loss sustained at the Courtney Meadows complex.” (App. O, p. 3). The trial
consistent with Appellant’s demand for appraisal contained within the same
correspondence. (App. S, pp. 39-41). Thus, the other claimed damage items
appraisal.
the insurance contract and not by litigation. See Allstate Ins. Co. v. Suarez,
833 So. 2d 762, 765 (Fla. 2002). Courts should grant motions to compel
be remedied by appeal.” U.S. Fire Ins. Co. v. Franko, 443 So. 2d 170, 172
(Fla. 1st DCA 1983) (citing Lapidus v. Arlen Beach Condo. Ass’n, Inc., 394
So. 2d 1102 (Fla. 3d DCA 1981)). The trial court below has so erred.
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II. THE TRIAL COURT ERRED BY FAILING TO EVALUATE WAIVER
BY THE CORRECT STANDARD
Regarding the third issue of waiver, the trial court failed to apply the
correct authorities regarding what constitutes waiver when the court is faced
to compel arbitration, this Court has held “If a party has manifested an
acceptance of the judicial forum, a court could reasonably conclude that the
party waived any right he or she may have had to arbitration.” Piercy v. Sch.
Bd. of Washington County, 576 So. 2d 806, 808 (Fla. 1st DCA 1991)
18, 2008. (App. N, Ex. D). In response to Appellee’s suit, on January 29,
2009, Appellant filed its Motion to Dismiss and/or Abate Action and Compel
Appraisal based upon the insurance policy and its November 18, 2008
demand. (App. F). On February 5, 2009, Appellant filed its Motion for
based upon the potential of waiving its right to compel appraisal if it engaged
G). On March 9, 2009, this Court entered an Order providing that “any
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conduct, including but not limited to initiating or responding to discovery,
file an answer or counterclaim, and has sought no affirmative relief from the
trial court other than compelling this matter to appraisal. Appellant has not
to the extent necessary to secure its right to have this dispute regarding the
were singularly consistent with its position that this matter should be
submitted to appraisal and not litigation. Thus, there has been no waiver and
the trial court’s finding of waiver is against well-established case law directly
on point.
The trial court erred in accepting the argument that the Appellant
waived its right to demand appraisal by making an offer in the amount of the
final estimate. This ruling is without factual or legal support. In U.S. Fire
Ins. v. Franko, 443 So. 2d 170, 172 (Fla. 1st DCA 1983), this Court addressed
See also Preferred Mut. Ins. Co. v. Martinez, 643 So. 2d 1101, 1102 (Fla. 3d
was not waiver). In this matter, on October 22, 2008, Appellant made
Appellee an offer by tender of the total amount of loss (App. N, Ex. B); on
November 11, 2008, Appellee rejected the offer, made a counter-offer, and
well as other damages it believed were not adjusted (App. N, Ex. C) (App. O,
Ex. B); on November 18, 2008, Appellant demanded appraisal (App. N, Ex.
D). These are clearly settlement negotiations and nothing more. Contrary to
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B. The Right To Demand Appraisal Has No Time Frame
The trial court failed to apply binding precedent finding that the
contractual right to demand appraisal has no time frame. The trial court
expressly found that Appellant “did not demand appraisal until November 18,
2008, beyond the thirty (30) days provided for under [sections E4a(3) and
E4c of] the contract.” (App. A, p. 5). The appraisal provision provides “If
we and you disagree on the value of property or the amount of loss, either
may make written demand for an appraisal of the loss.” (emphasis added).
There is no time limitation listed therein. This language has been interpreted
Farm Fire & Cas. Ins. Co., 805 So. 2d 814, 817 (Fla. 3d DCA 2000)(in
construing a similar appraisal provision, the court held: “This policy allows
mandates presuit appraisal.”) Thus, the trial court erred when it found that
there was a time limit for demanding appraisal under the instant policy.
arbitration, courts have held that the five year statute of limitation applies to
Gissendanner v. Manchester Ins. Co., 307 So. 2d 876, 877 (Fla. 3d DCA
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1975) (holding arbitration demand made 2 years after accident timely under
§95.11, Fla. Stat.); see also Hypower, Inc. v. DOT, 839 So. 2d 856, 857 (Fla.
1st DCA 2003)(approving of Gissendanner). One court has held that when a
after the claim, dispute or other matter in question has arisen,” a four month
Flagler County, 444 So. 2d 971, 972 (Fla. 5th DCA 1983). In this matter,
Appellant’s demand for appraisal was made five months 17 days after the
hailstorm, 35 days before Appellee filed suit, 27 days after tendering its good
faith offer, and only 7 days after receiving Appellee’s rejection and counter-
offer. Thus, under any interpretation of the case law, Appellant’s demand
was timely made. The trial court thus erred in finding waiver upon that basis.
C. The 30-Day Notice Of Intent Language Does Not Impact The Time
Within Which To Demand Appraisal
The trial court erred in finding sections E4a(3) and E4c of the policy
dictated that Appellant had 30 days after October 3, 2008 (the date which the
trial court improperly determined that Appellant waived its right to request
sworn proofs of loss) within which to demand appraisal. (App. S, pp. 28, 29-
30). The policy’s Loss Payment section, paragraph E.4.c., provides: “We
will give notice of our intentions within 30 days after we receive the sworn
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proof of loss.” (App. B, p. 9). The “intentions” refer to the four options
Terra Indus., Inc. v. Commonwealth Ins. Co. of Am., 981 F. Supp. 581, 596
(N.D. Iowa 1997); see also SR Int’l Bus. Ins. Co., Ltd. v. World Trade Center
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Props., LLC, 2003 U.S. Dist. LEXIS 3881, at *4 (S.D.N.Y. Mar. 18,
2003)(approving Terra). Thus, the trial court erred in finding that paragraphs
parties proceeded with the claim as one for repair or replacement --Appellant
Gellman v. Cincinnati Ins. Co., 602 F. Supp. 2d 705, 710 (W.D.N.C. 2009).
The trial court erred in confusing timeliness with waiver. The trial
court expressly held that Appellant “failed to timely assert its right to demand
the trial court’s order was based on the timeliness of the demand.
Timeliness is an issue for the arbitrator, not the trial court. See
O’Keefe Architects, Inc. v. CED Constr. Partners, Ltd., 944 So. 2d 181, 186-
87 (Fla. 2006); see also Alderman v. City of Jacksonville, 902 So. 2d 885,
887 (Fla. 1st DCA 2005); Piercy v. Sch. Bd. of Washington County, 576 So.
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2d 806, 807 (Fla. 1st DCA 1991); City of Crystal River, Fla. v. United Bhd. of
Carpenters, 884 So. 2d 440, 440-41 (Fla. 5th DCA 2004); Howsam v. Dean
Witter Reynolds, 537 U.S. 79, 85 (2002). This Court defined waiver as
v. Knuck, 419 So. 2d 818, 820 (Fla. 3d DCA 1982) (citation omitted). The
trial court did not employ this Court’s waiver analysis, but instead improperly
based its finding upon what it considered the untimeliness of the Appellant’s
demand (App. A, p. 5), a determination for the arbitrator, not the court.
In concert with this Court’s opinion in Piercy, the Third DCA held
repudiation of the right to arbitrate so as to make the issue of delay one for a
court to decide.” ARI Mut. Ins. Co. v. Hogen, 734 So. 2d 574, 575 (Fla. 3d
Constr. Corp., 415 So. 2d 756, 758 (Fla. 3d DCA 1982)) (emphasis added).
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that creates waiver.” The Hillier Group, Inc. v. Torcon, Inc., 932 So. 2d 449,
456 (Fla. 2d DCA 2006) (emphasis added); see also Alderman v. City of
Jacksonville, 902 So. 2d 885, 887 (Fla. 1st DCA 2005). In this matter, there
the waiver analysis required under Piercy and Ziegler, and interpreted by
Appellant’s demand for appraisal was untimely under the subject policy.
The trial court improperly found Appellant’s request for sworn proofs
of loss triggered any time period within which Appellant was required to
demand appraisal. (App. A, pp. 3-5) (App. S, p. 44). As stated above, there
is no such time period in this policy to demand appraisal. The section of the
paragraph E.3.a.(7), it provides the insured “must see that the following are
investigate the claim. You must do this within 60 days after our request. We
will supply you with the necessary forms.” (App. B, p. 8). There is no time
frame within which the insurer must request the sworn proof of loss.
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Further, sworn proofs of loss are available to assist the insurer in
adjusting the claim so it does not have to rely solely on the insured’s bare
statements. Their use is not mandated by the policy in any event. Even
where an insurer has paid for part of a loss on a property damage claim, and
the insured then disputes the amount of loss, the insurer has the right to
request, and the insured has the obligation to complete, sworn proofs of loss
as part of the insured’s post-loss obligations. See U.S. Fid. & Guar. Co. v.
Romay, 744 So. 2d 467 (Fla. 3d DCA 1999). The Romay court stated:
which to base its conclusion.” Id. at 471. Thus, sworn proofs of loss have no
The trial court misapplied and misconstrued the policy as well as failed to
consider, apply, or distinguish any of the cited cases and binding authorities.
Court and the Florida Supreme Court. If it had evaluated the matter correctly
under the proper case law, no waiver would have been found and Appellant’s
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It is well established that a trial court is bound by the decisions of the
Florida Supreme Court just as the district courts of appeal follow controlling
precedents by the Florida Supreme Court. See State v. Dwyer, 332 So. 2d
333, 335 (Fla. 1976)(quoting State v. Lott, 286 So. 2d 565 (Fla. 1973)); see
also Putnam County Sch. Bd. v. Debose, 667 So. 2d 447, 447 (Fla. 1st DCA
1996) (holding “Under the doctrine of stare decisis, lower courts are bound to
adhere to the rulings of higher courts when considering similar issues even
though the lower court might believe the law should be otherwise.” (citing
situation similar to that in the former,” suggests that same result should occur
here. Cuisick v. City of Neptune Beach, 765 So. 2d 175, 177 (Fla. 1st DCA
2000)(citing Forman v. Fla. Land Holding Corp., 102 So. 2d 596 (Fla.
1958)). As aptly stated by the Florida Supreme Court, “the decisions of the
district courts of appeal represent the law of Florida unless and until they are
overruled by this Court. Stanfill v. State, 384 So. 2d 141, 143 (Fla. 1980).
Thus, in the absence of interdistrict conflict, district court decisions bind all
Florida trial courts. Weiman v. McHaffie, 470 So. 2d 682, 684 (Fla. 1985).”
Pardo v. State, 596 So. 2d 665, 666 (Fla. 1992). As such, the trial court erred
similar issues.
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In its Memorandum in Support, Appellant provided the trial court with
and the case law addressing these same factual circumstances and results.
(App. Q). At the hearing, counsel for the Appellant attempted to direct the
trial court back to its Memorandum, but the trial court severely limited
counsel for Appellant’s participation. (App. S, pp. 16, 30, 49, 50, 51). As a
filed its Motion for Reconsideration, raising the points and arguments herein
prior to the trial court entering any written order on the disposition of
Appellant’s motion. (App. T). Notwithstanding, the trial court’s order fails
Appellant. (App. S). Instead, it relies upon four cases (American Bankers
Ins. Co. of Fla. v. Terry, 277 So. 2d 563 (Fla. 3d DCA 1973), Llerena v.
Lumberman’s Mutual Casualty Co., 379 So. 2d 166 (Fla. 3d DCA 1980),
Bear v. New Jersey Ins. Co., 189 So. 252 (Fla. 1939) and Cincinnati Ins. Co.
v. Palmer, 297 So. 2d 96 (Fla. 4th DCA 1974)), which are discussed and
The trial court failed to follow the results in factually similar cases
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accepted coverage, a disagreement on the amount of the loss occurred,
Appellant tendered payment for what it believed was the amount of loss,
demanded appraisal, and then Appellee filed suit. The instant appraisal
(App. B, p. 8).
In Johnson v. Nationwide Mut. Ins. Co., 828 So. 2d 1021, 1025 (Fla.
2002), the Florida Supreme Court was faced with a virtually identically
worded appraisal clause--the only difference being the instant clause adds
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language referring to disagreements as to the “value of the property.”1
Interpreting this appraisal clause, the Florida Supreme Court adopted Judge
Cope’s analysis in Gonzalez v. State Farm Fire & Casualty Co., 805 So. 2d
Thus, even when the insurer admits there is a covered loss (as here) but there
In Florida Farm Bureau Cas. Ins. Co. v. Sheaffer, 687 So. 2d 1331,
1334 (Fla. 1st DCA 1997), overruled on other grounds Allstate Ins. Co. v.
Suarez, 833 762 (Fla. 2002), the insurer conceded that the roof damage was a
covered claim and the only dispute was the scope of the required repair and
1
The Johnson appraisal clause provided as follows:
If we and you disagree on the amount of loss, either may make written
demand for an appraisal of the loss. In this event, each party will select a
competent and impartial appraiser. The two appraisers will select an umpire.
If they cannot agree, either may request that selection be made by a judge of a
court having jurisdiction. The appraisers will state separately the amount of
loss. If they fail to agree, they will submit their differences to an umpire. A
decision agreed to by any two will be binding. Each party will:
a. Pay its chosen appraiser; and
b. Bear the other expenses of the appraisal and umpire equally.
If there is an appraisal, we will still retain our right to deny the claim.
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amount of the loss. The insurer further conceded that if the appraisers found
that the entire roof needed to be replaced, the insurer would be bound by that
decision to the policy limits. Id. at 1334. Under those circumstances, this
Court remanded the matter to appraisal upon the insurer’s motion to dismiss
and compel appraisal. This is the same situation presented here and therefore
In Scottsdale Ins. Co. v. Desalvo, 666 So. 2d 944 (Fla. 1st DCA 1995),
fire and filed a sworn proof of loss, claiming $563,000.00, the limit of
concluded that the insured's loss was only $405,402.08, which sum it paid to
the insured. When the parties were unable to resolve their disagreement over
the additional sum claimed by the insured, the insured filed suit. In response,
2
The Desalvo appraisal provision provided:
If we and you disagree on the value of the property or the amount of loss,
either may make written demand for an appraisal of the loss. In this event,
each party will select a competent and impartial appraiser. The two appraisers
will select an umpire. If they cannot agree, either may request that selection
be made by a judge of a court having jurisdiction. The appraisers will state
separately the value of the property and amount of loss. If they fail to agree,
they will submit their differences to the umpire. A decision agreed to by any
two will be binding. Each party will:
a. Pay its chosen appraiser; and
b. Bear the other expenses of the appraisal and umpire equally.
If there is an appraisal, we will still retain our right to deny the claim.
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the insurer filed a motion requesting the trial court to stay the action, and to
compel the parties to submit to appraisal the amount of the loss, pursuant to
the policy. The trial court denied the motion, ruling that the appraisal clause
reversed and remanded with directions that the trial court compel appraisal,
and stay the action pending the outcome of that appraisal. The instant
scenario mirrors those same facts and should dictate the same result.
distinguish these strikingly similar cases, which would dictate granting the
allegation that Appellant breached its contract also fails. Applicable case law
Even where a party alleges the insurer breached its contract, that does
not amount to waiver of the right to demand appraisal. Post Tensioned Eng’g
Corp. v. Fairway Plaza Assocs., 412 So. 2d 871, 874 (Fla. 3d DCA 1982).
Further, many cases hold where an insured files suit based upon nearly
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e.g., Goff v. State Farm Ins. Co., 999 So. 2d 684 (Fla. 2d DCA 2008); Wilson
v. Federated Nat’l Ins. Co., 969 So. 2d 1133 (Fla. 2d DCA 2007); Nationwide
Mut. Ins. Co. v. Johnson, 774 So. 2d 779 (Fla. 2d DCA 2000) quashed on
other grounds 828 So. 2d 1021 (Fla. 2002); Fla. Farm Bureau Cas. Ins. Co. v.
Sheaffer, 687 So. 2d 1331 (Fla. 1st DCA 1997) overruled on other grounds
Allstate Ins. Co. v. Suarez, 833 So. 2d 762 (Fla. 2002); State Farm Fire &
Cas. Co. v. Middleton, 648 So. 2d 1200 (Fla. 3d DCA 1995); Preferred Mut.
Ins. Co. v. Martinez, 643 So. 2d 1101 (Fla. 3d DCA 1994). This matter is not
distinguishable from these cases and thus the same result should occur.
C. The cases of Bear, Terry, Llerena, and Cincinnati Are Not Controlling
In finding that the Appellant had waived its right to demand appraisal
as to the damages included in the October 3, 2008 estimate, the trial court
relied heavily on the cases of American Bankers Ins. Co. of Fla. v. Terry, 277
Co., 379 So. 2d 166 (Fla. 3d DCA 1980), Bear v. New Jersey Ins. Co., 189
So. 252 (Fla. 1939), and Cincinnati Ins. Co. v. Palmer, 297 So. 2d 96 (Fla. 4th
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review of these cases, however, evidences they are factually dissimilar,
In Bear, specific policy language dictated that case’s outcome and was
significantly different than the instant policy provision. The terms of the
189 So. at 253 (emphasis added). Thus, by its own terms, appraisal was
Additionally, the loss became payable sixty days after “ascertainment” which
The Bear policy language is not present in the instant policy. The
disagree on the value of the property or the amount of loss, either may make
3
See Pando v. United States, 1998 U.S. Dist. LEXIS 11941(S.D. Fla. June
29, 1998), and Columbia Casualty Co. v. S. Flapjacks, Inc., 868 F.2d 1217,
1221-22 (11th Cir. 1989), for additional discussion of limitations and
distinctions from the instant appraisal clause.
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8). Unlike the mandatory language in Bear, demanding appraisal is one of
Other than in the Llerena, Terry, and Cincinnati decisions, Bear has
sworn proof of loss, but not addressing appraisal, in English & Am. Ins. Co.
v. Swain Groves, Inc., 218 So. 2d 453, 457 (Fla. 4th DCA 1969); in a per
curiam affirmance without opinion in Aetna Cas. & Surety Co. v. CK&K
Enters., Inc., 528 So. 2d 561 (Fla. 1st DCA 1988); distinguished in Columbia
Cas. Co. v. Southern Flapjacks, Inc., 868 F.2d 1217, 1221 (11th Cir. 1989);
and simply cited as part of an argument not addressed by the court in Florida
Gaming Corp. v. Affiliated FM Ins. Co., 502 So. 2d 1257, 1265 (S.D. Fla.
The second case of American Bankers Ins. Co. of Fla. v. Terry, 277 So.
2d 563 (Fla. 3d DCA 1973), is likewise distinguishable from the instant facts.
The Terry court held that the motorcycle insurance company “did not invoke
timely the arbitration clause of the policy in its letter of January 11, 1972, the
clause providing for a sixty (60) day period which we conclude began to run
however, the court found the Bear opinion controlling. Thus, the Terry policy
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language must have mirrored the Bear policy language, which is significantly
different than the language of the policy at issue, as stated above. Therefore,
much simpler loss to evaluate and adjust than the instant property
Terry was an action by the insured, not the insurer, and therefore had
demand period under the Terry policy began to run. The court discussed
the existence of the sworn statement in the context of the insurer’s attempt
advanced by any party in the instant suit. Appellant asserts that Terry is
States, 1998 U.S. Dist. LEXIS 11941 (S.D. Fla. June 29, 1998); and
Co., 2008 U.S. Dist. LEXIS 42635 (S.D. Fla. May 29, 2008). Thus, Terry
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iii. Llerena v. Lumbermens Mut. Cas. Co.
The third case improperly relied upon by the Appellee and accepted by
the trial court is Llerena v. Lumbermens Mutual Casualty Co., 379 So. 2d
166 (Fla. 3d DCA 1980). In Llerena, the automobile policy provided “Within
60 days following the filing of proof of loss either the insurer or the insured
Id. at 167 (emphasis added). No such time limitation exists in the language
of the instant policy. To the extent the trial court construed Llerena as
determining the date upon which any time period to demand appraisal should
run (which Appellant disputes), the beginning date should have been October
22, 2008, when the settlement offer check was tendered to Appellee, not
October 3, 2008 when the estimate was provided without payment. The
Llerena court construed and applied its earlier 1973 Terry opinion, as well as
submission of the first settlement offer on February 15, 1978, along with its
formal proof of loss and the time in which it was required to demand
appraisal under the policy (60 days) began to run.” Id. at 167. (emphasis
added). Thus, the time at which the 60 days (in that case) began to run was
the date of the first submission of their settlement offer “along with its draft.”
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In this matter, the first time that Appellee had Appellant’s estimate and draft
was October 22, 2008. Arguendo, if the alleged 30 day period within which
construed, applied, and clarified its previous decision in Terry. Llerena has
never been cited by another Florida state court; but, as stated supra, has been
Commonwealth Ins. Co. of America, 981 F. Supp. 581, 597 (N.D. Iowa
11941 (S.D. Fla. June 29, 1998); and simply cited as part of an argument not
502 So. 2d 1257, 1265 (S.D. Fla. 2007). Thus, Llerena is even more limited
control the instant matter, nor do they lead to a conclusion that Appellant
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iv. Cincinnati Ins. Co. v. Palmer
Palmer, 297 So. 2d 96 (Fla. 4th DCA 1974) is misplaced. The trial court
and Terry trigger a time frame within which appraisal must be demanded.
waiver of formal proofs of loss, not the right to demand appraisal. Id. at
98. Thus, the trial court misapplied this case to the instant facts.
controlling precedent on the trial court. Cincinnati has often been cited
mid-August 1971, the adjuster was satisfied that the loss was covered
under the policy, no other applicable insurance applied, “and that the
balance due the SBA on the loan and mortgage was $56,000.” Id. at 97.
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Thus, the insurer agreed to an amount certain at that time. Under those
facts, the Fourth District found “by the middle of August, 1971, the
insurer had admitted its liability for the loss, at least as to the interest of
opinion never addressed any demands for appraisal. Further, the court
stated that the Cincinnati policy, unlike the instant policy, “required
payment sixty days after proof of loss.” Id. Additionally, the opinion did
(italics and bold emphasis added). (App. B, pp. 8-9). Here, Appellee has not
alleged (nor could it allege) there has been an agreement between the parties
as to the amount of loss, nor that an appraisal award had been made.
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O, p.3, Ex. D) show that Appellee has not complied with all terms of the
language does not require payment of any undisputed portion of the claim by
the insurer that the insured believes is ready for payment. Notwithstanding,
Appellant has made a tender of payment on all undisputed items that it agreed
to on October 22, 2008, only 19 days from the date of the estimate completed
by Mr. Gildenmeister, which would satisfy any 30 day period which would
arguably, but does not, apply. Appellee refused this tender, refused to
the multitude of other opinions published by the Florida Supreme Court and
supports Appellant’s argument that they are not applicable in this factual
settlement offers, making partial payments to the insured, and even to the
extent of not demanding appraisal until filing a motion in the trial court after
the insured files a complaint, the right to demand appraisal has been
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uniformly upheld and no waiver has been found. See, e.g., Johnson v.
Nationwide Mut. Ins. Co., 828 So. 2d 1021 (Fla. 2002); Gonzalez v. State
Farm Fire & Cas. Co., 805 So. 2d 814 (Fla. 3d DCA 2000); Fla. Farm Bureau
Cas. Ins. Co. v. Sheaffer, 687 So. 2d 1331, 1334 (Fla. 1st DCA 1997),
overruled on other grounds Allstate Ins. Co. v. Suarez, 833 So. 2d 762 (Fla.
2002); Scottsdale Ins. Co. v. Desalvo, 666 So. 2d 944 (Fla. 1st DCA 1995);
U.S. Fire Ins. v. Franko, 443 So. 2d 170, 172 (Fla. 1st DCA 1983).
that in the event they could not agree as to the amount of a loss, they would
requested and properly invoked the appraisal provisions. Appellant has not
waived its right to demand appraisal in this matter. As such, this litigation
the Appellee’s bringing of this suit, which has not been met. To allow this
from the essential requirements of law. The trial court, through its order and
Accordingly, in addition to being error as shown above, the trial court’s order
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clearly constitutes a departure from the essential requirements of law, which
cannot be remedied on appeal. See U.S. Fire Ins. Co. v. Franko, 443 So. 2d
170, 172 (Fla. 1st DCA 1983) (citing Lapidus v. Arlen Beach Condo. Ass’n,
Inc., 394 So. 2d 1102 (Fla. 3d DCA 1981)). Therefore, the trial court’s order
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VII. CONCLUSION
respectfully requests that this Honorable Court reverse and vacate the trial
court’s June 1, 2009 Order to the extent that it finds Appellant waived
remand the same to the trial court with directions to compel those damages be
personal property (the table and computers), and for any further relief this
Respectfully Submitted,
GUY E. BURNETTE, JR. P.A.
__________________________
GUY E. BURNETTE, JR., ESQ.
Florida Bar No. 236578
A. DEAN JOHNSON, ESQ.
Florida Bar No. 012084
3020 N. Shannon Lakes Drive
Tallahassee, Florida 32309
Telephone: (850) 668-7900
Facsimile: (850) 668-7972
Attorneys for Appellant
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VIII. CERTIFICATE OF SERVICE
via U.S. Mail to P. Campbell Ford, Esq., Ford, Miller & Wainer, P.A., 1835
N. Third Street, Jacksonville Beach, FL 32250 this ____ day of June 2009.
______________________________
A. DEAN JOHNSON
Roman 14 point font in compliance with the font standards required by Rule
_______________________________
A. DEAN JOHNSON
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