A Florida appeals court sided with an insurer on August 5, 2026, ruling that an estate's claim came years too late to trigger coverage.
The case began in 2012, when an 87-year-old resident wandered away unsupervised from an assisted living facility run by J&S Assisted Living & Consultant LLC. He was struck by a logging truck while crossing a busy intersection and died at the scene. State agencies opened investigations, and the facility's manager called the insurance agent to report the death.
The estate sued J&S for wrongful death and, in 2018, won a $20 million judgment. When J&S did not pay, the estate stepped into J&S's shoes under a 2012 policy from National Assisted Living Risk Retention Group and sued the insurer for refusing to cover and defend the case.
The policy ran from January 13, 2012 to January 13, 2013. The catch: it was a claims-made policy, spelled out in bold at the top of the declarations page - and that detail decided everything.
A claims-made policy pays only if the claim reaches the insurer during the policy period. As the court quoted, "[i]f the claim is reported to the insurer during the policy period, then the carrier is legally obligated to pay; if the claim is not reported during the policy period, no liability attaches."
A "claim," the court said, "is when a demand for monetary damages or services is made because of an injury." The manager's phone call reporting the death did not qualify. Neither did the agency investigations, which were not brought on behalf of the resident or his estate.
The estate did not file its wrongful-death suit until 2014, long after the 2012 policy expired. By then J&S had let coverage lapse, missed the deadline to buy "tail coverage" that extends the reporting window, and renewed only in March 2013 under a new retroactive date - leaving a gap no later policy could bridge.
A trial court had gone the other way. It treated the 2012 phone call and the agencies' questions about coverage as a claim and ordered the insurer to pay the policy's $50,000 limit.
The appeals court rejected that on every point. The phone call was notice of a possible claim, not a claim itself; regulators asking about coverage did not count; and the estate's demand arrived only in 2014, after the policy had expired. The court reversed the judgment against the insurer.
The court drew a sharp line between notice of an incident that might later lead to a claim and an actual claim made under the policy.
