Filing Number: 787578
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| Filing Accepted: 10/18/2024 |
| Last/Business Name
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| Street Address
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4443 DE KALB AVENUE |
| City, State Zip
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JACKSONVILLE,
FL
32207
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| Email Address
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RAY_CURTIS@ATT.NET |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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RAY |
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First Name |
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GLORY |
| Policy # * |
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P000311542 |
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Claim #* |
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255567 |
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Attorney is Applicable
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| Last Name* |
KRAPF
First Name *
GRANT
Initial
W.
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| Street Address* |
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2790 SUNSET POINT ROAD |
| City, State Zip* |
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CLEARWATER
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FLORIDA
33579
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| Email Address * |
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ASSIST@KRAPFLEGAL.COM |
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| Insurer Type
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Authorized Insurer
Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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SECURITY FIRST 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 10117 |
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| Name of individual responsible for violation (if any):*
DANIEL SANTOS, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, SECURITY FIRST INSURANCE COMPANY, WHO WAS INVOLVED IN THE CLAIM.
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Unfair Trade Practice
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Claim Denial
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Claim Delay
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Other
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Misrepresenting the terms of the insurance policy
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Other
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Not treating the Insured with good faith claims conduct
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Other
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Looking for ways to deny full recovery to the Insured
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Other
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Looking for ways to delay full recovery to the Insured
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Other
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Failing to properly investigate the Insured’s loss
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Other
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Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
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Other
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Not training, supervising, or managing adjusters properly so that prompt and full payments are made,
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Other
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Not adjusting claims and evaluating loss properly
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Other
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Shifting the burden of insuring the loss to the Insured
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Other
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Intentionally misstating the terms, conditions, and benefits of the insurance policy to the insured
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Other
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Failing to implement proper standards for the adjustment and investigation of claims
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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)(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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
627.70131 (1)(a) - Upon an insurer's receiving a communication with respect to a claim, the insurer shall, within 7 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. If the acknowledgment is not in writing, a notification indicating acknowledgment shall be made in the insurer's claim file and dated. A communication made to or by a representative of an insurer with respect to a claim shall constitute communication to or by the insurer.
627.444(2)(a) Notwithstanding any other law, an insurer shall provide to an insured within 15 calendar days after an individual or entity designated by the insurer receives the insured's written request, either: A loss run statement;
627.4137(1)(e) – Each insurer which does or may provide liability insurance coverage to pay all or a portion of any claim which might be made shall provide, within 30 days of the written request of the claimant, a statement, under oath, of a corporate officer or the insurer's claims manager or superintendent setting forth the following information with regard to each known policy of insurance, including excess or umbrella insurance: A copy of the policy.
Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language. “It is an accepted principle of law that when parties contract upon a matter which is the subject of statutory regulation, the parties are presumed to have entered into their agreement with reference to such statute, which becomes a part of the contract, unless the contract discloses a contrary intention.” Westside EKG Assocs. v. Found. Health, 932 So. 2d 214, 216 (Fla. 4th DCA 2005), aff’d, 944 So. 2d 188 (Fla. 2006).
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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.
Security First Insurance Company (the “Insurer”) has committed the following in handling the Insured’s claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the policyholder and the Insured; 3) looking for ways to deny benefit payments and otherwise “low ball” or “stone wall” claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; 9) shifting the burden of investigating the loss onto the Insured; 10) failing to acknowledge and act promptly upon communications with respect to claims; 11) failing to respond to or acknowledge correspondence within statutory time period; 12) failing to provide a loss run statement; and 13) misrepresenting the terms of the insurance policy.
On or about June 9, 2024, while the subject policy was in full force and effect, the Insured’s suffered a loss caused by a water leak. The areas impacted include but are not limited to the master bathroom, master shower, bathroom closet, master bedroom, and laundry room. The Insured timely submitted a claim on June 10, 2024, to the Insurer for water damage and the ensuing damage therefrom. Thereafter, the Insurer assigned claim number 255567 to the loss and sent a field adjuster to inspect the property on June 12, 2024. Given the scope and nature of the damage, the Insured retained plumbing services for which they paid $256.43 out-of-pocket, as well as a public adjuster. After assessing the damage and the true scope of repairs, the public adjuster prepared an estimate identifying $40,537.23 in covered damage to the dwelling. The foregoing estimate, photographs, and a letter of representation from the public adjuster were sent to the Insurer who thereafter failed to timely respond to the Insured’s communications.
Subsequently, in a coverage determination letter dated July 25, 2024, the Insurer notified the Insured that it was denying coverage for the loss. The Insurer misrepresented the loss and issued a wrongful denial. The Insurer based this denial on the rationale that the damage sustained was a result of “…chronic water damage...” as well as “…chronic exposure to elevated humidity resulting from an improperly installed exhaust fan.” Although the Insurer and Insured are in dispute about how the dwelling was damaged, the Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697.
This coverage determination additionally failed to detail an accurate date of loss, to the detriment of the Insured. The Insured’s reported date of loss is June 9, 2024, which the Insurer has misrepresented as March 9, 2024. Initially, the Insurer knows or should know that a denial based on a disputed date of loss is improper when damage did in fact occur from a covered peril within the effective policy period. It is the Insured’s duty to report when damage results from a covered peril and that which occurs within the effective policy period. Correspondingly, the Insurer has an obligation to determine whether a covered peril caused the alleged damages within the policy period irrespective of a disputed date of loss. In other words, the Insured has a right to be compensated for the alleged damages and the Insurer has no right to wrongfully deny coverage. Despite the obvious damage occurring during the effective policy period, the Insurer wrongfully denied the Insured’s valid claim.
The insurer moreover materially misrepresented the terms of the insurance policy. Insurer stated that the policy excluded "constant or repeated seepage or leakage of water.” The insurer has drafted and interpreted its policy in such a way as to appear to provide coverage to its policyholders for mold and mildew while providing itself a way to deny every claim reported to it. Pursuant to the policy of insurance issued by Insurer to Insured, Insurer appears to provide coverage for “fungi”, wet or dry rot, or bacteria in certain situations. However, the policy issued by Insurer also excludes coverage for any damage caused by “constant or repeated seepage or leakage of water or the presence or condensation of humidity, moisture or vapor, over a period of 14 or more days.” These terms under the policy are contradictory as the development of “wet or dry rot” cannot occur without the presence of moisture over a period of time. Insurer has intentionally misled its Insureds into believing that it provides coverage for “fungi”, wet or dry rot, or bacteria in certain situations when, in fact, Insurer has the ability to deny every claim for mold or fungi reported to it. Insurer has accepted premiums from its policyholders under the pretense that it provides coverage for the development of “wet or dry rot” when it has no intention of paying for any mold, rot, or fungi claim reported to it.
Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer’s claim file and standards and procedures for the adjustment and investigation of claims.
Furthermore, the Insurer and its agents failed to comply with Fla. Stat. § 627.444 by not providing the Insured and the Insured’s representatives with a loss run statement. On August 19, 2024, the Insured’s legal counsel provided the Insurer with a letter of representation. Within the letter, legal counsel requested a copy of a loss run statement. The Insurer and its agents have not acknowledged the request for a loss run statement nor has a loss run statement been provided. Upon an Insurer receiving a written request for a loss run statement, the Insurer is required, within fifteen (15) calendar days, to provide either a loss run statement or information on how to obtain a loss run statement at no charge through a consumer reporting agency. There has been no response within fifteen (15) calendar days of the Insured’s written request and the Insurer has not provided information on how to obtain a loss run statement at no charge through a consumer reporting agency. This Insurer has breached its duty to settle claims in good faith when, under all the circumstances, it could and should have done so. The Insurer and its agents have not acted fairly and honestly toward the Insured and the Insured’s representative and have moreover failed or refused to promptly acknowledge the Insured’s communications in an attempt to frustrate and delay the resolution of the Insured’s claim.
In addition, on September 3, 2024, September 10, 2024, September 17, 2024, September 24, 2024, October 1, 2024, October 8, 2024, and October 16, 2024, the Insured, through legal counsel, asked for the Insurer to confirm receipt of the Letter of Representation that was sent on August 19, 2024. To date, the Insurer has not responded to any of these communication attempts. This shows that Insurer has failed to acknowledge the receipt of communications within seven (7) days in violation of Florida Statute 627.70131(1)(a). Upon an Insurer’s receiving a communication with respect to a claim, the Insurer shall, within seven (7) 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 prevents such acknowledgement.
Not surprisingly, the Insurer continued to delay and frustrate the Insured’s ability to have this claim adjusted promptly by failing to timely provide the Insured with the policy after it was requested. The Insured’s legal counsel requested the policy in its letter of representation and multiple times after that. The policy was not received within 30 days of the first written request. More concerning is that the policy has yet to be received. Each Insurer which does or may provide liability insurance coverage to pay all or a portion of any claim which might be made shall provide, within 30 days of the written request of the Insured, a statement, under oath, of a corporate officer or the insurer’s claims manager or superintendent, a copy of the policy. Fla. Stat. 627.4137(1)(e). Insurers have a duty to settle claims in good faith when, under all the circumstances, they could and should have done so, had they acted fairly and honestly toward its insureds and with due regard for their interests. This is to say, this Insurer has failed and/or refused to promptly acknowledge the Insured’s communication in an attempt to frustrate and delay the resolution of this claim.
In short, the Insurer is not acting with due regard for the Insured’s interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully denied coverage for a loss that should have been covered under the subject policy. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer’s actions and inactions have continued to frustrate and delay the resolution of the Insured claim.
The Insurer’s actions amount to but are not limited to the following:
1. Claim denial
2. Claim delay
3. Not treating the Insured with good faith claims conduct
4. Looking for way to reduce recovery to the Insured
5. Looking for ways to deny recovery to the Insured
6. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured
7. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the Insured's interests
8. Placing the financial interest of the Insurer over that of the health and safety of the Insured
9. Shifting the burden of investigating onto the Insured
10. Conducting inadequate investigations
11. Failing to provide a loss run statement
12. Making material misrepresentations
Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must:
(1). Admit full coverage for the Insured’s loss.
(2). Tender full benefits owed to the Insured under the insurance contract.
A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com.
Via E-mail:
Security First Insurance Company
P. O. Box 105649
Atlanta, GA 30348
claims@securityfirstflorida.com
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The submitter hereby states that this notice is given in order to perfect the rights of the
person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.
Before submitting a Notice using this system, please verify that all text has been entered
correctly and completely. Once the Notice has been submitted, the text cannot be changed
or deleted.
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DFS-10-363
Rev. 10/14/2008
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