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Ocean Point Claims Company
Ocean Point Claims:policy conditions denial
Denial Playbook

Policy Conditions Denial

Florida policies contain specific conditions: duties after loss, cooperation, proof of loss, examination under oath. Failure to meet these conditions can be grounds for denial, but the standard is specific.

Common conditions

  • Prompt notice of loss
  • Protect property from further damage
  • Cooperate with investigation
  • Submit proof of loss
  • Attend examination under oath
  • Produce requested documents

The strict compliance vs. substantial compliance debate

Florida courts have varied:

  • Some conditions require strict compliance
  • Others require only substantial compliance
  • Material breach required for denial

Ocean Point Claims:bad faith indicators in denial

Common denial patterns

"You didn't provide proof of loss"

  • Did carrier demand proof of loss?
  • Was demand specific?
  • Was time to comply reasonable?
  • Did you respond?

"You didn't attend EUO"

  • Was EUO properly noticed?
  • Was time to prepare adequate?
  • Did you attend or offer alternative?

"You didn't mitigate"

  • Documented mitigation efforts
  • Reasonable action under circumstances
  • Carrier-caused delays in mitigation

Rebutting condition-based denial

  • Document compliance attempts
  • Challenge specificity of demand
  • Raise carrier's own non-compliance (627.70131)
  • Cite substantial compliance case law

Related

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