Mariana Gracia v. Security First Insurance Company
District Court of Appeal of Florida, Fifth District
2018-CA-000942-O, 5D21-1456, September 9, 2022
The trial court originally granted summary judgment in favor of Security First finding that the insured had made affirmative misrepresentations of the pre-loss condition of the property which warranted the forfeiture of coverage under the concealment or fraud provision of the policy. The Fifth District reversed the trial court’s ruling.
The insured submitted a claim for alleged damages to the roof of the subject property for which Security First found coverage and issued payment. Gracia subsequently submitted a sworn proof of loss for more than Security First had paid. Security First denied any additional coverages and a breach-of-contract suit followed seeking additional damages to the roof and interior.
During her deposition, Gracia stated that the pre-purchase inspection in 2015 found that, “Everything was good” and the “roof was in good condition.” Security First then amended its affirmative defenses to include concealment or fraud as the inspection report indicated that the property had roof and interior ceiling damage in 2015 including photographs of the same, which appeared to be substantially similar to those claimed in the lawsuit.
The issue on appeal was whether the insurer was required to establish that the insured’s statements were made with the intent to mislead, in order to justify forfeiture of coverage under the policy’s concealment or fraud provision. The Fifth District recognized that misrepresentation during the insurance application process can void a policy based upon an insured’s false statement — without a showing of intent to mislead. However, false statements made post-loss require proof of intent to mislead to avoid coverage based on concealment or fraud.
The Fifth District Court held that factual questions relating to fraudulent intent or state of mind are generally not ripe for summary judgment determination and reversed the trial court’s granting of summary judgment in favor of Security First on its concealment or fraud affirmative defense.