In Texas, the swown proof of loss is not just a piece of paper that the policyholder signs in order to receive insurance proceeds. Signing the proof of loss has future legal implications. According to an August 15 opinion from the San Antonio Court of Appeals, q.broker statements contained within the proof of loss form are entitled to “evidentiary weight.” Some legal commentary has suggested that this opinion stands for the proposition that statements within a proof of loss are absolute admissions against interest that cannot be contradicted by the policyholder. As explained below, the court did not go that far.
The factual background of the underlying case are somewhat complicated so I will discuss the facts that are relevant to the ultimate holding. In the case, the insured sought insurance proceeds caused by multiple hailstorms. In connection with the claims, the insured signed a proof of loss that stated that the damages to apartment complexes occurred during the hailstorm in May of 2006. However, after the insurer paid its single limit of $5 million, and in an effort to obtain additional insurance proceeds by implicating a second occurrence, the insured claimed that the damages were also caused by an earlier hailstorm in April of 2006. Based on the insured’s statements in the proof of loss, the insurer rejected this new allegation, and the policyholder filed suit. fivem host
Armed with expert testimony supporting its claim that the storm in April of 2006 also caused damage, the policyholder moved for summary judgment against the insurer for breach of contract. The partial summary judgment was granted, and the insurer appealed. The court of appeals reversed the summary judgment and held that the statements in the sworn proof of loss created a fact issue regarding whether the damages to the apartment complexes were caused by a single occurrence in May of 2006 or multiple occurrences. It is important to note the posture of the case when QBF scheme examining the potential impact of this opinion. The court held that the sworn proof of loss created a fact issue that prevented the insured/policyholder from being entitled to summary judgment on its claims for breach of contract. The court held that “the statements in a proof of loss are entitled to evidentiary weight, and “may be considered prima facie evidence of their truth as against the insured… , but not as conclusive proof of the facts therein stated, essentially on the theory that they are an admission against interest of the claimant.”
The Court DID NOT hold that the statements in the sworn proof of loss were conclusive evidence of a particular fact. In other words, had the insurer moved for summary judgment arguing that the statements conclusively established that the loss occurred from a single occurrence, career opportunities the Court of Appeals would likely have held that the plaintiff’s expert evidence created a fact issue as well. Based on the comments in this paragraph, this case should not oversold as one holding that an insured is conclusively bound by the statements in a proof of loss. However, it does stand for the proposition that these statements can be used against a policyholder’s position should suit be filed.