Third DCA holds that request to exceed emergency mitigation policy limit submitted after services already provided is ineffective and does not require a response
In, All Ins. Restoration Servs. a/a/o Cediel v. Citizens Prop. Ins. Co., 2021 Fla. App. LEXIS 13644 (Fla. 3d DCA 2021), the Court upheld a grant of summary judgment in favor of Citizens based upon Citizens’ argument that it had tendered the $3,000 reasonable emergency measures limit. In the underlying claim, Citizens’ insureds executed an Assignment of Benefits for emergency mitigation services (“AOB”) to All Insurance Restoration Services, Inc. (“AIRS”) on October 26, 2017, AIRS completed the mitigation services on October 30, 2017, but did not contact Citizens until November 17, 2017 at which time AIRS submitted, via email, a copy of the AOB and an invoice for $7,238.75. Prior to submitting the invoice, neither AIRS or the insureds requested prior approval from Citizens to exceed the $3,000 limit for reasonable emergency measures. Citizens did not respond to the email, instead, Citizens tendered payment in the amount of $3,000 to AIRS. AIRS then filed suit alleging breach of contract. Citizens moved for summary judgment on the basis that it had tendered all benefits due and owing to AIRS. In opposition, AIRS argued that the November 17, 2017 email submission was its “request” to exceed the $3,000 limit and that because Citizens failed to respond to the “request” within 48 hours as required by the policy, AIRS was not subject to the $3,000 limit. In upholding the grant of summary judgment in favor of Citizens, the 3d DCA held that the submission of the AOB and Invoice was nothing more than a demand for payment for services already rendered and that, “Seeking payment of an invoice for services already rendered does not equate to requesting authorization to exceed the $3,000 limit”. The Court held that while Citizens was required to respond within 48 hours to a request to exceed the limit, Citizens is not required to respond to a demand for payment of an invoice for reasonable emergency measures already rendered.
The takeaway: The submission of an AOB and Invoice after services already rendered is ineffective to request to exceed reasonable emergency measures limit as the request must be made before services are rendered. Also, an insurer is not required to respond to a request to exceed the limit if the request is made after services have already been provided.