In Castle Key Insurance Company v. Benitez, 3D13-1758 (Fla. 3DCA 2013), the Florida Third District Court of Appeal ruled that an insurance company does not have to produce its claims file prior to resolving whether coverage exists for a Florida insurance claim.
Claims File Work Product Privilege
The homeowners sued their insurance company for breach of contract for failing to pay their insurance claim. The trial court entered an order requiring the insurance company to provide better answers to interrogatories. The insurance company appealed that order arguing the order improperly required it provide information from its claims file.
The Third District Court of Appeal struck down the trial court order. The test constructed by the Court was whether the claim was for bad faith or breach of contract. The appellate court held that if the homeowner is pursuing a breach of contract claim, the claims file need not be produced until the coverage issue for the dispute has been decided.
What is at issue: The Insured’s Right to Know versus the Claims File
A homeowner has a right to know the basis for the denial of his or her insurance claim. A denial letter from the insurance company provides conclusions but no supporting documentation. Without the supporting documentation, there is no way to challenge the rationale for denying the insurance claim. Since insurance companies assert everything is part of the “claims file”, the result is that insurance companies will not give the homeowner anything other than a denial letter during the lawsuit for breach of contract. Only under a trial order must the insurance company disclose all proof it will rely upon for the denial. As a consequence, the only way a homeowner can challenge the specific reasons for the denial of an insurance claim is in final preparation for trial and during the trial. Florida insurance lawyers are therefore encouraged to notice all their cases for trial when possible to obtain all proof that the insurance company relies upon for the denial of the claim.
Related Topics: Florida insurance claim; Florida insurance law; Claims File Work Product Privilege; Miami insurance lawyer
