Homeowner Wins Miami Insurance Coverage Verdict
Table of Contents
Case Background
Clotaire Borgella initiated this lawsuit on April 29, 2021, in the Eleventh Judicial Circuit in and for Miami-Dade County, Florida. The case involved a dispute over a homeowners’ insurance policy issued by Universal Property and Casualty Insurance Company (UPCIC). The homeowner, Mr. Borgella, claimed that his property, located at 14750 S Spur Drive, Miami, sustained a direct physical loss sometime during the policy period, which ran from November 12, 2019, to November 12, 2020. After Mr. Borgella filed a claim, UPCIC either denied coverage or refused to pay the full cost of the loss. The dispute primarily centered on whether the damage was covered under the policy and whether the homeowner had complied with his post-loss obligations. The case went to trial because the parties could not agree on the insurer’s responsibility to pay for the claimed damage.
Cause
The action began as a Petition for Declaratory Relief and a claim for Breach of Contract. The Petition sought a Court order defining the rights of the homeowner under the insurance policy. The underlying cause was UPCIC’s failure to recognize or fully compensate for the damage. Mr. Borgella asserted that a covered physical loss had occurred during the policy period, meaning UPCIC breached the contract by denying the claim and causing the homeowner financial injury.
Injury
The primary injury claimed was the uncovered physical damage to the insured property and the resulting financial burden placed on Mr. Borgella. Because the insurer refused to pay for the repairs, the homeowner sustained a financial loss equivalent to the cost of restoring the property to its pre-loss condition. Additionally, the need to hire legal counsel to compel the insurer to honor the policy represented a further financial injury, for which Mr. Borgella sought compensation in the form of attorney's fees and costs, as allowed under Florida law when a policyholder successfully sues an insurer.
Damages Sought
The Petitioner initially sought non-monetary declaratory relief to establish that the policy covered the loss. However, the true measure of damages was the monetary judgment required to repair the property. The initial petition stated the value of the loss exceeded $30,000.00. Ultimately, Mr. Borgella sought a jury verdict for the total amount of damages that would fully compensate him for the covered loss, along with interest accrued from the date of the loss and attorney's fees and costs incurred during the litigation.
Key Arguments and Proceedings
The trial proceedings focused heavily on the policy’s coverage provisions and the affirmative defenses raised by UPCIC. The battle centered on the specific date and cause of the physical loss and whether the damage fell under the policy’s long list of exclusions.
Legal Representation
Plaintiff(s): Clotaire Borgella
· Counsel for Plaintiff(s): Slava Borshchukov
· Experts for Plaintiff(s): Elier Gonzalez | Al Brizuela
Defendant(s): Universal Property | Casualty Insurance Company
· Counsel for Defendant(s): Natalie Eusebe | Joshua Strudwick | Lisset Trujillo | Kaitlyn Dugas
· Experts for Defendant(s): Jay Coughlin
Key Arguments or Remarks by Counsel
The two sides presented diametrically opposed views on whether the loss qualified for coverage under the terms of the policy.
Claims
Mr. Borgella’s counsel had the burden of proving that a direct physical loss occurred between November 12, 2019, and November 12, 2020. The claim argued that the damage was a sudden, unforeseen event covered under the policy’s core provisions. Furthermore, the Plaintiff’s attorneys argued that Mr. Borgella had substantially complied with all policy conditions, including notifying the insurer of the loss and allowing inspections, meaning the insurer’s denial of the claim was a wrongful breach of contract.
Defense
UPCIC’s legal team filed a comprehensive defense strategy, challenging almost every aspect of the claim and asserting numerous Affirmative Defenses.
Duty After Loss Non-Compliance: The insurer argued that Mr. Borgella failed to substantially comply with the "Duties After Loss" provisions in the policy. Specifically, they questioned whether the homeowner had provided prompt notice of the loss, shown the cause of loss, or submitted documents requested by the company.
Pre-Existing Damage: The defense argued that any damage to the property existed prior to the policy period (November 12, 2019) or resulted from non-covered events.
Exclusions: UPCIC heavily relied on policy exclusions, claiming the damage was the result of faulty, inadequate, or defective workmanship and/or maintenance, which the policy typically excludes from coverage. They asserted that maintenance failures, not a covered peril, caused the property’s issues.
Jury Verdict
The jury confirmed that the Plaintiff, Clotaire Borgella, proved by the greater weight of the evidence that the subject property sustained a direct physical loss during the policy period.
Next, the jury analyzed the insurer’s affirmative defenses regarding the “Duties After Loss” and found:
Mr. Borgella failed to substantially comply with the duty to show the cause of loss.
The jury found against the insurer on the other four duties (prompt notice, mitigate damage, allow inspection, submit documents requested), concluding that the homeowner did not fail on those points.
On November 4, 2024, the jury returned a verdict in favor of the Plaintiff, Clotaire Borgella.
Court Documents