Filing Number: 651000
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| Filing Accepted: 10/12/2022 |
| Last/Business Name
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| Street Address
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2748 NW 56TH STREET |
| City, State Zip
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MIAMI,
FL
33142
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| Email Address
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SHAWNEVANS1575@YAHOO.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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EVANS |
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First Name |
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LASHAWN |
| Policy # * |
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MLR870594604 |
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Claim #* |
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00201496641 |
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Attorney is Applicable
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| Last Name* |
KRAPF
First Name *
GRANT
Initial
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| Street Address* |
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2790 SUNSET POINT ROAD |
| City, State Zip* |
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CLEARWATER
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FLORIDA
33759
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| Email Address * |
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GRANT@KRAPFLEGAL.COM |
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| Insurer Type
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Authorized Insurer
Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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AMERICAN SECURITY INSURANCE COMPANY
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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 42978 |
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| Name of individual responsible for violation (if any):*
GEOFFREY STEPHENS AND ANY INDIVIDUAL FROM, OR AGENT OF, AMERICAN SECURITY INSURANCE COMPANY WHO WAS INVOLVED IN THE CLAIM.
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Unfair Trade Practice
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Claim Denial
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Claim Delay
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Other
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Not treating the policyholder with good faith claims conduct
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Other
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Looking for ways to deny full recovery to the Insureds
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Other
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Looking for ways to delay full recovery to the Insureds
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Other
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Not training, supervising, or managing adjusters properly so that prompt and full payments are made,
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Other
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Failing to provide the Insureds with the full benefits awarded to him under the contract of insuranc
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
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| 626.9541(1)(i)(2) |
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A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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| 626.9541(1)(i)(3)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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| 626.9541(1)(i)(3)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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| 626.9541(1)(i)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language.
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Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
American Security Insurance Company (the “Insurer”) has committed the following in handling the Insureds’ claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the Policy Holder and Claimant; 3) not adjusting the claims promptly and fairly; 4) not attempting in good faith to settle claims; 5) looking for ways to delay benefit payments; 6) shifting the burden of investigating the loss onto the Insureds; 7) conducting inadequate investigations; and 8) making material misrepresentations of the coverages afforded under the insurance policy.
The Claimant timely submitted a claim to the Insurer on May 18, 2022, for damage sustained to the above-referenced insured property as a result of a water loss, which occurred on May 3, 2022.
Given the scope and nature of the damage the Insured retained a public adjuster who produced an estimate of the covered damage dated June 8, 2022 detailing $12,827.46 in required repairs to the dwelling. On July 22, 2022, the Insurer sent a claims determination letter, which denied the Claimant’s claim. The letter merely advises, “[o]ur investigation indicates lack of documentation. Pending the plumber’s report with the cause of loss and description of rate and flow of water release. Denied for mold.” The claims determination letter fails to explain which documentation is lacking and copied and pasted boilerpoint language from the insurance policy. Furthermore, the Insurer never explains why the documentation is necessary for its investigation. The claims determination letter references a plumber’s report. The letter is unclear as to why the Insurer is awaiting a plumber’s report from the Claimant or from one it retained. The Claimant is not required to investigate its own claim and prove a cause of loss. The Insurer is capable of retaining its own plumber if it required a description of rate and flow of water release. The Insurer is shifting the burden and cost. Here, the Insurer shifted the burden and cost of investigating and insuring the loss onto the Claimant. The Insurer upon the Claimant’s loss had the duty to provide the full benefits under the policy. This includes providing the Claimant with the proper investigation and the funds necessary to return their home to its pre-loss condition.
The Insurer here knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697. The Insurer intentionally ignored covered damage to deny the reported loss and wrongfully fail to pay the Claimant. This is an underhanded attempt to place the financial interests of the Insurer over those of the Claimant and to delay and frustrate the Claimant’s ability to have his claim adjusted promptly to begin restoring his property.
Additionally, although there was interior water damage the adjuster did not use a water meter. A water meter can be purchased online from Amazon for around $40 before tax. The Insurer could purchase a water meter and assess thousands of properties with one meter. Instead, the Insurer would rather place its financial interests over those of the Claimant by failing to provide the adjuster with the necessary tools to correctly inspect the loss. As a result of the inadequate investigation and surrounding circumstances it is apparent that Insurer significantly underestimated the scope of the loss to the Claimant’s property. Insurer and its adjuster have colluded to misrepresent the true scope of damages to the insured property and the true replacement costs of the damages. This is an underhanded attempt to place the financial interest of Insurer over those of the Claimant, to delay the Claimant’s claim, and to delay the Claimant in restoring his property to its pre-loss condition.
In short, Insurer is not acting with due regard for the Insureds’ interests or safety. In Florida the work of adjusting insurance claims engages the public trust. Insurers have a duty to treat all Claimants equally and the Insurer has breached this duty. The Insurer has conducted poor and inadequate investigations and has significantly underestimated the replacement costs of the Claimant’s property to further frustrate and delay the Claimant’s claim. The Insurer is placing their financial interests over those of the Claimant and the Claimant’s safety. The foregoing has only delayed the Claimant’s ability to begin restoring her home to its pre-loss condition.
The Insurer’s actions amount to but are not limited to the following:
1. Claim delay
2. Not treating the policyholder with good faith claims conduct
3. Looking for ways to reduce recovery to the Claimant
4. Looking for ways to deny recovery to the Claimant
5. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Claimant
6. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholder’s interests
7. Placing the financial interest of the Insurer over that of the Claimant
8. Conducting inadequate investigations
9. Making material misrepresentations of the coverages afforded under the insurance policy.
10. Shifting the burden of investigating onto the Claimant
Therefore, to cure the defects outlined in this Civil Remedy Notice, the Insurer must:
(1) Admit full coverage for the Insureds’ loss.
(2) Tender full benefits owed to the Insureds under the insurance contract.
(3) Pay all attorney’s fees, costs, and interest.
A copy of this form submitted to the FDFS has been sent via electronic mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com.
Via Electronic Mail:
American Security Insurance Company d/b/a Assurant
260 Interstate North Cir., SE
Atlanta, GA 30339-2210
myclaiminfo@assurant.com
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The submitter hereby states that this notice is given in order to perfect the rights of the
person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.
Before submitting a Notice using this system, please verify that all text has been entered
correctly and completely. Once the Notice has been submitted, the text cannot be changed
or deleted.
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DFS-10-363
Rev. 10/14/2008
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