Filing Number: 687415
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| Filing Accepted: 4/10/2023 |
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PETERSON
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First Name |
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THEODORE AND MAMIE |
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| Street Address
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3810 SE 18TH AVE |
| City, State Zip
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GAINESVILLE,
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32641
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| Email Address
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PETERSON4181@HOTMAIL.COM |
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Insured |
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| Last/Business Name* |
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PETERSON |
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First Name |
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THEODORE AND MAMIE |
| Policy # * |
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80-E5-7235-1 |
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Claim #* |
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59-39Q1-22G |
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Attorney is Applicable
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| Last Name* |
DUNNAVANT
First Name *
ERIN
Initial
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| Street Address* |
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901 W SWANN AVE |
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TAMPA
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FL
33606
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| Email Address * |
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SERVICE@DANDDLAW.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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STATE FARM FLORIDA INSURANCE COMPANY
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| Insurer Name* |
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NAIC Company Code 10739 |
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| Name of individual responsible for violation (if any):*
CLAIMS DEPARTMENT, SUPERVISORS, MANAGEMENT, AGENTS, AND ADJUSTERS, INCLUDING THE FOLLOWING REPRESENTATIVE & ADJUSTER(S) AND VENDORS SPECIFICALLY: TONY SWINDOLL AND ANDREW AURIG
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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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Claim Denial
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Claim Delay
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Unfair Trade Practice
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Other
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Violation of Code of Ethics
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Other
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Litigation Strategy and Behavior
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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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| 624.155(1)(b)(3) |
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Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
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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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
The Insureds believe the language relevant to the violations includes the valuation and payment provisions, the declarations pages, and the following applicable provisions.
The Insureds do not have a certified copy of the applicable policy (or otherwise), but believe the following policy language from their declarations page may apply:
SECTION I – PROPERTY COVERAGES AND LIMITS
Coverage Limit of Liability
A Dwelling $148,600
Other Structures $14,860
B Personal Property $113,000
C Loss of Use $44,580
Additional Coverages
…
Debris Removal Additional 5% available/$1,000 tree debris
In addition, State Farm has cited to the following policy language as being relevant to the applicable insurance claim in prior correspondence to its Insureds:
SECTION I – LOSSES INSURED
COVERAGE A – DWELLING
We will pay for accidental direct physical loss to the property described in Coverage A, unless the loss is excluded or limited in SECTION I – LOSSES NOT INSURED or otherwise excluded or limited in this policy. However, loss does not include and we will not pay for, any diminution in value.
SECTION I – CONDITIONS
1. Insurable Interest and Limit of Liability. Even if more than one person has an insurable interest in the property covered, we will not be liable:
a. to the Insured for an amount greater than the Insured’s interest; or
b. for more than the applicable limit of liability.
2. Your Duties After Loss. After a loss to which this insurance may apply, you must cooperate with us in the investigation of the claim and also see that the following duties are performed:
a. give immediate notice to us or our agent and also notify:
(1) the policy if the loss is caused by theft, vandalism, or any other criminal act; and
(2) the credit card company or bank if the loss involves a credit card or bank fund transfer card;
b. protect the property from further damage or loss and also:
(1) make reasonable and necessary temporary repairs required to protect the property;
(2) take reasonable and necessary actions to preserve and retain any damaged property;
and
(3) keep an accurate record of repair expenses;
c. prepare and inventory of damaged or stolen personal property:
(1) showing in detail the quantity, description, age, replacement cost, and amount of loss;
and
(2) attaching all bills, receipts, and related documents that substantiate the figures in the inventory;
d. as often as we reasonably require:
(1) exhibit the damaged property;
(2) provide us with any requested records and documents and allow us to make copies;
(3) while not in the presence of any other insured;
(a) give statements; and
(b) submit to examinations under oath; and
(4) produce employees, your representatives, including public adjusters, members of the insured’s household, or others for examination under oath to the extent it is within the insured’s power to do so;
e. submit to us, within 60 days after the loss, your signed, sworn proof of loss that sets forth, to the best of your knowledge and belief:
(1) the time and cause of loss;
(2) interest of the insured and all others in the property involved and all encumbrances on the property;
(3) other insurance that may cover the loss;
(4) changes in title or occupancy of the property during the term of this policy;
(5) specifications of any damaged structure and detailed estimates for repair of the damage;
(6) an inventory of damaged or stolen personal property described in 2.c;
(7) receipts for additional living expenses incurred and records supporting the fair rental value loss; and
(8) evidence of affidavit supporting a claim under SECTION I – ADDITIONAL COVERAGES, Credit Card, Bank Fund Transfer Card, Forgery, and Counterfeit Money coverage, stating the amount and cause of loss; and
f. if hurricane or windstorm coverage is provided by this policy or by endorsement, give notice to us or our agent of any windstorm or hurricane loss, including, but not limited to, initial, supplemental and reopened claims, in accordance with policy requirements and within 3 years after the hurricane first made landfall or the windstorm caused the covered damage.
6. Suit Against Us. No action will be brought against us unless there has been full compliance with the policy provisions. Any action by any party must be started within five years after the date of loss or damage.
Damage resulting from these causes of loss are not covered by your policy. Please refer to the following policy provisions:
SECTION I – LOSSES NOT INSURED
1. We will not pay for any loss to the property described in Coverage A that consists of, or is directly and immediately caused by, one or more of the perils listed in items a. through m. below, regardless of whether the loss occurs abruptly or gradually, involves isolated or widespread damage, arises from natural or external forces, or occurs as a result of any combination of these:
g. wear, tear, decay, marring, scratching, deterioration, inherent vice, latent defect, or mechanical breakdown;
h. corrosion, electrolysis, or rust;
i. wet or dry rot;
k. settling, cracking, shrinking, bulging, or expansion of pavements, patios, foundations (including slabs, basement walls, crawl space walls, and footings), walls, floors, roofs, or ceilings;
However, we will pay for any resulting loss from items a. through l. unless the resulting loss is itself a Loss Not Insured as described in this Section.
3. We will not pay for, under any part of this policy, any loss consisting of one or more of the items below. Further, we will not pay for any loss described in paragraphs 1. and 2. Immediately above regardless of whether one or more of the following: (a) directly or indirectly cause, contribute to, or aggravate the loss; or (b) occur before, at the same time, or after the loss or any other cause of loss:
a. conduct, act, failure to act, or decision of any person, group, organization, or governmental body whether intentional, wrongful, negligent, or without fault;
b. defect, weakness, inadequacy, fault, or unsoundness in:
(1) planning, zoning, development, surveying, or siting;
(2) design, specifications, workmanship, repair, construction, renovation, remodeling, grading, or compaction;
(3) materials used in repair, construction, renovation, remodeling, grading, or compaction;
or
(4) maintenance;
of any property (including land, structures, or improvements of any kind) whether on or off the residence premises; or
c. weather conditions.
However, we will pay for any resulting loss from items 3.a, 3.b., and 3.c. unless the resulting loss is itself a Loss Not Insured as described in this Section.
VIII. TO ENABLE THE INSURER TO INVESTIGATE AND RESOLVE YOUR CLAIM, DESCRIBE THE FACTS AND CIRCUMSTANCES GIVING RISE TO THE INSURER'S VIOLATION AS YOU UNDERSTAND THEM AT THIS TIME.
In addition of the above statutory provisions alleged to have been violated, see also the following statutes and rules:
624.155(1)(a)1 Any person may bring a civil action against an insurer when such person is damaged: (a) by violation of any of the following provisions by the insurer: (1) Section 626.9541(1)(i), (o), or (x)
69B-220.201(3)(b)(2) An adjuster shall adjust all claims strictly in accordance with the Insurance contract.
69B-220.201(3)(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
69B-220.201(3)(d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.
69B-220.201(3)(k) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise.
626.877 Every adjuster shall adjust or investigate every claim, damage, or loss made or occurring under an insurance contract, in accordance with the terms and conditions of the contract and of the applicable laws of this state.
626.878 An adjuster shall subscribe to the code of ethics specified in the rules of the department. The rules shall implement the provisions of this part and specify the terms and conditions of contracts, including a right to cancel, and require practices necessary to ensure fair dealing, prohibit conflicts of interest, and ensure preservation of the rights of the claimant to participate in the adjustment of claims.
627.70131(7)(a) Within 90 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer which reasonably prevent such payment. The insurer shall provide a reasonable explanation in writing to the policyholder of the basis in the insurance policy, in relation to the facts or applicable law, for the payment, denial, or partial denial of a claim. If the insurer’s claim payment is less than specified in any insurer’s detailed estimate of the amount of the loss, the insurer must provide a reasonable explanation in writing of the difference to the policyholder. Any payment of an initial or supplemental claim or portion of such claim made 90 days after the insurer receives notice of the claim, or made more than 15 days after there are no longer factors beyond the control of the insurer which reasonably prevented such payment, whichever is later, bears interest at the rate set forth in s. 55.03. Interest begins to accrue from the date the insurer receives notice of the claim. The provisions of this subsection may not be waived, voided, or nullified by the terms of the insurance policy. If there is a right to prejudgment interest, the insured must select whether to receive prejudgment interest or interest under this subsection. Interest is payable when the claim or portion of the claim is paid. Failure to comply with this subsection constitutes a violation of this code. However, failure to comply with this subsection does not form the sole basis for a private cause of action.
624.155(5) No punitive damages shall be awarded under this section unless the acts giving rise to the violation occur with such frequency as to indicate a general business practice and these acts are:
(a) Willful, wanton and malicious;
(b) In reckless disregard for the rights of any insured; or
(c) In reckless disregard for the rights of a beneficiary under a life insurance contract.
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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.
FACTS AND CIRCUMSTANCES GIVING RISE TO THE VIOLATION
The property located at 3810 SE 18th Ave., Gainesville, Florida 32641 (“the Insured Property”) was damaged by a windstorm loss on or about September 21, 2022. Fortunately, prior to the loss, the Insureds, Theodore Peterson and Mamie Peterson, had obtained comprehensive all-risks coverage with State Farm Florida Insurance Company (“State Farm”). State Farm’s administrative and home address is 215 S. Monroe Street, Tallahassee, FL 32301 and its mailing address is 3903 Northdale Blvd., Suite 112W, Tampa, FL 33624.
On or about September 21, 2022, the Insureds suffered a covered windstorm loss at their Insured Property. The Insureds timely reported the loss to State Farm. State Farm assigned claim number 59-39Q1-22G to the Insureds’ claim and claim representatives, Tony Swindoll and Andrew Aurig, to adjust the claim.
Prior to all of this, and being responsible homeowners who being themselves of retirement age (and thus unable to easily climb on their roof) had Worthmann Roofing inspect their roof on or about June 3, 2022. Photographs from June 3, 2022, showed that there were no damages to the shingles of the roofing system.
Following the storm that occurred on or about September 21, 2022, the Insureds noticed damages to the roof. As such, they reported the claim to State Farm. Instead of attempting to properly adjust the claim with their Insureds, State Farm almost immediately began to take an accusatory tone with the Insureds. On or about September 26, 2022, State Farm sent correspondence to the Insureds which implicitly read as though State Farm was accusing the Insureds of having done something wrong by opening a claim with it. The letter also identifies an inaccurate date of loss. State Farm placed the date of loss as August 21, 2022.
On or about October 18, 2022, State Farm sent correspondence to its Insureds wrongfully denying their claim. State Farm’s denial letter contradicted itself. First, State Farm stated that “it was determined the wind speeds on the date of loss reported were not strong enough to damage shingles on your dwelling roof.” However, then State Farm goes on to state that “since the property damage was reported approximately one month from the reported date of loss, it is not possible to establish when and how often the observed damages to your dwelling roof occurred. Therefore, State Farm has been prejudiced in [its] ability to thoroughly investigate this claim thus we are unable to provide coverage for this loss at this time.”
From the onset, State Farm continues to identify a wrong date of loss. The loss was not reported almost one month after its occurrence. Nonetheless, State Farm’s analysis is illogical. State Farm cannot both be “prejudiced” and unable to “establish when and how often the observed damages to [the] dwelling roof occurred,” but yet also determine that “wind speeds on the date of loss reported were not strong enough to damage shingles on [the] dwelling roof.” The applicable insurance policy covers damages if the Insured Property sustains losses from wind-related damages within the policy period, not “dates of loss.” Simply put, the manner of loss is what is most relevant in deciding if a claim is covered, not which date it occurred (as long as the loss falls within the effective period of the policy).
After State Farm denied the claim, Worthmann Roofing came back out to the Insured Property and inspected the roof again on or about October 25, 2022. The photographs taken by Worthmann clearly evidence that the roofing system had sustained damages following the September 2022 windstorm.
Suspect of State Farm’s claim decision, the Insureds retained the services of TRIAD Restoration Services (“Triad”) to independently inspect the Insured Property and render an opinion as to cause and origin of the loss and to prepare an estimate of damages as to amounts required to bring the Insured Property back into a pre-loss condition. In its report dated March 16, 2023, Triad made the following determinations:
Conclusions and Recommendations:
It should be noted that review of the Worthmann’s Roofing Photos taken on 6/3/22 and 10/25/22 showed that there were no damages to the shingle roof prior to September 2022. The damages present within the Worthmann’s Roofing Photos taken 10/25/22 were consistent with the damages we observed on 2/8/23 as a result of the wind damages.
Based on the conditions observed, it was our opinion the Peterson Property had experienced damages caused by a wind event in September 2022 as reported by the owner. Damages observed and reported at the Peterson Property consisted of lifted, debonded, and/or torn shingles.
Triad Forensic Engineering recommends the following scope of work:
1. Based on sample measurements taken on the roof the extent of necessary repairs will be approximately 35.5%. Florida Building Code: Existing Building, Section 706.1.1 states that “Not more than 25 percent of the total roof area or roof section of any existing building or structure shall be repaired, replaced or recovered in any 12-month period unless the entire existing roofing system or roof section is replaced to conform to requirements of this code.” Based on the conditions observed the extents of damages and associated repair areas to the roof exceed 25% of the total roof area. Given the requirements of the Florida Building Code, the entire shingle roof system and associated underlayment should therefore be completely removed and replaced.
2. During the replacement of the roof system, the roof deck should be surveyed and areas evidencing damages/deterioration should be removed and replaced.
3. Upon removal of the roof system, the roof deck fastening pattern should be inspected for conformance to the Florida Building Code. If the deck fastening is found to not conform, the deck should be refastened in conformance with the building code.
4. Any insulation or interior finishes that were affected by moisture or cracking should be removed and replaced.
In its estimate of damages dated March 17, 2023, Triad ascertained that it would cost approximately $18,243.28 (RCV) to properly and adequately restore the Insured Property into a pre-loss state. To date, State Farm has not altered its coverage decision and no payments have been made to the Insureds for their loss.
The Insured Property was clearly damaged by a covered loss. The Insureds timely reported the damage to State Farm. State Farm conducted a deficient investigation and improperly denied, underpaid, and undervalued the covered loss, particularly in light of the evidence it received which identified the cause of the loss and damages and costs required for remediation. State Farm has failed to create and implement adequate guidelines for proper claims investigation, claims evaluation, claims handling, and for training and supervision of employees and independent contractors handlings its claims resulting in statutory violations as set forth above. State Farm has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insureds’ claim for damages.
The concept of insurance is that it is the insurer's granting of timely and prompt indemnity or security against a contingent loss. Fla. Stat. § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment is made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. State Farm has failed to comply with its duty to fully indemnify its Insureds.
State Farm has refused and/or failed to pay the full insurance proceeds owed to the Insureds as required by the policy and law. Refusal and/or failure to settle the Insureds’ claim when under all the circumstances it could have and should have done so had it acted fairly and honestly towards the Insureds is wrong.
The actions taken by State Farm in the handling and adjustment of its Insureds’ claim was willful, wanton, and in complete disregard for the rights of its Insureds and occurs with such a frequency as to indicate a general business practice, and further, is in violation of Florida Statutes § 624.155 and § 626.9541.
Based on the foregoing actions and omissions, State Farm has engaged in wrongful conduct. That wrongful conduct includes, but is not limited to, the following:
1. Improper claim denial.
2. Improper claim delay.
3. Not conducting a full and fair investigation of its Insureds’ claim.
4. Looking for ways to deny recovery to its Insureds.
5. Looking for ways to delay recovery to its Insureds.
6. Not adjusting the claim and not evaluating the loss properly, promptly, and fairly so as to provide full and prompt indemnity to its Insureds.
7. Failing to implement proper standards for the adjustment and investigation of insurance claims.
8. Making misrepresentations to the Insureds about the cause and extent of damages.
9. Not training, supervising, or managing adjusters and independent contractors properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholders’ interests by attempting to deny or minimize payments owed.
10. Establishing severity control initiatives and otherwise establishing a culture of not fully and promptly paying claims following losses.
11. Ignoring submitted claim documentation from the Insureds.
12. Refusing to re-evaluate its claim decision (and/or to further adjust the claim) upon receipt of new information and documentation from the Insureds.
Therefore, to cure the defects outlined in this Civil Remedy Notice, State Farm must:
(1) Tender all insurance monies owed to the Insureds for the windstorm loss to the Insured Property per the Triad estimate, and;
(2) Pay reasonable fees and costs associated with the dispute of this action per the Insureds’ NOI, as well as interest from the date of loss.
A copy of this form has been submitted to the FDFS and has been printed out and mailed to the following parties providing them notice of the filing of the Civil Remedy Notice:
State Farm Florida Insurance Company, via Certified Mail R.R.R.
Mr. Andrew Aurig, State Farm Florida Ins. Co. via U.S. Mail.
Claims Department, State Farm Florida Ins. Co. via U.S. Mail.
Theodore Peterson and Mamie Peterson, via email.
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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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