Supplemental Federal Flood-Insurance Claims Require Amount-Specific Proofs of Loss

Introduction

This decision addresses whether an insured that has received payment under a federal flood-insurance policy may recover additional amounts without submitting a signed and sworn proof of loss covering the additional demand. The Eleventh Circuit answered no: an earlier proof of loss supports the amount stated in that document, not an open-ended entitlement to further payment. Supplemental recovery requires compliance with the applicable proof-of-loss requirements, unless an authorized substitute or an express written waiver applies.

Bay Haven at Coco Bay Condominium Association, Inc. managed eleven condominium buildings in Fort Myers, Florida, that sustained flooding during Hurricane Ian. Hartford Insurance Company of the Midwest insured the buildings through the National Flood Insurance Program. Hartford paid the amounts identified in Bay Haven’s initial proofs of loss, but Bay Haven sought more based on its contractors’ invoices.

The central issue was not whether Bay Haven had incurred additional repair expenses. It was whether Bay Haven had satisfied the federally prescribed conditions necessary to recover those expenses under its policies.

Precedential qualification: The opinion is designated “NOT FOR PUBLICATION.” Its significance lies in its application of established strict-compliance principles to supplemental claims and its agreement with other circuits, rather than in the creation of a new binding published precedent.

Factual and Procedural Background

The policies and initial payments

Each building was covered by a Standard Flood Insurance Policy issued through Hartford. The applicable policy form was the residential condominium building association policy prescribed in 44 C.F.R. part 61, Appendix A(3).

Following Hurricane Ian in September 2022, Hartford’s independent adjuster inspected the damage and prepared eleven proofs of loss. Bay Haven’s representative signed and submitted them in November 2023.

Ordinarily, the policy requires a signed and sworn proof of loss within sixty days of the loss. For Hurricane Ian, the Federal Emergency Management Agency extended that period to one year through Bulletin W-22012. Bay Haven nevertheless missed the extended September 2023 deadline.

Hartford therefore obtained FEMA waivers permitting payment of the late submissions. Those waivers were expressly limited to the proofs of loss, dates, and amounts identified in Hartford’s requests. They did not waive requirements for other proofs of loss or modify other policy conditions. Hartford then paid the specified amounts in full.

The supplemental demand

Bay Haven maintained that the payments did not cover additional work reflected in its contractors’ invoices. It sought further payment through an administrative appeal to FEMA, submitting invoices rather than additional signed and sworn proofs of loss.

FEMA rejected the request because the proof-of-loss and appeal documentation did not sufficiently support the claimed flood loss or requested amount. Its decision also informed Bay Haven that additional payment required a signed and sworn proof of loss supported by appropriate documentation.

The litigation

Bay Haven sued Hartford for breach of contract. Hartford sought summary judgment because no signed and sworn proof of loss covered the additional amount. Bay Haven argued that its original submissions, invoices, FEMA waivers, and administrative appeal materials collectively established compliance or substantial compliance.

The district court rejected that position. It held that strict compliance was required and that the documents were not equivalent to the sworn statement demanded by the regulations. The Eleventh Circuit affirmed.

Summary of the Opinion

The court’s conclusions can be organized into five propositions:

1. The original proofs of loss covered only their stated amounts. Hartford’s payment of those amounts did not establish an entitlement to additional compensation.
2. Supplemental demands required corresponding proofs of loss. The additional amounts were themselves amounts claimed under the policy and therefore subject to its submission requirements.
3. FEMA’s waivers were limited. Permission to pay specified late claims did not excuse compliance for later supplemental demands.
4. Invoices and administrative processing were insufficient substitutes. Unsworn invoices did not constitute proofs of loss, and FEMA’s handling of the appeal did not create an implied waiver.
5. The adjuster-report alternative did not cover the supplemental demand. Hartford’s earlier acceptance of an adjuster’s report for one policy related to the initial claim, and Bay Haven submitted no corresponding report for the additional amount.

Because the relevant noncompliance was undisputed, no genuine issue of material fact prevented summary judgment.

Analysis

1. The federal framework changes the ordinary insurance analysis

The National Flood Insurance Program combines private claims administration with federal financial responsibility. Private insurers issue and administer policies as fiscal agents of the United States, while covered claim payments draw on federal funds. The opinion grounds that structure in 42 U.S.C. §§ 4001(b), 4011(a), 4128(a), 4017(a), (d), and 4071(a)(1), together with the implementing regulations.

Consequently, the policy is not simply a privately negotiated insurance contract. Its terms are prescribed by federal regulation. Under 44 C.F.R. § 61.13(d) and Article VIII.C of the applicable policy, those terms cannot be altered, varied, or waived without FEMA’s express written consent.

This distinction drives the result. Substantial compliance, administrative accommodation, or an insurer’s willingness to investigate a claim cannot independently authorize payment contrary to the governing federal conditions.

2. Precedents cited and their influence

Existing Eleventh Circuit authority

Shuford v. Fid. Nat'l Prop. & Cas. Ins. Co., 508 F.3d 1337 (11th Cir. 2007). This decision supplied three important principles. First, summary judgment receives de novo review, with facts and reasonable inferences viewed favorably to the nonmoving party. Second, federal flood-insurance policies demand strict compliance. Third, failure to file a required proof of loss bars recovery unless FEMA expressly waives the requirement in writing. The court also relied on this precedent to reject waiver inferred from claims-handling conduct.

Sanz v. U.S. Sec. Ins. Co., 328 F.3d 1314 (11th Cir. 2003). This case provided the principal justification for strict compliance: federal flood-insurance payments implicate the public treasury. The opinion relied on its requirement that insureds strictly satisfy policy conditions before receiving monetary awards against the government. Its rejection of constructive waiver also supported the conclusion that processing a claim cannot replace an express written waiver.

Together, these cases established the controlling circuit framework. The present opinion applied that framework specifically to additional amounts sought after payment of an earlier claim.

Supreme Court authority protecting public funds

Fed. Crop Ins. Corp. v. Merrill, 332 U.S. 380 (1947). Quoted through Sanz v. U.S. Sec. Ins. Co., this decision supplied the principle that courts must respect the conditions governing charges against the public treasury. Its importance was structural: government-backed insurance remains subject to federal legal restrictions, notwithstanding considerations that might favor an individual claimant.

Off. of Pers. Mgmt. v. Richmond, 496 U.S. 414 (1990). Also quoted through Sanz v. U.S. Sec. Ins. Co., this case reinforced that public expenditure must follow Congress’s legal judgments rather than the preferences of government agents or the equitable appeals of litigants. It supported the court’s refusal to treat administrative conduct as authority to dispense with payment conditions.

Heckler v. Cmty. Health Servs. of Crawford Cnty., Inc., 467 U.S. 51 (1984). The court invoked this decision for the proposition that persons seeking public funds must act with scrupulous regard for legal requirements. That principle explained why the court enforced the proof-of-loss rule despite acknowledging its unforgiving operation.

Other circuits on supplemental claims

Ferraro v. Liberty Mut. Fire Ins. Co., 796 F.3d 529 (5th Cir. 2015). This case directly supported requiring a second proof of loss for additional recovery on an existing claim. It confirmed that an initial submission does not satisfy the documentation requirement for later demands exceeding the original sworn amount.

Gunter v. Farmers Ins. Co., 736 F.3d 768 (8th Cir. 2013). The court cited this decision for its conclusion that failure to submit a proof of loss for a supplemental amount bars recovery. Its role was to reinforce the amount-specific nature of compliance.

DeCosta v. Allstate Ins. Co., 730 F.3d 76 (1st Cir. 2013). This authority influenced two aspects of the analysis. First, a signed and sworn proof of loss claims only the amount listed in that form. Second, unsigned and unsworn estimates do not expand the amount claimed merely because they accompany executed proofs identifying smaller sums. The latter point closely supported the rejection of Bay Haven’s contractor invoices as substitutes for supplemental proofs of loss.

The court stated that every sister circuit to have considered the question had reached the same conclusion. The opinion therefore reinforced an existing inter-circuit consensus rather than creating a conflict.

Other-circuit authority on waiver

Dawkins v. Witt, 318 F.3d 606 (4th Cir. 2003). The court cited this case for the conclusion that FEMA’s initial acceptance of a late proof of loss does not waive compliance with the proof-of-loss requirement. It supported treating an accommodation for one submission as limited, rather than as continuing permission to disregard policy conditions.

3. Why the additional amount required its own proof of loss

Article VIII.G.4 defines a proof of loss as the insured’s signed and sworn statement of the amount claimed under the policy. It also requires information about the loss, damage specifications, a detailed repair estimate, and other supporting particulars.

The court’s reasoning turned on the relationship between the sworn statement and the amount requested. Bay Haven’s original proofs identified particular sums. Hartford paid those sums. A subsequent demand for more money therefore required a corresponding sworn submission; the original proofs did not function as continuing certifications of whatever repair costs might later be asserted.

This distinction also explains why invoices were insufficient. Invoices may help document repair expenses, but they are not the insured’s signed and sworn statement claiming those expenses under the policy. Supporting evidence and the required proof of loss perform different functions.

4. Why the waivers did not extend to supplemental recovery

The court treated the text of FEMA’s waivers as decisive. They authorized payment for identified proofs of loss filed on specified dates and in specified amounts. They expressly preserved the proof-of-loss requirement for other submissions and left other policy conditions unchanged.

The consequence was narrow but important: waiver of lateness for an original submission did not waive the requirement to submit a proof of loss for additional amounts. Nor did it establish a general extension for supplemental claims.

Bay Haven’s reliance on FEMA’s appeal decision failed for a related reason. Even assuming that FEMA proceeded as though a supplemental proof existed, such conduct was not an express written waiver. Moreover, the decision itself directed Bay Haven to provide a signed and sworn proof of loss when requesting additional payment.

5. The adjuster-report alternative remains available, but only within its scope

Article VIII.G.9 permits an insurer, at its option, to accept an adjuster’s report instead of the insured’s proof of loss. The insured must sign the report, and the insurer may require the insured to swear to it.

Bay Haven relied on a January 2023 letter stating that Hartford had elected to accept an adjuster’s report for one policy. The court rejected the argument because that report concerned the initial claim that Hartford had paid. The election did not dispense with requirements for later additional amounts, and Bay Haven had not submitted an adjuster’s report covering those amounts.

An important qualification: The quoted provision does not invariably require a sworn adjuster’s report. It requires the insured’s signature and permits the insurer to demand an oath. The decision should therefore not be read as eliminating this expressly authorized alternative or imposing a universal oath requirement upon it.

6. Why summary judgment was appropriate

Bay Haven characterized the combined effect of its documents as a disputed factual question. But it admitted that it had not submitted additional signed and sworn proofs of loss. The remaining question—whether the other documents legally satisfied or excused that requirement—could be resolved from the policy and waiver language.

The court did not need to determine the precise amount of additional covered damage. Failure to satisfy the prerequisite to recovery independently defeated the breach-of-contract claim for supplemental payment.

Potential Impact

• Supplemental claims require separate attention. Policyholders should not assume that an initial proof of loss preserves recovery for every later-identified expense from the same flood.
• Documentation must satisfy distinct functions. Estimates, invoices, and appeal materials may substantiate damage without constituting the required sworn claim.
• Waiver language matters. A FEMA waiver must be examined for its precise scope, including the submission, amount, and requirement it addresses.
• Administrative review does not itself cure noncompliance. An agency’s consideration of supporting materials does not necessarily excuse an unmet payment condition.
• Authorized substitutes remain claim-specific. Acceptance of an adjuster’s report for an initial claim does not automatically extend to later demands.

For future litigation, the opinion offers persuasive support for resolving supplemental-payment disputes at summary judgment when the absence of a qualifying proof or authorized exception is undisputed. Its unpublished status limits its precedential force, but its reasoning follows established Eleventh Circuit authority and aligns with three other circuits.

The holding does not establish that Bay Haven’s additional repairs were unnecessary or that every supplemental claim fails. It establishes that potentially covered expenses remain unrecoverable when the claimant has not satisfied the applicable conditions for payment.

Complex Concepts Simplified

Standard Flood Insurance Policy

A federally prescribed insurance contract whose terms generally cannot be changed by the insurer or insured without FEMA’s express written consent.

Proof of loss

The insured’s formal, signed, sworn statement identifying the amount claimed and supplying required information about the damage. It is more than an invoice or estimate.

Condition precedent

A requirement that must be satisfied before a contractual right to payment becomes enforceable. The court treated the applicable proof-of-loss requirement this way.

Strict versus substantial compliance

Strict compliance requires satisfying the prescribed conditions. Substantial compliance asks whether a claimant came sufficiently close to fulfilling their purpose. The court required the former.

Express written waiver

A written authorization clearly excusing a requirement within a defined scope. Silence, investigation, or administrative processing is not enough.

Public fisc and Appropriations Clause

The public fisc means government funds. The Appropriations Clause restricts withdrawals from the Treasury to legally authorized expenditures, explaining the court’s insistence on compliance.

De novo review

Independent appellate review of the legal ruling, without deference to the district court’s conclusions.

Conclusion

The Eleventh Circuit affirmed because Bay Haven sought additional federal flood-insurance payments without submitting proofs of loss covering those amounts. Its original sworn claims, limited FEMA waivers, contractor invoices, and administrative appeal did not collectively cure that omission.

The opinion’s central lesson is that compliance is amount-specific: an earlier paid claim does not automatically support supplemental recovery. Although unpublished, the decision reinforces a consistent judicial approach requiring strict adherence to federally prescribed payment conditions while preserving expressly authorized waivers and policy alternatives.