.

Defense Digest

A Warning on Wording: Appellate Court Reverses Summary Judgment Ruling for Insurer After Finding Condition Precedent Affirmative Defense Too Narrowly Pled

Defense Digest, Vol. 29, No. 3, September 2023

September 1, 2023

by Sean P. Greenwalt

Key Points:

  • Florida’s Sixth District Court of Appeal recently examined the pleading requirements for condition precedents as they relate to an examination under oath.
  • The court concluded that an affirmative defense that is narrowly worded may not be extended to a broader definition despite overall non-compliance with a condition precedent.
  • Pleading condition precedent failure requires specificity by a defendant, but, in certain situations, a broader description of condition precedent noncompliance may be warranted. 

In a cautionary tale, the Sixth District Court of Appeal, in Advanced Florida Medical Group, Corp. v. Progressive American Ins. Co., 364 So.3d 1131 (Fla. 6th DCA 2023), after finding the underlying affirmative defense insufficient, reversed a final summary judgment in favor of an insurer where a claimant failed to complete an examination under oath. The examination was a mandatory condition precedent to receiving personal injury protection benefits under the insurer’s policy and per § 627.736(6)(g), Fla. Stat. (2023).

In the lower court, the insurer obtained summary judgment by arguing the claimant failed to “submit” to a mandatory examination under oath. However, the insurer’s affirmative defense pled that the claimant “failed to appear for an examination under oath.” The trial court entered judgment for the insurer, finding no distinction. The plaintiff appealed. 

On appeal, the Sixth District analyzed the pleading standard for contractual condition precedents, noting that “the burden on the defendant [is] to identify the specific condition that the plaintiff failed to perform[.]” Colon v. JP Morgan Chase Bank, NA, 162 So. 3d 195, 197 (Fla. 5th DCA 2015). The court then analyzed the dictionary definitions of the words “submit” (“to yield oneself to the authority or will of another: or permit oneself to be subjected to something”) and “appear” (“to come formally before an authoritative body[.]”)

The Sixth District went on to hold that the defendant’s choice of wording failed to plead its actual defense that the plaintiff failed to “submit” to an examination because a defendant:

[H]as the burden of pleading its affirmative defense with enough specificity and particularity to alert [the Plaintiff] of what condition was violated[.]” Therefore, the insurer “was bound by its pleadings in moving for summary judgment.”

Citing Inphynet Contracting Servs. v. Soria, 77 So. 3d 776, 781 (Fla. 4th DCA 2011).

However, the irony of the situation is that given the District Court of Appeal’s dictionary references, a claimant who fails to “submit” or “yield oneself to the authority or will of another” would certainly also have failed to “appear” or “come formally before and authoritative body[.]” Had the insurer pled more broadly in this situation, they actually would have met the specificity requirement that the Sixth District had placed before them. 

This opinion is an important reminder that no defense should be left behind when drafting an answer and that all affirmative defenses should be artfully worded to encompass the specificity requirement of condition precedents. 

*Sean is an associate in our Tampa, Florida, office. He may be reached at 813.989.1814 or spgreenwalt@mdwcg.com.

 

Defense Digest, Vol. 29, No. 3, September 2023, is prepared by Marshall Dennehey to provide information on recent legal developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. ATTORNEY ADVERTISING pursuant to New York RPC 7.1. © 2023 Marshall Dennehey. All Rights Reserved. This article may not be reprinted without the express written permission of our firm. For reprints, contact tamontemuro@mdwcg.com.

Firm Highlights

Thought Leadership

Ohio Supreme Court Holds That a Binding Appraisal Award May Not Be Set Aside Absent Specific Evidence of Manifest Mistake or Fraud

On July 23, 2026, the Ohio Supreme Court issued a rare opinion on the binding effect of an appraisal award in a property insurance policy.  The Court in One Church held: A binding appraisal award will not be set aside unless an error is so palpably wrong that it undermines the intent of the agreement, such as corruption or gross mistake, not a mere error of judgment—To plead a claim of mistake with particularity as required by Civ.R. 9(B), facts alleged in a complaint must constitute the elements of mistake—Allegation that additional, hidden damage was discovered after appraisal award failed to state a claim of mistake that could justify setting aside binding appraisal.  The case arose out of a claim brought by One Church against its insurer, Brotherhood Mutual Insurance Company for roof damage from a storm. Pursuant to the terms of the insurance policy, the parties agreed to submit the matter to appraisal. The two appraisers inspected the building, and both appraisers agreed that the damages were $313,271.98. The insurer paid the agreed appraised amount.  Thereafter, the insured submitted a claim for an additional $206,663.09 in damages. The insured argued that these additional damages were not discovered until after the repairs began, and that they should be permitted to submit an additional claim, even though there had already been a binding appraisal of damages. The insurer refused to pay the additional damages, and the insured sued for breach of contract and bad faith.  In the trial court, the insurer moved to dismiss for failure to state a claim, arguing that the binding appraisal award barred any further claims. The insured took the position that additional hidden damages could not be discovered until after the repairs began, and therefore there was a mutual mistake. The trial court dismissed the case on the insurer’s motion, because there was no “evidence of fraud, misfeasance, or mistake”. The Court of Appeals agreed that appraisal awards are generally binding, but noted that an appraisal award can be set aside for fraud or manifest mistake. The Court of Appeals reversed and remanded the case to the trial court, finding that the insured had pled mistake with sufficient particularity. The insurer appealed to the Ohio Supreme Court. On appeal, the Ohio Supreme Court reversed the Court of Appeals, and reinstated the trial court decision dismissing the case for failure to state a claim upon which relief can be granted. The Supreme Court found that since the insured had already demanded appraisal, and the appraisal award was binding, “something more than error of judgement, such as corruption in the arbitrator, or gross mistake” must be pled with particularity, and proven for the insured to override the appraisal award. Since the complaint did not allege fraud or manifest mistake with sufficient particularity, something more than a mere error of judgment, the complaint was insufficient to state a claim.  The complaint in this case did not challenge the appraisal award. It pled that additional damages were discovered that were not apparent when the appraisal was done. It did not specify “who discovered the damages, how they were discovered, where they were found, why they were previously hidden, or why they rise to the level of a manifest mistake that the “appraiser would have corrected...had it been called to his attention”. Id at ¶22 citing Lakewood Mfg. Co. v. Home Ins. Co. of New York, 422 F.2d 796, 798 (6th Cir. 1970). Cases deciding the effect of appraisal awards are unusual. The Ohio Supreme Court’s decision in One Church relies primarily on 19th century case law for its conclusion. This emphasizes the fact that there is minimal case law deciding the effect of binding appraisal clauses in property insurance policies, and makes this case all the more significant. A lengthy dissent was written by Justice Fisher, who would have affirmed the Court of Appeals decision reversing and remanding the case for a decision on the merits. Of course, the decision works both ways, and an insurer dissatisfied with a binding appraisal award will likewise be without further recourse absent evidence of corruption, fraud, misfeasance, or manifest mistake, which must be pled with particularity. To constitute manifest mistake, “the mistake must be of such character that the arbitrator or appraiser would have corrected it had it been called to his attention.”  Lakewood Mfg. Co. v. Home Ins. Co. of New York, 422 F.2d 796, 798 (6th Cir. 1970).  The majority opinion does not specifically identify what would have been sufficient to plead mistake with particularity, or if the insured could have amended the complaint to overcome the deficiencies. The dissent argues that this was not really a case alleging mistake, but rather a question of contract interpretation. The insured did not challenge the appraisal, but argued that the hidden damage was not part of the appraisal, and the appraisal only covered the known damages.  However, this argument did not carry the day with the majority.  *Thomas F. Glassman, a shareholder in Marshall Dennehey’s Cincinnati office, filed a brief in the Ohio Supreme Court on behalf of the Ohio Association of Civil Trial Attorneys, in support of the insurer’s position.

Result

No-Cause Jury Verdict Secured in Wrongful Death Trial

We successfully obtained a no-cause jury verdict in a 13-day wrongful death trial. The decedent, a 59-year-old man, was admitted to the emergency room on February 15, 2019, with complaints of abdominal pain, decreased appetite, and constipation, despite the use of laxatives. The patient did not complain of any nausea, vomiting, or diarrhea. He had a significant medical history including diabetes, hypertension, prior coronary artery stenting, morbid obesity (with past gastric bypass surgery), longstanding ventral hernia, and back pain. A CT scan revealed multiple hernias and a potential closed-loop bowel obstruction, leading to a surgery consultation. Our client, an emergency general surgeon, interpreted that the patient did not have a closed loop or any significant obstruction and recommended non-surgical management. The patient was approved to have clear liquids, and had a vomiting incident shortly after, but our client was not notified. The patient was returned to NPO status, and after improving overnight, he was returned to “clears” and additional medical and renal consults were ordered. Our client did not receive any communications from the residents/nurses of any changes in the patient’s condition. On February 18, 2019, two rapid responses were called due to increased heart rate and vomiting. It is believed that the vomiting resulted in aspiration, causing sepsis, ultimately leading to the patient’s death. During the trial, the plaintiff’s sole medical expert highlighted imaging on the wrong hernia, which called into question all of his opinions in the case. We made key objections related to the expert testimony, limiting what the allegations were, and preventing new allegations from being made. After approximately two and a half hours of deliberating, the jury returned a no-cause verdict.