Filing Number: 785293
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| Filing Accepted: 10/2/2024 |
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MCNAIR
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First Name |
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VALARIE |
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| Street Address
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9550 SCADLOCKE ROAD |
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JACKSONVILLE,
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32208
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VLYNNMCNAIR@GMAIL.COM |
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Insured |
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MCNAIR |
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First Name |
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VALARIE |
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P007940511 |
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Claim #* |
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255017 |
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Attorney is Applicable
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| Last Name* |
PIASECKI
First Name *
JACOB
Initial
D
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4016 SOUTH THIRD STREET, #1156 |
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JACKSONVILLE BEACH
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FLORIDA
32250
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JAKE@JDP-LAW.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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SECURITY FIRST INSURANCE COMPANY
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NAIC Company Code 10117 |
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| Name of individual responsible for violation (if any):*
SHAYLA MITCHELL, CLAIMS EXAMINER, FL LIC. NO. W618963; AND EVERY ADJUSTER, AGENT, CLAIM REPRESENTATIVE, MANAGER, SUPERVISOR, DIRECTOR, OFFICER, AND INDEPENDENT CONTRACTOR WHO WAS INVOLVED IN THE HANDLING, INVESTIGATION, AND EVALUATION OF 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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Claim Denial
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Claim Delay
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Unfair Trade Practice
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Other
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Unfair claim settlement practices.
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Other
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Failure to conduct a reasonable investigation based on available information.
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Other
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Failure to maintain proper claim handling procedures.
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Other
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Misrepresenting the benefits, advantages, conditions, or terms of any insurance policy.
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Other
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Misrepresenting the insurance policy provisions to the insured(s) or any person(s) with an interest
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Other
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Misrepresenting Florida statutory provisions to an insured.
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Other
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Misrepresenting facts to an insured.
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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)(2) |
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Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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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)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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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)(f) |
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Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
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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.
***ADDITIONAL STATUTORY PROVISIONS ALLEGED TO HAVE BEEN VIOLATED ARE AS FOLLOWS:***
FLORIDA ADMINISTRATIVE CODE SECTIONS & OTHER APPLICABLE STATUTES
Fla. Stat. §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.
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)(f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim.
69B-220.201(3)(j) An adjuster shall not knowingly fail to advise a claimant of the claimant’s claim options in accordance with the terms and conditions of the insurance contract.
69B-220.201(3)(m) An adjuster shall not knowingly fail to advise a claimant of their rights in accordance with the terms and conditions of the contract and applicable laws of the state of Florida.
627.4133(3). Claims on property insurance policies that are the result of an act of God may not be used as a cause for cancellation or nonrenewal, unless the insurer can demonstrate, by claims frequency or otherwise, that the insured has failed to take action reasonably necessary as requested by the insurer to prevent recurrence of damage to the insured property.
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Valarie McNair considers the following specific policy language relevant to the Violation(s) described in this Notice:
AGREEMENT
Based upon the information you have given us, we agree to provide the insurance coverages indicated on the Policy Declarations. In return, you must pay the premium when due and comply with all the policy terms and conditions and inform us within 60 days of any change of title, use or occupancy of the
Described Location.
DEFINITIONS
A. In this policy, "you" and "your" refer to the "named insured" shown in the Declarations and the spouse if a resident of the same household. "We," "us" and "our" refer to the Company providing this insurance.
B. In addition, certain words and phrases are defined as follows:
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“Actual Cash Value” means the cost to repair or replace covered property, at the same time of loss or damage, whether that property has sustained partial or total loss or damage, with material of like kind a quality, subject to a deduction for deterioration, depreciation and obsolescence as determined by “us”.
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DEDUCTIBLE
Unless otherwise noted in this policy, the following deductible provision applies:
Subject to the policy limits that apply, we will pay only that part of the total of all loss payable that
exceeds the deductible amount shown in the Declarations.
COVERAGES
This insurance applies to the Described Location, Coverages for which a Limit of Liability is shown and Perils Insured Against for which a Premium is stated.
COVERAGE A – Dwelling
We cover:
1. The dwelling on the Described Location shown in the Declarations, used principally for dwelling
purposes, including attached structures and attached wall to wall carpeting if damage to the dwelling is
caused by a covered loss;
2. Materials and supplies located on or next to the Described Location used to construct, alter or repair
the dwelling or other structures on the Described Location; and
3. If not otherwise covered in this policy, building equipment and outdoor equipment used for the service
of and located on the Described Location.
This coverage does not apply to land, including land on which the dwelling is located.
COVERAGE B – Other Structures
When a limit for Coverage B is shown on the Declaration Page, Coverage B – Other Structures
becomes part of the policy.
We cover other structures on the Described Location, set apart from the dwelling by clear space. This
includes structures connected to the dwelling by only a fence, utility line, or similar connection.
This coverage does not apply to land, including land on which the other structures are located.
We do not cover other structures:
1. Used in whole or in part for commercial, manufacturing or farming purposes; or
2. Rented or held for rental to any person not a tenant of the dwelling, unless used solely as a private
garage.
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COVERAGE D – Loss of Use
When a limit for Coverage D is shown on the Declaration Page, Coverage D – Loss of Use becomes part of the policy.
The limit of liability for Coverage D is the total limit for the coverages in 1. Additional Living Expense, 2. Fair Rent-al Value and 3. Civil Authority Prohibits Use below.
1. Additional Living Expense
If a loss covered under Coverage A, B or C by a Peril Insured Against makes that part of the Described Location where you reside unfit for its normal use, we will cover any necessary increase in the living
expenses incurred by you so that your household can maintain its normal standard of living.
Payment will be for the shortest time required to repair or replace the damage or, if you permanently
relocate, the shortest time required for your household to settle elsewhere. In either case, the time period for this coverage is limited to a maximum of 12 months.
2. Fair Rental Value
If a loss covered under Coverage A, B or C by a Peril Insured Against makes that part of the Described Location rented to others or held for rental by you unfit for its normal use, we will cover the fair rental
value of such premises less any expenses that do not continue while it is not fit for its normal use.
Payment will be for the shortest time required to repair or replace that part of the Described Location rented or held for rental subject to a maximum of 12 months.
3. Civil Authority Prevents Use
If a civil authority prohibits you from use of the Described Location as a result of direct damage to a neighboring location by a Peril Insured Against in this policy, we cover the loss as provided in
1. Additional Living Expense and 2. Fair Rental Value above for no more than two weeks.
4. Loss Or Expense Not Covered
We do not cover loss or expense due to cancellation of a lease or agreement.
The periods of time referenced above are not limited by the expiration of this policy.
OTHER COVERAGES
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4. Reasonable Emergency Measures.
a. We will pay up to the greater of $3,000 or 1% of your Coverage A limit of liability for the reasonable costs incurred by you for necessary measures taken solely to protect covered property from further damage, when the damage or loss is caused by a Peril Insured Against.
b. We will not pay more than the amount in a. above, unless we provide you with approval within 48 hours of your request to us to exceed the limit in a. above. In such circumstance, we will pay only up to the
additional amount for the measures we authorize.
If we fail to respond to you within 48 hours of your request to us and the damage or loss is caused by a Peril Insured Against, you may exceed the amount in a. above only up to the cost incurred by you for the reasonable emergency measures necessary to protect the covered property from further damage.
c. If damage occurs as a result of a covered “Hurricane Loss” as defined in your policy, the amount that we pay under this additional coverage will be the reasonable cost incurred by you for the reasonable
emergency measures taken solely to protect the property from further damage and is not limited to the
amount in a. above.
d. A reasonable measure under this Other Coverage may include a permanent repair when necessary to
protect the covered property from further damage or to prevent unwanted entry to the property. To the
degree reasonably possible, the damaged property must be retained for us to inspect.
e. This coverage does not
(1) Increase the limit of liability that applies to the damaged covered property; or
(2) Relieve you of your duties, in case of a loss to covered property, as set forth in
CONDITIONS, 4. Your Duties After Loss.
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PERILS INSURED AGAINST
Unless the loss is excluded in the General Exclusions, we insure for direct physical loss to the property covered caused by:
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2. Windstorm or hail.
This peril does not include loss:
a. To the inside of a building or the property contained in a building caused by rain, snow, sleet, sand or dust unless the direct force of wind or hail damages the building causing an opening in a roof or wall and the rain, snow, sleet, sand or dust enters through this opening; or
b. To the following property when outside of the building:
(1) awnings, signs, radio or television antennas or aerials including lead-in wiring, masts or towers; or
(2) canoes and rowboats.
GENERAL EXCLUSIONS
A. We do not insure for loss caused directly or indirectly by any of the following. Such loss is excluded regardless of any other cause or event contributing concurrently or in any sequence to the loss.
1. Ordinance or Law, meaning enforcement of any ordinance or law regulating the use, construction, repair, or demolition of a building or other structure.
2. Earth Movement, meaning earthquake including land shock waves or tremors before, during or after a volcanic eruption; landslide; mine subsidence mudflow; earth sinking, rising or shifting; unless direct loss by:
a. Fire; or
b. Explosion;
ensues and then we will pay only for the ensuing loss.
3. Water Damage, meaning:
a. Flood, surface water, waves, tidal waves, tsunami, tides, tidal water, storm surge, overflow of any body of water, or spray from any of these, whether or not driven by wind, including storm surge;
b. Water, water-borne material, sewage or any other substance which backs up through sewers or drains;
c. Water, water-borne material, sewage or any other substance that overflows from a sump pump, sump pump well or other system designed for the removal of subsurface water which is drained from a
foundation area of a structure; or
d. Water, water-borne material, sewage or any other substance on or below the surface of the ground,
regardless of its source.
This includes water or any other substance which exerts pressure on or flows, seeps or leaks through a building, sidewalk, driveway, foundation, swimming pool or other structure;
e. Waterborne material, sewage or any other substance, carried or otherwise moved by any of the water referred to in 3.a through 3.d of this exclusion;
f. Escape, overflow or discharge, for any reason, of water, waterborne material, sewage, or any other
substance from a dam, levee, seawall or any other boundary or containment system.
However, direct loss by fire or explosion resulting from any of the above in 3.a through 3.e is covered.
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CONDITIONS
1. Policy Period. This policy applies only to loss which occurs during the policy period.
2. 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 in any one loss:
a. For an amount greater than the interest of a person insured under this policy; or
b. For more than the applicable limit of liability.
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4. Your Duties After Loss. In case of a loss to covered property, we have no duty to provide coverage under this Policy if the failure to comply with the following duties is prejudicial to us. These duties must be
performed either by you, an insured seeking coverage, or a representative of either:
a. Give prompt notice to us or our agent;
(1) In the case of a windstorm or “hurricane loss”, you must give us notice of the initial claim,
“supplemental claim”, or “reopened claim” within three years after the hurricane first made landfall or the windstorm caused the covered damage.
(2) Except for Reasonable Emergency Measures taken as described in COVERAGES, OTHER
COVERAGES, Reasonable Emergency Measures, there is no coverage for repairs that begin before the earlier of:
(a) 72 hours after we are notified of the loss;
(b) The time of loss inspection by us; or
(c) The time of other approval by us
b. Protect the covered property from further damage. The following must be performed:
(1) Take reasonable emergency measures that are necessary to protect the covered property from fur-ther damage, as described in COVERAGES, OTHER COVERAGES, Reasonable Emergency Measures. A reasonable emergency measure may include permanent repair when necessary to protect the covered property from further damage or to prevent unwanted entry to the property.
(2) To the degree reasonably possible, the damaged property must be retained for us to inspect;
(3) Keep an accurate record of repair expenses;
c. Prepare an inventory of damaged personal property showing the quantity, description, age, actual cash value and amount of loss. Attach all bills, receipts and related documents that establish ownership of the damaged property and justify the figures in the inventory;
d. As often as we reasonably require:
(1) Show us the damaged property to the degree reasonably possible;
(2) Provide us with records and documents we request and permit us to make copies;
(3) You or any other insured under this Policy must:
(a) Submit to examinations under oath and recorded statements, while not in the presence of any other insured; and
(b) Sign the same;
(4) If you are an association, corporation or other entity; any members, officers, directors, partners or similar representatives of the association, corporation or other entity must:
(a) Submit to examinations under oath and recorded statements, while not in the presence of any other insured; and
(b) Sign the same;
(5) Your agents, your representatives, including any public adjusters engaged on your behalf, and
anyone insured under this Policy other than an insured in 4.d.(3) or 4.d.(4) above, must:
(a) Submit to examinations under oath and recorded statements, while not in the presence of any insured; and
(b) Sign the same;
(c) Submit to a recorded statement.
e. Send to us, within 60 days after our request, your signed, sworn proof of loss which sets forth, to the best of your knowledge and belief:
(1) The time and cause of loss;
(2) Your interest and that of all others in the property involved and all liens on the property;
(3) Other insurance which may cover the loss;
(4) Changes in title or occupancy of the property during the term of the policy;
(5) Specifications of damaged buildings and detailed repair estimates;
(6) The inventory of damaged personal property described in 4c;
(7) Receipts for additional living expenses incurred and records that support the fair rental value loss.
f. At our request, provide to us or execute an authorization which allows us to obtain on your behalf,
records and documentation we deem relevant to the investigation of your loss.
g. Cooperate with us in the investigation of a claim.
The duties above apply regardless of whether you, an insured, an insured seeking coverage, or representative of either retains or is assisted by a party who provided legal advice, insurance advice or expert claim advice, regarding an insurance claim under this Policy.
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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.
In Florida, insurance claims adjustment engages the public trust. Security First Insurance Company dba Security First Florida (hereinafter Security First) breached this duty in its adjustment of claim number 255017 (the “Claim”) from Valarie McNair (“Valarie”) for her home located at 9550 Scadlocke Road, Jacksonville, Florida 32208, (the “Property”). The Property was covered by a policy of insurance issued by the Insurer numbered P007940511 (the “Policy”).
Without limitation, Security First: 1) failed to promptly pay all benefits due; 2) failed to fairly and completely investigate the Claim; 3) failed to act in due diligence and good faith to resolve the Claim; 4) placed its financial interests ahead of that of Valarie; 5) failed to properly train, evaluate, and manage adjusters so that policyholders receive fair, prompt, and accurate adjustment of claims in good faith; 6) failed to provide facts and reasons to Valarie for elements of the Claim that were not covered in its adjustment; 7) failed to property calculate and issue payment to Valarie per the Policy; 8) sought to delay full benefit payments and to “low ball” the Claim; 9) improperly denied portions of the Claim without reasonable investigation; and 10) engaged in unfair claim underpayment and delay resulting in the violation of Florida statutes as set forth in this civil remedy notice. Additionally, on information and belief, Security First’s conduct is pervasive and wide-spread and has affected numerous other policyholders in addition to Valarie. If pervasive, Security First’s tactics indicate a systematic and intentional business model of denying, underpaying, or delaying the payment of claims in order to maximize revenues and investment income on reserves while minimizing claims payments.
Specific Facts:
Valarie paid premiums to Security First in exchange for the Policy which insured the Property against all perils in the Perils Insured Against section of the Policy unless specifically excluded in the General Exclusions section of the Policy.
On or around May 10, 2024, the Property, including the main dwelling space, an outdoor shed, and the fence, suffered significant damage from wind and wind-driven rain and debris including water intrusion to the interior of the dwelling from storm-created openings caused by a tree limb striking the roof of the Property, (the “Loss”). The Loss was a covered peril under the Policy.
Valarie reported the Loss to Security First requesting an investigation, coverage admission, and full indemnity, less deductible. Security First failed to handle the claim in good faith, breaching the Policy by miscalculating indemnity due, denying multiple areas of damages, underestimating multiple areas of damages, performing an inadequate investigation, and misrepresenting Policy coverage and exclusions.
Upon notice from Valarie, Security First sent its emergency tarp services company to tarp the roof and protect the Property from additional water damage. Unbeknownst to Valarie, Security First’s tarp service company nailed the tarps into her roof causing significant additional damage to the roofing system and increasing the necessary scope of repairs. Security First then investigated and confirmed storm related damages. Security First sent a letter to Valarie which confirmed partial coverage, denied the remainder, misrepresented policy coverages and tendered payment of only $8,732.33 (the “Coverage Determination Letter”). Under Florida law, a specific refusal to pay a claim triggers a cause of action for breach of contract. Allstate Ins. Co. v. Kaklamanos, 843 So. 2d 885, 892 (Fla. 2003); Donovan v. State Farm Fire and Cas. Co., 574 So. 2d 285, 286 (Fla. 2nd DCA 1991). It follows that Security First breached the Policy when it issued the Coverage Determination Letter.
Concerned with the accuracy and completeness of Security First’s investigation, Valarie retained a licensed public adjuster, Trojan Claims Consulting (“TCC”), to investigate and evaluate the damage in accordance with industry standards, the Policy, and Florida law. TCC concluded that a windstorm on or about May 10, 2024, including wind and rain, caused damage to the exterior of the insured property, particularly the roof which had storm-created openings that allowed water to intrude into the interior, causing additional damages. Further, TCC concluded that the same peril caused additional damages to the Property’s shed and fence.
TCC’s investigation showed that the Security First’s roof tarp caused significant additional and unnecessary damage to the roof. TCC concluded that windstorm-only damages could have been repaired for between $1,000 and $2,000. However, Security First’s tarp servicer hammered nails into the Property’s roof to secure the tarp causing widespread additional damage that then necessitated full roof replacement. TCC estimated that at least $34,289.80 worth of repairs are required to replace the roof as a direct result of Security First’s improper mitigation and “protection” efforts.
Further, Security First’s coverage determination improperly omitted overhead and profit contrary to Florida law and omitted coverage for conspicuous damages to the Property’s interior. Security First improperly omitted overhead and profit from its estimate and payment. Actual cash value includes overhead and profit where the insured is reasonably likely to need a general contractor for repairs. Goff v. State Farm Fla. Ins. Co., 999 So. 2d 684, 689 (Fla. Dist. Ct. App. 2008). Valarie’s Loss is reasonably likely to require a general contractor because it includes damages to the roof, shed, fence, and interior requiring multiple trades to complete repairs. It follows that overhead and profit should have been included in Valarie’s loss adjustment but were improperly and unlawfully withheld by Security First.
Regarding the interior, Security First ignores clear and conspicuous covered damages in the Property’s foyer and laundry room. Further, Security First improperly under-scopes necessary repairs. Specifically and without limitation Security First failed to scope and provide payment for the necessary detachment and resetting of any lights and light fixtures or ceiling fans. This is egregious as these steps are clearly needed to repair water damaged ceilings.
As a result of unlawfully excluding overhead and profit, ignoring covered portions of the Loss, and under-scoping portions of the Loss, Security First inappropriately and unlawfully underestimated this Loss and underpaid Valarie. Security First’s estimate of ACV for interior damages is only $3,877.51. By contrast, TCC estimates the interior portions of this loss pursuant to the Policy and Florida law at no less than $27,212.21.
Security First improperly omitted and denied coverage for damages to Valarie’s shed and fence. The Policy includes coverage for windstorm losses to “Other Structures” like Valarie’s shed and fence. Security First ignored clear and conspicuous damages to Valarie’s shed and fence in its investigation and adjustment of the Loss. By comparison, TCC estimated that the ACV of Valarie’s other structures losses is $7,639.17.
Lastly, Security First miscalculated the loss payment. Security First improperly included $13,600 in emergency mitigation services for tarps in its calculation of the claim’s gross loss before applying its depreciation deduction. Emergency mitigation here was services provided by Security First in immediate response to the loss. This expense is related to the real-time costs incurred in protecting and preserving the property. These expenses are not subject to depreciation as there is no loss, decay, wear, tear, deterioration, or obsolescence associated with these services. By improperly characterizing these ACV mitigation services as depreciable, Security First underpaid the Loss in an amount equal to its depreciation rate multiplied by the $13,600.00 of emergency mitigation services.
Security First’s coverage partial denial, under-scoping of damages, miscalculation of depreciation, and underpayment misrepresents the available coverages under the Policy in direct violation of Florida Statutes Sections: 626.9541(1)(a)(1) – misrepresenting the benefits, advantages, conditions, or terms of any insurance policy; 626.9541(1)(i)(3)(b) - misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; and 626.9541(1)(i)(2) - 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.
As a result of the foregoing, Security First has materially misrepresented the coverages under the subject policy to the insured for the purpose and with the intent of affecting settlement of the Valarie’s claim on less favorable terms than those provided in, and contemplated by, the subject policy in direct violation of Florida Statutes § 626.9541(1)(i)(2). Further, Security First is in violation of Florida Statutes §§ 626.9541(1)(a)(1), 626.9541(1)(i)(3)(b), and 626.9541(1)(a)(1) by misrepresenting pertinent facts and insurance policy provisions relating to coverages at issue; and also in violation of Florida Statutes § 626.9541(1)(i)(3)(d) - Denying claims without conducting reasonable investigations based upon available information by denying the Valarie’s claim without conducting a reasonable investigation based upon available information.
Security First's denials of coverage misrepresents the available coverages under the Policy in direct violation of Florida Statutes §§ 626.9541(1)(a)(1), 626.9541(1)(i)(3)(b), 626.9541(1)(a)(1), and 626.9541(1)(i)(2) and is pretext to wrongfully deny and delay this claim. It follows that Security First has materially misrepresented the coverages under the subject policy to the insured for the purpose and with the intent of affecting settlement of the Valarie’s claim on less favorable terms than those provided in, and contemplated by, the subject policy in direct violation of Florida Statutes § 626.9541(1)(i)(2). Further, Security First is in violation of Florida Statutes §§ 626.9541(1)(a)(1), 626.9541(1)(i)(3)(b), and 626.9541(1)(a)(1) by misrepresenting pertinent facts and insurance policy provisions relating to coverages at issue. Security First is also in violation of Florida Statutes § 626.9541(1)(i)(3)(d) by denying portions of the Valarie’s claim without conducting a reasonable investigation based upon available information and Florida Statutes § 626.9541(1)(i)(3)(a) for failing to adopt and implement standards for the proper investigation of claims.
Valarie McNair has made every effort to comply with all policy requirements, and it is only fair that the insurance company reciprocates the same. Security First has failed to properly investigate the Loss and promptly indemnify the insured causing delay. An insurer’s obligation to make prompt payment is an essential part of the contract for insurance, and an insurer’s failure to make prompt payment constitutes a breach of the implied covenant of good faith and fair dealing. Vest v. Travelers Ins. Co., 753 So. 2d 1270, 1275 (Fla. 2000). Timely payment is particularly important here because Valarie urgently need the funds to repair and replace damaged property.
In summary, the Loss is clearly covered by the terms of the policy of insurance with Security First as evidenced by the investigation of TCC -- based on (a) the data and information obtained; (b) age of the home, roof, and other structures; (c) timing of damage; and (d) pattern and severity of damages. Notwithstanding, Security First chose to deny coverage for portions of the Loss, not accept responsibility for the damage it caused to the roof necessitating replacement versus less expensive repairs, under-scope portions of the loss, and calculate loss payout inappropriately and incorrectly low. To date, Security First continues to deny Valarie full indemnity for the claim. While Security First refuses to honor this claim, a jury in Duval County will likely do what Security First has refused; exercise the benefit of doubt in favor of the insured in finding full coverage for the Loss and calculating recovery pursuant to the Policy and Florida law. Under the Security First policy, while Security First provided insurance coverage, covered damage occurred to the insured property far in excess to what Security First provided coverage for to Valarie. See Jones v. Federated Nat'l Ins. Co., 235 So. 3d 936, 942 (Fla. 4th DCA 2018).
The concept of insurance in a state like Florida, where adjustment of claims engages the public trust, necessitates that insurers fully and fairly value policyholder claims and issue timely payment for the full value of those claims according to the unambiguous terms of the involved policies. Security First failed to do this for the Claim and thereby breached its duty to Valarie.
The actions taken by Security First in the handling and adjustment of the Claim were willful, wanton, and with complete disregard for the rights of its insured and occur with such a frequency as to indicate a general business practice and are in violation of Fla. Stat. §§ 624.155 and 626.9541.
Additional wrongful conduct by the Insurer may exist that has not yet been discovered. Certain conduct or actions cannot be verified without a review of the Insurer’s claim file, claim guidelines, and other internal documentation.
This notice is provided to Security First so that it may cure the defects described herein, or so that Valarie may pursue civil remedies pursuant to Fla. Stat. § 624.155 if Security First does not cure. To cure, Security First must:
1. Tender all monies due for the Claim pursuant to the Policy;
2. Pay statutory interest on the amount of unpaid contract damages from the date of loss to the date of cure pursuant to Florida Statutes § 627.70131.
3. Pay the insured’s attorney’s fees and costs pursuant to Florida Statutes §§ 627.155.
Failure to cure all defects during the 60-day safe harbor period may result in additional extra-contractual damages.
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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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