AMBASSADOR BEACH CONDOMINIUM ASS'N
v.
OMAHA PROPERTY & CASUALTY INSURANCE
AI-generated. These summaries, headnotes, and key points are machine-generated and may contain errors or omissions. Always verify against the full opinion text below. Not legal advice.
The court held that the insured's claim for additional payments was not authorized under the standard flood insurance policy because it was not supported by a timely proof of loss and the insured had accepted full payment on the initial proof of loss.
The plaintiff, Ambassador, submitted a proof of loss for flood damage and accepted payment from the defendant insurer, Omaha. Ambassador later sought …
The full statement of facts, procedural history, and disposition for this case are member content.
Join FLexlaw to unlock all legal intelligence© FLexlaw, Inc. — AI-generated enrichments are proprietary. All rights reserved.
Explore caselaw by topic → Browse Standard Flood Insurance Policy cases and more on FLexlaw
MICKLE, District Judge.
Pending before the Court is the Motion for Summary Judgment (doc. 22) filed by Defendant Omaha Property and Casualty Insurance Company. The parties have had the opportunity to fully brief the issues and to submit materials in accordance with Northern District of Florida Local Rules 56 and 7.1. For the reasons explained below, the Court finds that Defendant is entitled to judgment as a matter of law. The motion for summary judgment will therefore be granted.
I. Background
Plaintiff Ambassador Beach Condominium Association, Inc. (Ambassador) has petitioned the Court for appointment of an
*1316
umpire to preside over an appraisal of a flood insurance claim. The flood insurer, Defendant Omaha Property and Casualty Insurance Company (Omaha), denies that the claim can be paid under the terms of the flood insurance policy and contends, therefore, that appointment of an umpire is not warranted. Accordingly, Omaha seeks summary judgment on the ground that the claim is not payable under the terms of the policy.
II. Analysis
The policy at issue is a standard flood insurance policy Omaha issued to Ambassador through the National Flood Insurance Program. The program is operated by the Federal Emergency Management Agency (FEMA) and claims are paid by funds from the federal treasury.
See
Gowland v. Aetna, 148
F. 3d
951, 958 (5th
Cir.1998).
Omaha issued the policy to Ambassador through FEMA’s “Write Your Own” (WYO) program. The program allows participating private insurance companies to issue standard flood insurance policies in their own names.
See
44 C.F.R. § 62.23;
Gowland,
143 F. 3d at 953. “By statute, these WYO companies are fiscal agents of the United States.”
Gowland,
143 F. 3d at 953 (citing42 U.S.C. § 4071). FEMA controls the terms and conditions
of
all standard flood insurance policies, including the ones issued by WYO companies.
See id.
No provision of the standard flood insurance policy can be altered or waived without the express written consent of the Federal Insurance Administrator. See id.
The particular provision of the standard flood insurance policy at issue in the instant case is the requirement that a proof of loss be submitted by the insured within 60 days of the loss. No exception allows the insured to submit an amended or supplemental proof of loss after the 60 days, even if the insured later discovers that the flood damage it sustained exceeds the amount stated in the original proof of loss.
See Dogwood Grocery, Inc. v. South Carolina Ins. Co.,
49 F. Supp. 2d 511, 513, (W.D.La.1999);
Messa v. Omaha Property and Cos. Ins. Co.,
122 F. Supp. 2d 523, 529-30 (D.N.J.2000). Furthermore, once a claim is adjusted and payment on the claim is accepted, no additional payments are authorized under the provisions of the standard flood insurance policy.
See Dogwood Grocery, Inc.,
49 F. Supp. 2d at 513.
Although the parties disagree on many of the factual details surrounding the claim at issue, the material facts are not in dispute.
1
They show that Ambassador timely notified Omaha of flood damage.
2
Omaha then sent an adjuster to assess the amount of flood damage. In accordance with the adjuster’s report, on December 26, 1995, Ambassador signed a proof of loss in the amount of $225,980.11. Omaha paid this amount in full to Ambassador by paying $100,000.00 in advance and the remainder upon the signing of the proof of loss. Ambassador made no other claims for payments within the 60-day period allowed for submitting the proof of loss.
These material facts demonstrate: (1) the initial claim Ambassador made was adjusted; (2) Omaha offered full payment for the claim; and (3) Ambassador accepted the payment. Accordingly, Ambassa
*1317
dor is not entitled to any further payments.
See Messa v. Omaha Property and Cas. Ins. Co.,
122 F. Supp. 2d 523, 529-30 (D.N.J.2000) (payment and receipt of" full amount claimed on proof of loss precludes untimely claim for additional payments);
Dogwood Grocery, Inc. v. South Carolina Ins. Co.,
49 F. Supp. 2d 511, 513, (W.D.La.1999) (once a claim is adjusted and payment offered and accepted, no payments based on a subsequent amendment to the claim are authorized).
Ambassador’s contention, even if true, that Omaha never properly adjusted the claim would not entitle Ambassador to any relief. Ambassador’s claim for payments in excess of the amount adjusted and paid was not made within 60 days of the loss. In fact, approximately eight months passed from the date Ambassador sustained its flood damage until Anbassador contacted a public adjuster to reevaluate the amount of its flood damage.
See
doc. 34, ex. “B” (affidavit of public adjuster stating Anbassador first contacted him on June 6, 1996); ex. “A” (Ambassador Chronology). Several more months passed until the public adjuster notified Omaha of his involvement in the matter and submitted a new proof of loss for additional payments. See
id.
These additional payments sought by Ambassador are not authorized under the provisions of the standard flood insurance policy because they were not included in a timely proof of loss and because Ambassador accepted payment for the full amount on its initial proof of loss.
See Dogwood Grocery, Inc.,
49 F. Supp. 2d at 513;
Messa,
122 F. Supp. 2d at 529-30. Furthermore, Ambassador’s argument that its claim for additional payments was timely because Omaha treated it as timely (by taking actions to process the claim and settle it), is unavailing. The theories of waiver and estoppel are not applicable in cases where the insurer is an agent of the United States, as Omaha is with regard to the standard flood insurance policy.
See Gowland,
143 F. 3d at 954-55;
Messa,
122 F. Supp. 2d at 530-32. Therefore, the actions by Omaha cannot relieve Ambassador from the timely proof of loss requirement of the standard flood insurance policy.
III. Conclusion
Omaha paid Anbassador for the full amount of flood damages claimed in Ambassador’s initial proof of loss. Anbassa-dor’s claim for additional payments was not supported by a timely proof of loss. The claim for additional payments is not authorized under the terms of the standard flood insurance policy. Based on the foregoing, it is hereby
ORDERED AND ADJUDGED:
1. Omaha’s Motion for Summary Judgment (doc. 22) is granted.
2. In accordance with the granting of summary judgment, Ambassador’s Petition to Appoint Umpire (doc. 3) is denied and the clerk is directed to close this case.
Cases With Similar Vibessemantic neighbors from the corpus
Citator
Authorities Cited
- Anderson v. Liberty Lobby, Inc., 477 U.S. 242 (U.S. 1986)
- Tipton v. Bergrohr Gmbh-Siegen, 965 F.2d 994 (11th Cir. 1992)