4.1
Fire Insurance Claim General Instruction (With Defenses Based
Upon False Application, Arson, And False Claim Form)
In this case the Plaintiff seeks to recover from the Defendant under a
fire insurance policy issued by the Defendant insuring the Plaintiff's
[home] [business premises] and contents. There is no dispute that the
fire occurred and that the Plaintiff's property was [damaged] [destroyed]
as a result of that fire. The principal issues for you to decide, therefore,
arise out of the defenses asserted by the Defendant. The Defendant
claims [(1) that the Plaintiff made a fraudulent or a material
misstatement (or concealment) of fact in the original application for the
policy;] [(2) that the Plaintiff intentionally burned or procured the burning
of the insured property;] [(3) that the Plaintiff intentionally and
fraudulently misrepresented a material fact relating to the claim after the
loss had occurred]. With respect to the first defense, that the Plaintiff
made a fraudulent or a material misstatement [or concealment] in the
application for the insurance policy, the Defendant contends [describe
the misrepresentation or concealment alleged by the Defendant.] To
sustain this defense the Defendant must prove by a preponderance of
the evidence either:
First: That the Plaintiff made a fraudulent statement [or concealment] in
the application (without regard to the materiality of the subject matter);
or
Second: That the Plaintiff made a misrepresentation or [concealment]
in the application (without regard to fraudulent intent) concerning a
subject matter that was material to the risk. Accordingly, the first series
of questions you will be asked on your verdict form are:
1. Do you find from a preponderance of the evidence that the Plaintiff, in
the application for the subject insurance, made a fraudulent statement
[or concealment] (without regard to the materiality of the subject
matter)? Answer Yes or No.
2. Do you find from a preponderance of the evidence that the Plaintiff, in
the application for the subject insurance, made a misrepresentation [or
concealment] (without regard to fraudulent intent) concerning a subject
matter that was material to the risk? Answer Yes or No.
With respect to the second defense, that the Plaintiff intentionally
caused or procured the Plaintiff's own loss, the Defendant must prove
by a preponderance of the evidence both of the following facts:
First: That the fire was incendiary in origin; that is, that the fire did not
occur through accident or negligence, but was deliberately and
intentionally set by someone for the purpose of causing destruction of
the property; and
Second: That the Plaintiff is the person who intentionally and willfully set
the fire, or solicited, procured, aided or counseled some other person to
do so for the Plaintiff. Accordingly, the next series of questions you will
be asked on your verdict form are:
3. Do you find from a preponderance of the evidence that the fire in
question was incendiary in origin; that is, that the fire did not occur
through accident or negligence, but was deliberately and intentionally
set by some person with the intent to cause destruction of the insured
property? Answer Yes or No.
4. If you answered Yes to the preceding Question, do you find from a
preponderance of the evidence that the Plaintiff intentionally and
willfully set fire to the insured property or that the Plaintiff solicited,
procured, aided or counseled some other person to do so?
Answer Yes or No.
With respect to the third defense, that the Plaintiff fraudulently, willfully
and intentionally misrepresented or concealed material facts after the
loss had occurred, the insurance policy involved in this case provides
that the policy shall be void if the insured willfully misrepresents or
conceals any material fact in the claim form or otherwise during the
investigation of the loss.
This is a valid provision, and by its terms, if, after the loss, any false
answer is intentionally and willfully made by the insured concerning a
fact material to the inquiry, such answer would be fraudulent and the
policy would be rendered void. It is not necessary, however, that the
insurance company actually be deceived by the falsehood or rely upon
such misrepresentation to its detriment. In this case the false statement
that the Defendant alleges the Plaintiff made was [describe the false
statement alleged by the Defendant.] To establish this defense,
therefore, it must be proved by a preponderance of the evidence that
the insured in making such a statement knew that the statement was
false, and that the statement was material to the claim involved, that is
to say, that the statement affected the liability of the company to pay.
Thus, if such statement, even though erroneous, was made with the
honest belief that it was true, then the insured would not be guilty of
fraud, which is a necessary part of the Defendant's defense.
Accordingly, the next question you will be asked on your verdict
form is:
5. Do you find from a preponderance of the evidence that the Plaintiff
fraudulently, willfully and intentionally misrepresented or concealed
material facts or circumstances on the claim form or during the inquiry
made by the Defendant after the fire loss had occurred? Answer Yes or
No.
The word "intentionally," wherever that word has been used in these
instructions, means to say or do something deliberately, consciously
and voluntarily.
The word "willfully," wherever that word has been used in these
instructions, means to say or do something purposely and in bad faith,
with the specific intent to accomplish a wrongful result. The words
"fraud" or "fraudulent," wherever those words have been used in these
instructions, mean the making of any untrue statement of fact that is
then known to be untrue by the person making the statement, or making
a statement with reckless indifference as to its truth or falsity, and
making such statement with the intent to deceive. A "fraudulent"
statement or representation may also be made by statements of
misleading half truths, or a deliberate concealment of material facts,
when done with the intent to deceive. However, incorrect answers on an
insurance application are not fraudulent statements or material
misrepresentations and do not invalidate the policy when the particular
applicant in good faith makes an erroneous expression of opinion or
judgment, or the applicant misunderstands an inquiry that is couched in
language or refers to subjects in special fields beyond his or her
understanding.
The word "material" wherever that word has been used in these
instructions, means that the subject matter of the statement [or
concealment] related to a fact or circumstance that would be important
to the decision to be made as distinguished from an insignificant, trivial
or unimportant detail; that is, to be material, an assertion [or
concealment] must relate to a fact or circumstance that would affect the
liability of the insurer (if made during an investigation of the loss), or
would affect the decision to issue the policy, or the amount of coverage
to be afforded or the premium to be charged (if made in the application
for the policy). [If you find for the Plaintiff and against the Defendant on
its defenses, you will then consider the issue of the Plaintiff's damages.]
In considering the issue of the Plaintiff's damages, you are instructed
that you should assess the amount you find to be justified by a
preponderance of the evidence as full, just and reasonable
compensation for all of the Plaintiff's damages, no more and no less.
Compensatory damages are not allowed as a punishment and must not
be imposed or increased to penalize the Defendant. Also, compensatory
damages must not be based on speculation or guesswork because it is
only actual damages that are recoverable.
You should consider the following elements of damage, to the extent
you find them proved by a preponderance of the evidence, and no
others:
(a)Damages to the Building
(b) Damages to the Contents Accordingly, the next question you will be
asked on your verdict form is:
6. What sum of money do you find from a preponderance of the
evidence to be the amount of the Plaintiff's damages resulting
from the fire? Answer in Dollars and Cents. Damages to the Building
$ Damages to the Contents $ Total Damages $
4.1 Fire Insurance Claim
General Instruction
(With Defenses Based Upon False Application,
Arson, And False Claim Form)
SPECIAL INTERROGATORIES TO THE JURY
Do you find from a preponderance of the evidence:
1. That the Plaintiff, in the application for the subject insurance, made a
fraudulent statement [or concealment] (without regard to the materiality
of the subject matter)? Answer Yes or No
2. That the Plaintiff, in the application for the subject insurance, made a
misrepresentation [or concealment] (without regard to fraudulent intent)
concerning a subject matter that was material to the risk? Answer Yes
or No
3. That the fire in question was incendiary in origin; that is, that the fire
did not occur through accident or negligence, but was deliberately and
intentionally set by some person with the intent to cause destruction of
the insured property? Answer Yes or No
4. If you answered Yes to the preceding Question, that the Plaintiff
intentionally and willfully set fire to the insured property or that the
Plaintiff solicited, procured, aided or counseled some other person to do
so? Answer Yes or No
5. That the Plaintiff fraudulently, willfully and intentionally
misrepresented or concealed material facts or circumstances on the
claim form or during the inquiry made by the Defendant after the fire
loss had occurred? Answer Yes or No
6. What sum of money do you find from a preponderance of the
evidence to be the amount of the Plaintiff’s damages resulting from the
fire? Answer in Dollars and Cents. Damages to the Building $
Damages to the Contents $ Total Damages $
SO SAY WE ALL.
Foreperson
DATED:
ANNOTATIONS AND COMMENTS
The statutes of each of the three states in the Eleventh Circuit provide that an
insurance policy is void able if the application is fraudulent or contains
misrepresentations that are material to the risk. See Alabama Code § 27-14-7;
Fla. Stat. § 627.409; Georgia Code § 33-24-7.
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