BRUCE A. WONG KEN, AS PERSONAL REPRESENTATIVE OF THE ESTATE OF PAMELA R. WONG KEN, DECEASED, APPELLANT,
v.
STATE FARM FIRE & CASUALTY COMPANY, APPELLEE

Fla. 3d DCA | 1997-01-08
No. 96-1230
Before SCHWARTZ, C.J., and COPE and SHEVIN, JJ.
685 So. 2d 1002 Florida District Court of Appeal, Third District (1997) Caution
Cited by 23 cases

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Synopsis

State Farm sought rescission of a homeowners policy and recovery of over $1.1 million in property damage payments plus $85,000 in additional living expenses, alleging the insured fraudulently claimed living expenses while actually residing in the damaged home. The court affirmed summary judgment for State Farm on the liability issue, holding that the policy's anti-fraud provision validly applies to misrepresentations made in claims after a loss.


Holding

The court held that the policy clause voiding coverage for intentional misrepresentation after a loss is valid and enforceable, and that Wong Ken's fraudulent living expenses claim violated this provision as a matter of law, warranting summary judgment on liability in State Farm's favor.


Headnotes

[1] An insurance policy provision voiding coverage for intentional concealment or misrepresentation of material facts or circumstances relating to the insurance, whether befo…

[2] An insured's intentional misrepresentation made in the process of submitting a claim after a loss can render the entire insurance policy void.

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Key Quotes

“This policy is void as to you and any other insured, if you or any other insured under this policy has intentionally concealed or misrepresented any material fact or circumstance relating to this insurance, whether before or after a loss”

The operative policy provision that voids coverage for intentional misrepresentation or concealment, including misrepresentations made after a loss in the claims process.

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Facts & Procedural History

Hurricane Andrew caused extensive damage to a home in Dade County. State Farm paid over $1,100,000 for property damage repairs and contents replacemen…

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Opinion of the Court
SCHWARTZ, Chief Judge.

SCHWARTZ, Chief Judge.

The cacophony of Hurricane Andrew is over but its dissonance lingers on, and on and on. This case arises from the extensive damage Andrew inflicted on a very expensive home in Dade County owned by Wong Ken’s mother. Pursuant to its homeowners’ policy, State Farm voluntarily paid over $1,100,000 to repair and replace the structure and contents. Afterward, however, Wong Ken, as the representative of his mother’s estate, claimed and received some $85,000 under an insuring agreement which provided for reimbursement of “additional living expenses” incurred as a result of the storm. The carrier subsequently discovered evidence that the “living expenses” claim was fraudulent and brought the present case to rescind the policy and for the return both of the $85,000 and the $1,100,000 it had paid for property damage. The action was.based on the following policy provision:

2. Concealment or Fraud. This policy is void as to you and any other insured, if you or any other insured under this policy has intentionally concealed or misrepresented any material fact or circumstance relating to this insurance, whether before or after a loss, [emphasis supplied]

After extensive discovery, the carrier moved for summary judgment on liability in its favor. The insured has taken this non-final appeal, pursuant to Florida Rule of Appellate Procedure 9.130(a)(3)(C)(iv), from an order granting the motion. We affirm.

There is no question that the clause which voids coverage if the insured makes an intentional misrepresentation “after a loss”— that is, as here, in making a claim — is valid and enforceable. See Chaachou v. American Cent. Ins. Co., 241 F. 2d 889 (5th Cir.l957)(applying Florida law); American Employers’ Ins. Co. v. Taylor, 476 So. 2d 281 (Fla. 1st DCA 1985)(applying provision to conduct in making claim even when anti-fraud provision is silent as to its application after loss), dismissed, 485 So. 2d 426 (Fla.1985); cf. Wendel v. State Farm Fire & Casualty Co., 435 So. 2d 284 (Fla. 5th DCA 1983)(contrarily refusing to extend silent clause to misrepresentations after loss), pet. for review denied, 447 So. 2d 888 (Fla.1984).

Moreover, we agree that Wong Ken’s violation of that portion of the clause was established as a matter of law. The record shows uncontradictedly that, although Wong Ken in fact lived in the damaged home throughout the repair process, he fraudulently represented otherwise to the company, backing his temporarily successful claim with “leases” and a check representing purported rental payments for alternative housing — all of which were entirely bogus. Hence, the order granting the motion for summary judgment on liability1 was correct, Chaachou, 241 F. 2d at 889, and is affirmed. The cause is remanded for determination of the relief to which the carrier is entitled.2

Affirmed, remanded.

SHEVIN, J., concurs.

. The order below docs not, as it could not to permit review under Rule 9.130(a)(3)(C)(iv), see Miami Columbus, Inc. v. Ramlawi, — So. 2d — [1996 WL 734498] (Fla. 3d DCA Case no. 95-1161, opinion filed, December 26, 1996), reach any issue of damages, particularly the vital one of whether the carrier is entitled to recovery, in addition to the $85,000 for the fraudulent claim, also of the $1,100,000 paid for indisputably covered and untainted losses. Applying the rule that such issues arc better first resolved by the trial court, see Mendes v. Dowelanco Indus. LTDA., 651 So. 2d 776, 779 n. 2 (Fla. 3d DCA 1995); City of Coral Gables, v. Puiggros, 316 So. 2d 281 (Fla. 3d DCA 1979), we do not now decide this question. We do point out, however, its resolution may involve such factors as (a) whether, as a matter of policy interpretation, see Stuyvesant Ins. Co. v. Butler, 314 So. 2d 567 (Fla.1975), structure and contents coverage is severable from the living expenses claim so that the fraud may be attributed only to the latter, compare, c.g., Kerr v. State Farm Fire & Casualty Co., 731 F. 2d 227 (4th Cir.l984)(applying rule of sev-erabilitj'); Claxton v. Fidelity & Guaranty Fire Corp., 179 Miss. 556, 175 So.210 (1937)(same); Johnson v. South State Ins. Co., 288 S.C. 239, 341 S.E. 2d 793 (1986)(same); Tempelis v. Aetna Casualty & Surety Co., 169 Wis.2d 1, 485 N.W. 2d 217 (1992)(same) with, c.g.. Long v. Insurance Co. of N. America, 670 F. 2d 930 (10th Cir.l982)(holding that all coverages arc voided by fraud in claim process); Home Ins. Co. v. Hardin, 528 S.W. 2d 723 (Ky.l975)(same); Dale v. Iowa Mutual Ins. Co., 40 N.C.App. 715, 254 S.E. 2d 41 (1979), (same), review denied, 297 N.C. 609, 257 S.E. 2d 217 (1979); (b) whether, because, unlike most of the cited cases which are insureds' claims on the policies, this case is for rescission of the entire contract, the $85,000 fraud may be considered a "material or substantial” breach in light of all the amounts involved, so as to justify that arguably harsh remedy, Gittlin Cos., Inc. v. David & Dash, Inc., 390 So. 2d 86, 86 (Fla. 3d DCA 1980); see Cenal v. Jaramillo, 576 So. 2d 418 (Fla. 3d DCA 1991); (c) whether rescission requires that the premium be first refunded or proffered, First Nat'I Fire Ins. Co. v. Burnett, 79 Fla. 424, 84 So. 382 (1920), or whether it may be deducted from the amount the insured must return to the carrier; and (d) whether the argument that anything less than complete forfeiture would render the antifraud provision "virtually worthless” because the malefactor would "at worst be compelled to disgorge” only what he had fraudulently received, see Chaachou, 241 F. 2d at 892-93, is appropriately answered by permitting, instead of total rescission, claims by the carrier for treble damages for theft, see §§ 772.101 — . 19, Fla. Stat. (1995), or for punitive damages.

. Including any appropriate amendment of the pleadings which may be necessary to reflect the issues suggested in note 1.

Concurrence
COPE, Judge

COPE, Judge

(specially concurring).

I concur with all except the dicta contained in items (a) through (d) of footnote 1. The parties have not addressed any of those issues in this appeal.


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Citator

Cited By (13 total)

  • Flores v. Allstate Ins. Co., 819 So. 2d 740 (Fla. 2002)
    …the context of statutorily mandated coverage. We similarly conclude that the two Third District cases cited by the Second District—Schneer v. Allstate Indemnity Co., 767 So. 2d 485 (Fla. 3d DCA 2000), and Wong Ken v. State Farm Fire & Casualty Co., 685 So. 2d 1002 (Fla. 3d DCA 1997), do not address the issue presented in this case because the policies in both of these cases were homeowners’ policies containing clear language that the policy would be “void” for fraud or misrepresentation whether the fraud occu…
  • Schneer v. Allstate Indem. Co., 767 So. 2d 485 (Fla. 3d DCA 2000)
    …not necessary to the result). Properly considering the issue, then, as one of first impression in this state, I think, as I broadly (but apparently not broadly enough) hinted in what was clearly dictum in Wong Ken v. State Farm Fire & Casualty Co., 685 So. 2d 1002, 1004, n. 1 (Fla. 3d DCA 1997): 1. Unlike many of the non-severability holdings referred to by the majority, the Allstate policy before us does not expressly provide that a fraudulent claim voids the “entire policy” or “all claims.” 44 Am. Jur.2d.…
    1 / 2
  • Lexington Ins. Co. v. Ramdas and Chitra Bhandari, 807 So. 2d 727 (Fla. 3d DCA 2002)
    …sed on their alleged material misrepresentations on a supplemental loss claim. The trial court properly granted summary judgment as the record does not show any material misrepresentations by the insureds. Cf. Wong Ken v. State Farm Fire & Cas. Co., 685 So. 2d 1002 (Fla. 3d DCA 1997) (summary judgment proper as to whether insured made material misrepresentation as a matter of law). We, therefore, affirm that portion of the judgment. However, we reverse the prejudgment interest award. Insureds are not entitled…

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