Case Law Update: Generali v. Springel, Fourth DCA Affirms Coverage Over a Pre-Existing Condition Denial

Case Law Update: Generali v. Springel, Fourth DCA Affirms Coverage Over a Pre-Existing Condition Denial

On August 19, 2026, Florida's Fourth District Court of Appeal affirmed a judgment against travel insurer Generali-U.S. Branch and in favor of policyholders Barry and Wendy Springel, who sued after Generali denied their trip cancellation claim as a pre-existing condition. The case is Generali-U.S. Branch v. Barry Springel and Wendy Springel, No. 4D2025-1824, on appeal from the County Court for the Nineteenth Judicial Circuit in Martin County (Judge Jennifer Alcorta Waters, L.T. Case No. 432023CC001419CCAXMX). Judge Levine wrote for the panel, with Judges Gross and Forst concurring. The opinion is "Not final until disposition of timely-filed motion for rehearing."

What the insureds bought, and what the insurer said

Per the opinion, the Springels booked a cruise departing Oslo, Norway on July 22, 2022 for $38,658, and on February 15, 2022 bought a Generali policy costing $3,492.16 to insure it. The insured was 79. The policy paid 100% for trip cancellation if the insured was prevented from traveling by an "unforeseeable Covered Event," including a "Sickness" that "must first commence while your coverage is in effect under the Policy."

The policy excluded a "PRE-EXISTING CONDITION," which it defined as "a Sickness or Injury during the 180-day period immediately prior to your effective date for which you or your Traveling Companion: (1) received, or received a recommendation for, a diagnostic test, examination, or medical treatment; or (2) took or received a prescription for drugs or medicine."

The insured had been diagnosed with the onset of spinal stenosis in 2011 but received no examinations or treatment for it from 2011 to 2020. In early 2022 he had an MRI, saw a physician's assistant on February 1, had a special X-ray on February 4, and received back injections on February 10 and March 3, while still riding his bike, going to the gym, and taking a separate 12-day cruise on March 13, 2022 that Generali also insured. On March 28, 2022, he met a neurosurgeon for the first time and was told he needed spinal surgery. He had a lumbar fusion on May 17, 2022, and the couple canceled the cruise on June 28, 2022.

Generali's denial letter said: "The effective date of your policy is 02/16/2022, and the medical documentation provided by your doctor indicates that the sickness that caused your loss has been ongoing since being treated on 02/04/22, prior to when the coverage under the policy became effective. As the condition is Pre-Existing as defined, and did not occur after your policy became effective, no benefits are payable for your claim."

What the Fourth DCA held

After a non-jury trial, the county court found for the insureds and ordered reimbursement. The Fourth DCA affirmed on all three of Generali's arguments.

First, the court agreed the sickness commenced during coverage, reasoning that the insured's earlier back issues were "separate and distinct" from the condition that made surgery immediately necessary. Second, on foreseeability, the court treated the question as one of fact for the trial judge, quoting the rule that "Foreseeability is generally a question of fact," and found competent substantial evidence supported the finding that the need for surgery was not foreseeable when the policy was bought.

Third, and most useful to Florida policyholders, the court restated who must prove an exclusion. Citing the Florida Supreme Court, the panel wrote that "The burden of proving an avoidance of the action on the basis that the loss is not covered, since it comes within a specific exclusion contained in the policy is upon the insurer." It added the Third DCA's formulation that "[W]hile an insured or beneficiary carries the burden of proving coverage under a policy, the insurer bears the burden of proving applicability of a claimed policy exclusion."

On the scope of the exclusion, the court relied on Ganson, where the First DCA held that "the fact that both conditions have certain common symptoms . . . does not mean that they are the same condition." The panel concluded the condition that forced the cancellation was not the same condition treated in the 180-day lookback window. Its summary: "there is competent, substantial evidence supporting the trial court's conclusions that the insured's sickness commenced during the policy coverage, that the sickness was unforeseeable at the time coverage was purchased, and that the sickness is not a pre-existing condition excluded from coverage."

What this means if you have a denied first-party insurance claim

This was a travel insurance policy, not a homeowners policy, and the holding is tied to these facts and this policy language. But two points in the opinion are ordinary Florida first-party insurance law, not limited to travel coverage.

One, the insurer carries the burden on an exclusion. If a Florida carrier denies a claim by pointing at an exclusion, proving that exclusion applies is the carrier's job, not the policyholder's job to disprove. Two, a shared symptom is not automatically the same condition. A denial letter linking an earlier diagnosis to a later loss makes a factual assertion that can be tested against the record and the policy's own definitions.

The record the Springels built also mattered. The dates of each appointment, the separate insured cruise weeks earlier, and the insured's continued activity became the competent substantial evidence the appellate court deferred to. Where a claim is denied on an exclusion theory, the treatment timeline and the policy definition's exact wording are usually where the dispute lives. Outcomes turn on each case's facts and policy language, so nothing here predicts a result in any other claim.

If a Florida insurer denied or underpaid your property damage claim, see our guide to a denied homeowners insurance claim in Florida, or contact Louis Law Group for a free case evaluation.

Case information above is drawn from the Fourth District Court of Appeal's written opinion in No. 4D2025-1824, issued August 19, 2026. General information only, not legal advice. Current as of August 31, 2026.