The hypothetical situation:
1. The insurance carrier requests a proof of loss.
2. There exists a minor dispute as to the scope of the loss — as an example; additional gutter damage and damage to an other structure (that is believed to be covered under the policy).
3. The proof of loss is prepared and notarized which encompasses the entirety of the damage, but does of course not match the Carrier's Agreed Scope of loss due to the inclusion of the disputed items.
4. Subsequently the Carrier rejects the Proof of Loss due to the scope of the PoL differing from the Carrier's scope.
It is understood by us that the Proof of Loss is "the insured's opportunity to state the value of their loss" – Merlin Law
In such a scenario is the carrier correct or have they Erred in their refusal and dismissal of the requested proof of loss for above stated reason? Why or Why not?
Georgia Subscriber
The proof of loss requirement in the standard homeowners policy is straightforward and reads as follows (emphasis added): 7. Send to us, within 60 days after our request, your signed, sworn proof of loss which sets forth, to the best of your knowledge and belief: a. The time and cause of loss; b. The interests of all "insureds" and all others in the property involved and all liens on the property; c. Other insurance which may cover the loss; d. Changes in title or occupancy of the property during the term of the Policy; e. Specifications of damaged buildings and detailed repair estimates; f. The inventory of damaged personal property described in 5. above; and g. Receipts for additional living expenses incurred and records that support the fair rental value loss.
Note that the proof of loss provides the insured's best specifications as to damages along with repair estimates. Many, many insureds are not contractors or experts in renovation. They know what they see, and provide their best information they can to the insurer. This is why repair estimates are important – an insured with minimal knowledge of construction and repairs will rely on the contractor to provide an estimate showing necessary repairs. From that point the insurer needs to work with the insured to come to a resolution of any differences in scope of the damages. There is nothing in any policy language that we have seen that provides for an insurer rejecting an insured's proof of loss, although policy language doesn't necessarily get into the day-to-day details of claims handling.
The appraisal clause is for differences in amount of the loss, not scope. That would not apply in this situation.