Filing Number: 786004
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| Filing Accepted: 10/7/2024 |
| Last/Business Name
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MICHAUD
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First Name |
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ENANTHE |
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| Street Address
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2433 SW VARDON STREET |
| City, State Zip
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PORT ST. LUCIE,
FL
34953
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| Email Address
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ENANTHEP@YAHOO.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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MICHAUD |
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First Name |
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ENANTHE |
| Policy # * |
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80-C6-P907-7 |
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Claim #* |
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59-56T0-89M |
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Attorney is Applicable
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| Last Name* |
JUSTUS
First Name *
COREY
Initial
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| Street Address* |
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126 EAST JEFFERSON STREET |
| City, State Zip* |
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ORLANDO
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FLORIDA
32801
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| Email Address * |
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COREY@THEPAYNELAW.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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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 10739 |
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| Name of individual responsible for violation (if any):*
SHIRELLE TOLBERT
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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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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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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)(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)(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)(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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| 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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| 626.9541(1)(i)(4) |
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Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
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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.
SECTION I – LOSSES INSURED AGAINST
Coverage A – DWELLING
WINDSTORM AND/OR HAIL
Reference to specific policy language that is relevant to the violation, if any. If the person bringing the civil action is a third-party claimant, she or he shall not be requested to reference the specific policy language if the authorized insurer has not provided a copy of the policy to the third-party claimant pursuant to the written request.
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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.
On September 23, 2023, Enanthe Michaud owned property located at 2433 SW Vardon Street, Port St. Lucie, Florida 34953 and that property was insured by STATE FARM FLORIDA INSURANCE COMPANY who issued policy number 80-C6-P907-7. On September 23, 2023, a windstorm occurred at the subject property and caused a significant amount of damage to the property. The Insured timely reported this damage to STATE FARM FLORIDA INSURANCE COMPANY who assigned claim number 59-56T0-89M to the loss that occurred. After that point, the Insurance Company assigned an adjuster to the claim to adjust the loss on behalf of the Insurance Company.
The Insurance Company requested to come out to the subject property and perform a visual inspection of the property, and also take photographs of the home. Enanthe Michaud allowed Shirelle Tolbert to perform a full and complete inspection of the property while at the property. The Insured did not in any way impede or interfere with this inspection.
After the inspection, the Insurance Company requested the insured to comply with and/or provide a number of documents, information, and generally compliance with post-loss obligations as included in the Conditions Section of the Insurance Policy. The Insured substantially complied with all post-loss obligations and requests made by the Carrier. Despite the Insured’s compliance pursuant to the policy, the Insurance Company failed to clearly explain the nature of the requested information and the reasons why such information is necessary. Rather, the Carrier just asked for a voluminous amount of information and documents, but never took the time to actually explain why each of these documents were necessary in a clear manner that would have informed the Insured as to why same was necessary.
STATE FARM FLORIDA INSURANCE COMPANY, through its adjustment of the loss, submitted an estimate to the Insured which allegedly represented the actual cash value of the loss pursuant to the Policy Language, however the insurance company determined that the damage did not exceed the applicable deductible. The Insurance Company did not even attempt in good faith to settle this claim 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 their interests. STATE FARM FLORIDA INSURANCE COMPANY provided the insureds with a de minimis estimate titled “Structural Damage Claim Policy” and dated December 1, 2023, reflecting the basis for State Farm’s determination and assessment. In this estimate, STATE FARM FLORIDA INSURANCE COMPANY unreasonably estimated $2,460.53 would be able to restore the property to its pre-loss condition. Despite the presence of covered damage, STATE FARM FLORIDA INSURANCE COMPANY fails to provide sufficient facts and information applicable to the claim to justify their undervalued assessment in the repairs needed to restore the property to its pre-loss condition. Thus, State Farm’s conduct and determination is unreasonable as it undervalues the Insured’s claim, lacks good faith, and fails to indemnify the Insured when it had a contractual duty to do so.
Furthermore, the Insurance Company failed 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 as evidenced by the under deductible determination and estimate submitted by the Insurance Company. The Insurance Company also failed to promptly notify the insureds of any additional information necessary for the processing of their claim or advise of any such information that may also be needed in order to allow it to properly indemnify the Insureds.
The following are the different statutes that the Insurance Company has violated:
Florida Statutes 624.155(1)(b)(1):
(1) Any person may bring a civil action against an insurer when such person is damaged:
(b) By the commission of any of the following acts by the insurer:
(1) 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;
Florida Statutes 624.155(1)(b)(3)
(1) Any person may bring a civil action against an insurer when such person is damaged:
(b) By the commission of any of the following acts by the insurer:
(3) 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.
Florida Statutes 626.9541(1)(i)(3)(a)
(i) Unfair claim settlement practices.—
(3) Committing or performing with such frequency as to indicate a general business practice any of the following:
(a) Failing to adopt and implement standards for the proper investigation of claims;
Florida Statutes 626.9541(1)(i)(3)(c)
(i) Unfair claim settlement practices.—
(3) Committing or performing with such frequency as to indicate a general business practice any of the following:
(c) Failing to acknowledge and act promptly upon communications with respect to claims;
Florida Statutes 626.9541(1)(i)(3)(f)
(i) Unfair claim settlement practices.—
(3) Committing or performing with such frequency as to indicate a general business practice any of the following:
(f) 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;
Florida Statutes 626.9541(1)(i)(3)(g)
(i) Unfair claim settlement practices.—
(3) Committing or performing with such frequency as to indicate a general business practice any of the following:
(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim; or
Florida Statutes 626.9541(1)(i)(3)(h)
(i) Unfair claim settlement practices.—
(3) Committing or performing with such frequency as to indicate a general business practice any of the following:
(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
Florida Statutes 626.9541(1)(i)(4)
(i) Unfair claim settlement practices.—
(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 629.70131(5).
In addition to the statutory violations referenced above, the Insureds state that STATE FARM FLORIDA INSURANCE COMPANY violated the following Florida Administrative Code Sections: 69B-220.201(3)(b); 69B-220.201(3)(b)2; 69B-220.201(3)(c); 69B-220.201(3)(d); and 69B-220.201(3)(f).
First, an adjuster shall treat all claims equally and shall not provide favored treatment to any claimant. It has been made clear based on the factual circumstances of the claim, that the Insurance Adjuster, Shirelle Tolbert, did not treat the insured’s claim equally or in strict accordance with the insurance contract by actively taking steps to delay the adjustment of the Insurance Claim. The Insured substantially complied with all requests pursuant to the policy in a reasonable time frame, but the Insurance Adjuster, Shirelle Tolbert, failed to do the same.
Second, the Administrative Code Sections listed above state that an adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured. The facts of this claim clearly show that the voluminous requests for information and documentation were used by the Insurance Company as a sword in order to find any way possible to justify an underpayment of the Insurance claim; thereby, making the basis for the request specious at best.
Moreover, the Code states that an adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim. It is the Insurance Adjuster’s duty under the Administrative Code to do this and the Insurance Company has shown that it is not acting with dispatch and due diligence in achieving a proper disposition of the claim by all of its actions on this claim.
Florida Statute § 624.02 defines "insurance" as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies. Inherent in that definition is the fact that payment must be made timely and promptly so that the insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible.
The conduct of STATE FARM FLORIDA INSURANCE COMPANY referenced above is a clear violation of §624.155(1)(b)(1) as it constitutes an intentional, willful, wanton, and malicious conduct and shows that the Carrier did not attempt in good faith to settle the insured’s claim when, under all the circumstances, it could have and should have done so, had it acted fairly and honestly toward its Insured and with due regard for their interests. STATE FARM FLORIDA INSURANCE COMPANY’s refusal and/or failure to settle the claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards the Insured is wrongful conduct.
Florida Statutes 626.9541(1)(i)(4) states that it is an Unfair Settlement Practice for an insurer, such as STATE FARM FLORIDA INSURANCE COMPANY, to failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by an act of God, prevented by the impossibility of performance, or due to actions by the insured or claimant that constitute fraud, lack of cooperation, or intentional misrepresentation regarding the claim for which benefits are owed.
STATE FARM FLORIDA INSURANCE COMPANY must: (1) create and implement adequate guidelines for the proper investigation and evaluation of these type of claims and for the training and supervision of employees, which will avoid future statutory violations; (2) create and implement adequate guidelines for the proper investigation and evaluation of these type of claims and for the training and supervision of employees with regard to these type of claims to ensure that the claims handling procedure with regard to these type of losses are adequate to prevent other insureds from being treated unfairly and wrongfully; (3) immediately tender all undisputed advance insurance proceeds to the insured while continuing to adjust the loss with the insured. The basis for this is the estimate for damages and repairs that was submitted to the Insurance Company which totals $63,407.79 less the applicable deductible; (4) pay statutory interest on untimely payments from the date of loss; and (5) exercise good faith efforts to resolve these claim(s) by acting fairly and honestly towards Enanthe Michaud and with due regard for their interests in attempting to settle the claim.
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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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