Filing Number: 787459
|
| Filing Accepted: 10/18/2024 |
| Last/Business Name
*
|
|
|
STEWART
|
|
First Name |
|
LORI AND JOSEPH |
|
| Street Address
*
|
|
12541 HAMMOCK POINTE CIRCLE |
| City, State Zip
*
|
|
CLERMONT,
FL
34711
|
| Email Address
*
|
|
CFAUNTLEROY@FSATLAW.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
STEWART |
|
First Name |
|
LORI AND JOSEPH |
| Policy # * |
|
59C2Z5882 |
|
Claim #* |
|
5966G251X |
|
Attorney is Applicable
|
| Last Name* |
FAUNTLEROY
First Name *
CHRISTOPHER
Initial
B
|
| Street Address* |
|
100 S ASHLEY DRIVE, SUITE 600 |
| City, State Zip* |
|
TAMPA
,
FLORIDA
33602
|
| Email Address * |
|
CFAUNTLEROY@FSATLAW.COM |
|
|
| Insurer Type
*
|
|
Authorized Insurer
Unauthorized Insurer
|
|
|
| Insurer Name |
|
|
| Insurer Name* |
|
STATE FARM FLORIDA INSURANCE COMPANY
|
| Insurer Name* |
|
|
| Street Address* |
|
|
| City, State Zip* |
|
,
|
|
NAIC Company Code 10739 |
|
|
| Name of individual responsible for violation (if any):*
STATE FARM INSURANCE COMPANY AND ITS ADJUSTERS AND WILLIAM JOHNSTON
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
Claim Denial
|
|
Claim Delay
|
|
Unsatisfactory Settlement Offer
|
|
Unfair Trade Practice
|
|
|
*
Statutory provision(s) which the insurer allegedly violated.
|
|
|
| 624.155(1)(b)(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.
|
| 626.9541(1)(i)(3)(a) |
|
Failing to adopt and implement standards for the proper investigation of claims.
|
| 626.9541(1)(i)(3)(b) |
|
Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
|
| 626.9541(1)(i)(3)(c) |
|
Failing to acknowledge and act promptly upon communications with respect to claims.
|
| 626.9541(1)(i)(3)(d) |
|
Denying claims without conducting reasonable investigations based upon available information.
|
| 626.9541(1)(i)(3)(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.
|
| 626.9541(1)(i)(3)(g) |
|
Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
|
| 626.9541(1)(i)(3)(h) |
|
Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
|
|
*
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 – PROPERTY COVERAGES
COVERAGE A – DWELLING
1. Dwelling. We cover the dwelling and materials and
supplies located on or adjacent to the residence
premises for use in the construction, alteration, or repair
of the dwelling or other structures on the residence
premises.
LOSS SETTLEMENT
COVERAGE A – DWELLING
1. A1 – Replacement Cost Loss Settlement – Similar
Construction.
a. We will pay the cost to repair or replace with similar
construction and for the same use on the
premises shown in the Declarations, the damaged
part of the property covered under SECTION
I – PROPERTY COVERAGES,
COVERAGE A – DWELLING, except for wood
fences, subject to the following:
(1) we will pay only the actual cash value at
the time of the loss prior to repair or replacement
of the damaged part of the property,
up to the applicable limit of liability
shown in the Declarations, not to exceed
the cost to repair or replace the damaged
part of the property;
(2) in addition, we will pay any remaining covered
additional amounts you actually and
necessarily incur to perform such repair or
replacement as work is performed and expenses
are incurred and submitted, or an
amount up to the applicable limit of liability
shown in the Declarations, whichever
is less. There will be no deduction for
depreciation;
(3) we will not pay for increased costs resulting
from enforcement of any ordinance or law
regulating the construction, repair or demolition
of a building or other structure, except
as provided under OPTIONAL
POLICY PROVISIONS, Option OL –
Building Ordinance or Law Coverage;
and
(4) if a total loss occurs to the dwelling used
principally as a private residence on a residence
premises shown in the Declarations,
payment on a replacement cost
basis will not require repair or replacement
of the damaged property. There will be no
deduction for depreciation.
LOSS PAYMENT
Loss Payment. We will adjust all losses with you.
We will pay you unless some other person is named
in the policy or is legally entitled to receive payment.
Loss will be payable upon the earlier of the following:
a. 20 days after we receive your proof of loss and
reach agreement with you; or
b. 60 days after we receive your proof of loss and:
(1) there is an entry of a final judgment; or
(2) there is a filing of an appraisal award with
us.
If we do not pay or deny a loss within 90 days after
we receive notice of an initial, reopened, or supplemental
property insurance claim from you and no factors
beyond our control would reasonably prevent us
from making payment, interest will be paid in accordance
with Section 627.70131(5) of the Florida Insurance
Code.
***ADDITIONAL STATUTORY PROVISIONS ALLEGED TO HAVE BEEN VIOLATED ARE AS FOLLOWS:***
§624.155(1)(B)(1) Any person may bring a civil action against an insurer when such person is damaged:
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 towards its insured and with due regard for her interests;
2. Making claims payments to insures or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made; or
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.
§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 beneficiaries under a life insurance contract;
(8) The damages recoverable pursuant to this section shall include those damages which are a reasonably foreseeable result of a specified violation of this section by the authorized insurer and may include an award or judgment in an amount that exceeds the policy limits.
§627.70131 Insurer’s duty to acknowledge communications regarding claims; investigation
(1)(a) Upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgement. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer’s claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer.
(4) For purposes of this section, the term “insurer” means any residential property insurer.
§626.9541(i) Unfair Claim Settlement Practices
|
| |
*
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, the work of adjusting insurance claims engages the public trust. State Farm Florida Insurance Company (State Farm) has breached this duty in the adjustment of Lori Stewart’s and Joseph Keith Stewart’s (the Stewarts’) claim.
State Farm has failed to adopt and implement proper standards for investigation, evaluation and adjustment of claims; has failed to properly train, manage, supervise and promote claims adjusters so that policy holder receives good faith, fair, prompt adjustment of claim, service and indemnity; has failed to conduct a full and fair investigation of the claim and has failed to provide full reasons and facts to the claimant for delay of the claim resulting in statutory violations as set forth in this notice.
Furthermore, State Farm has engaged in unfair claim delay; has used business or outcome-oriented investigations and experts to determine the outcome of the claim; has wrongfully denied the claim without fully stating reasons and reserving unwritten reasons; has looked for ways to, delay payment and otherwise “stonewall” the claim; and has used improper claims practices to rush the claims process and profit from wrongful claims practices.
The Stewarts’ claim results from hail damage to the dwelling roof and elevations of their home that occurred on April 1, 2024. To mitigate the damages to their home, the Stewarts contacted their insurance company, State Farm, to report the damages. As part of the investigation of the Stewarts’ claim, State Farm assigned a claim number 5966G251X and field claims adjuster William Johnston. State Farm inspected the damages to the Stewarts’ property on April 29, 2024. Subsequently, State Farm provided an estimate of $789.17 to repair the damages, which is insufficient coverage to return the Stewarts’ property back to pre-loss condition.
In view of the foregoing, it is clear and unequivocal that State Farm has failed to provide proper and sufficient compensation to repair the damages caused to the Stewarts’ property. Due to State Farm’s handling of the Stewarts’ claim, the Stewarts chose to retain a public adjuster to further assess the damages to their home. As such, upon inspection and view of the damages, it was clear that the dwelling roof, shingles, vents, elevations, gutters, and window screens of the property required extensive repair. After the inspection, the public adjuster provided an estimate for repairs in the amount of $56,355.27, which is the full amount to return Stewarts’ home back to pre-loss condition. State Farm continues to hold their stance for their claim determination concerning the Stewarts’ loss.
The Stewarts have complied with all conditions under the policy. Nonetheless, State Farm failed to properly compensate the Stewarts for their loss. The facts of this claim show that for whatever reason, State Farm not only substantially misinterpreted the scope of damages to the Stewarts’ property, but also failed to conduct a thorough investigation as to the scope of damages to the roof and elevations of their home. Upon view of State Farm’s claims handling procedures, it is clear State Farm conducted a limited and quick outcome orientated investigation in the hopes that the Stewarts would make the required repairs with their own money. The Stewarts now must incur costs for assistance to obtain what should have been paid had they been treated fairly and honestly by State Farm.
Florida Statute §626.9744(2) provides that “When a loss requires replacement of items and the replaced items do not match in quality color or size, the insurer shall make reasonable repairs or replacement of items in adjoining areas”. In the instance of State Farm, their adjusters and the estimate provided, it is clear that State Farm did not adhere to Florida law, as their estimate provides paltry repair items that would result in mismatching areas which fails to acknowledge the true extent of damage of the Stewarts’ home as well as the surrounding areas that would need to be replaced. Florida Statute §624.02, defines “insurance” as a contract where one undertakes to indemnify another or pay or allow specified amounts, or a determinable benefit, upon determinable contingencies – inherent is the fact that payment must be made timely and promptly. The fact that payment must be made timely and promptly so that the insureds may mitigate their damages, and to put the insureds back into the position they enjoyed prior to the loss as quickly as possible. State Farm has breached this duty by improperly investigating the Stewarts’ claim and failing to properly pay the Stewarts for their loss. State Farm has refused and/or failed to tender insurance proceeds as required by the policy and/or Florida law. It has refused and/or failed to settle the claim when under all the circumstances it could have and should have done so if it had acted fairly and honestly towards the Stewarts.
In view of the facts surrounding the Stewarts’ claim, it is evident that State Farm has failed to create and implement adequate guidelines for proper investigations to evaluate claims handling for training and supervision of employees in violation of Fla. Stat. §624.155 and §626.9541 statutory regulations, as well as the applicable provisions in the Florida Administrative Code resulting in the statute violations set forth herein. As stated, State Farm has failed and/or refused to investigate the insureds’ claim thoroughly, accurately, and completely for damages.
Furthermore, State Farm has failed to adopt and implement proper standards for investigation, evaluation, and adjustment of claims; has failed to properly train, manage, supervise, and promote claims adjusters so that policy holder receives good faith, fair, prompt adjustment of claim, service, and indemnity, has failed to conduct a full and fair investigation of the claim.
Florida Statutes Violated by State Farm are as applied to the facts in this matter is as follows: § 626.951 engaging in acts defined as “unfair trade practices” relating to the business of insurance in accordance with the intent of congress as expressed in the act of congress of March 9, 1945 (pub. L. No. 15, 79th congress), by defining, or providing for the determination of, all such practices in this state which constitute unfair methods of competition or unfair or deceptive acts or practices and by prohibiting the trade practices so defined or determined.
§ 624.155(1)(b)(1) to tender all insurance proceeds monies due and owing the insured or assist the insured in the mitigation of their damages. The insurer breached these statutory duties. Not attempting in good faith to settle claims when, under all circumstance, insurer could have and should have done so, had the insurer acted fairly and honestly toward its insured and with due regard. § 624.155(1)(b)(3) failing to promptly settle claims, when the obligation to settle the 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. § 626.9541(1)(i)(3)a Failing to adopt and implement standards for the proper investigations of claims. § 626.9541(1)(i)(3)c Failing to acknowledge and to act promptly upon communications with respect to claims.
Their actions are willful, wanton and in disregard of the rights of its insured and occur with such a frequency as to indicate a general business practice. State Farm can cure this default by the following:
A. Create, adopt, and implement adequate standards and/or guidelines for the proper investigation and adjustment of claims.
B. Provide sufficient training and supervision of employees and agents to avoid further violations as set forth in the paragraphs above from occurring in the future.
C. Tender payment to the Stewarts in the amount of $56,355.27, which is the amount to return the Stewarts’ home back to pre-loss condition.
D. Tender prejudgment interest from the date the claim was reported through today.
E. Agree to pay the Stewarts’ reasonable attorney’s fees pursuant to Florida Statute §627.428 and all taxable costs
|
|
*
|
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.
|
DFS-10-363
Rev. 10/14/2008
|