Filing Number: 788778
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| Filing Accepted: 10/25/2024 |
| Last/Business Name
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HOLMES
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First Name |
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SHIRLEY |
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| Street Address
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21343 SE RIDGE AVE |
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BLOUNTSTOWN,
FL
32424
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| Email Address
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CARRIEBAKER12@YAHOO.COM |
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Insured |
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| Last/Business Name* |
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HOLMES |
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First Name |
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SHIRLEY |
| Policy # * |
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P000073660 |
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Claim #* |
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162350 |
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Attorney is Applicable
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| Last Name* |
LEVIN
First Name *
YITZHAK
Initial
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| Street Address* |
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6100 HOLLYWOOD BLVD, STE 520 |
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HOLLYWOOD
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FLORIDA
33024
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| Email Address * |
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SERVICE-TEAM09@LEVINLITIGATION.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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,
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NAIC Company Code 10117 |
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| Name of individual responsible for violation (if any):*
RAY GILBERT, GEDDES BROWN, JOSH WILSON, BRIAN DAVIDSON, BRIAN ATKINS.
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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)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(3)(j) |
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Altering or amending an insurance adjuster’s report without:
(I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and
(II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or
(III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
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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.
F.A.C. 69B-220.201(3)(b)2.: An adjuster shall adjust all claims strictly in accordance with the insurance contract.
F.A.C. 69B-220.201(3)(c): An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
F.A.C. 69B-220.201(3)(e): An adjuster shall handle every adjustment and settlement with honesty and integrity, and allow a fair adjustment or settlement to all parties without any remuneration to himself except that to which he is legally entitled.
F.A.C. 69B-220.201(3)(m): An adjuster shall not knowingly fail to advise a claimant of the claimant’s claim rights in accordance with the terms and conditions of the contract and of the applicable laws of this state. An adjuster shall exercise care not to engage in the unlicensed practice of law as prescribed by the Florida Bar.
F.A.C. 69B-220.201(1)(h): An adjuster shall exercise extraordinary care when dealing with elderly clients to assure that they are not disadvantaged in their claims transactions by failing memory or impaired cognitive processes.
Relevant Policy Language:
SECTION I – PERILS INSURED AGAINST
COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES
We insured against risk of direct loss to property described in Coverages A and B only if that loss is a physical loss to property.
- Form HO 00 03 04 91, Pg. 7 of 21.
SPECIAL PROVISIONS – FLORIDA
SECTION I – CONDITIONS
2. Your Duties After Loss
The sentence “In case of a loss to covered property, you must see that the
following are done:” is deleted and replaced by the following:
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:
2.a. is deleted and replaced by the following:
a. Give prompt notice of us or our agent;
(1) Except for Reasonable Emergency Measures taken as described in
SECTION I – ADDITIONAL COVERAGES, Reasonable Emergency
Measures, there is no coverage for permanent repairs that begin before
the earlier of:
(b) The time of loss inspection by us.
SPECIAL PROVISIONS – FLORIDA
SECTION I – CONDITIONS
2. Your Duties After Loss
The sentence “In case of a loss to covered property, you must see that the
following are done:” is deleted and replaced by the following:
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:
2.d. is deleted and replaced with the following:
d. 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 further damage, as described in SECTION I – ADDITIONAL COVERAGES, Reasonable Emergency Measures. A reasonable emergency measure may include a permanent repair when necessary to protect the property from further damage or to prevent unwanted entry to the property.
(2) To the degree reasonably possible, the damage property must be retained for us to inspect;
(3) Keep an accurate record of repair expenses.
SPECIAL PROVISIONS – FLORIDA
SECTION I – CONDITIONS
2. Your Duties After Loss
The sentence “In case of a loss to covered property, you must see that the
following are done:” is deleted and replaced by the following:
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:
2.f.(3) is deleted in its entirety and replaced by the following:
(3) As often as we reasonably require:
(a) Show the damaged property;
SPECIAL PROVISIONS – FLORIDA
SECTION I – CONDITIONS
2. Your Duties After Loss
The sentence “In case of a loss to covered property, you must see that the
following are done:” is deleted and replaced by the following:
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:
2.f.(3) is deleted in its entirety and replaced by the following:
(3) As often as we reasonably require:
(b) Provide us with records and documents we request and permit
us to make copies;
2. Your Duties After Loss. In case of a loss to covered property, you must
see that the following are done:
g. 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) The interest of the “insured” and all others in the property involved and all liens on the property;
(3) Other insurance which may cover the loss;
(4) Changes in the title or occupancy of the property during the
term of the policy;
(5) Specifications of damaged buildings and detailed repair estimate;
(6) The inventory of damaged personal property described in 2.e. above;
(7) Receipts for additional living expenses incurred and records that support the fair rental value loss; and
(8) Evidence or affidavit that supports a claim under the Credit Car, Fund Transfer Card, Forgery and Counterfeit Money coverage, state the amount and cause of loss.
The law requires the insurer to issue payment for all losses and damages that arise during the Policy period as a consequence of direct physical loss to property. The only exceptions being: fraud; intentional damage; and/or the evidentiary determination that a Policy exclusion or limitation applies. That said, and in order to lawfully assert any exclusion and/or limitation, the insurer must have a good faith basis to conclude that it can prove the application thereof by a preponderance of the evidence gathered while at the same time fulfilling its legal duty to promptly investigate and adjust the claim.
At a very minimum, the insurer is required to issue payment for any losses or damages for which such exceptions and/or limitations cannot be promptly verified per the evidentiary considerations referenced, and for an amount that corresponds with the actual cash value of the loss, or the amount necessary to perform repairs in relation to the losses or damages.
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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.
The Complainant and insured (“including their authorized representative and collectively referred to as “Complainant”), maintained a homeowner’s policy of insurance (“Policy”) with Security First Insurance Company d/b/a Security First Florida (INSURER), which generally and broadly provided coverage for any direct physical loss to the property (“Insured Property”) that occurred during the Policy period. The only exceptions being, for which INSURER carries the evidentiary burden to prove by a preponderance of the evidence, are: fraud; intentional damage; and/or the qualification of a Policy exclusion or limitation that is specified and disclosed to the Complainant. That said, and although many days have passed since the claims for losses and damages were presented for payment under the Policy, INSURER has failed to specify and disclose the evidentiary considerations to support the basis for not fully compensating the losses and damages as presented in various forms.
The Complainant is an 88-year-old woman who suffers from dementia and is particularly vulnerable. Therefore, pursuant to governing law, an adjuster must exercise extraordinary care when dealing with elderly insured such as the Complainant in order to assure that they are not disadvantaged in their claims transactions by failing memory or impaired cognitive processes. In this instance, the Complainant submitted a claim with the assistance of her daughter Carrie Baker.
On or about October 10, 2018, the Complainant’s property located at 21343 SE Ridge Avenue, Blountstown, Florida, 32424 sustained significant, sudden and accidental damage as a result of Hurricane Michael. Hurricane Michael was the first Category 5 hurricane on record to impact the Florida Panhandle region, the fourth-strongest landfalling hurricane in the contiguous United States in terms of wind speed, and the most intense hurricane on record to strike the United States in the month of October. At least 74 deaths were attributed to the storm, including 59 in the United States and 15 in Central America. Michael caused an estimated $25.1 billion in damages. At one point, 1.2 million customers were without power in multiple states throughout the US. The National Centers for Environmental Information estimated that Michael caused $18.4 billion in damage in Florida, primarily incurred by property and infrastructure.
The claim was reported to the insurer on November 1, 2018. The Insurer assigned claim number 162350. On December 4, 2018, field adjuster Ray Gilbert inspected the risk on behalf of the Insurer. On December 6, 2018, the Insurer received Mr. Gilbert’s estimate in the amount of $3,099.47 (RCV)/$3,098.53 (ACV) for Coverage A – Dwelling. On December 12, 2018, Geddes Brown spoke with the Complainant’s daughter and advised that the damages were determined to be below the applicable hurricane deductible, and as such, no payment would be forthcoming. On December 15, 2018, the Insurer issued a coverage determination letter advising that the damages were determined to be below the applicable hurricane deductible, and as such, no payment would be issued.
On September 22, 2020, Imperial Claims Adjusters (a licensed public adjusting firm, that had been retained by the Complainant’s daughter to assist in submission of the claim), sent a letter of representation to the Insurer and a copy of the public adjusting contract. On October 14, 2020, field adjuster Josh Wilson conducted a second inspection of the property at the direction of the Insurer. On October 21, 2020, field adjuster Wilson submitted his estimate, photographs and report to the Insurer. On November 9, 2020, the parties attended DFS mediation, which ended in an impasse. On April 25, 2022, a sworn proof of loss was submitted on behalf of the Complainant, which requested payment in the amount of $68,973.93.
On July 20, 2022, a third inspection of the Complainant’s property was conducted by field adjuster Brian Davidson, along with a representative from Tadlock Roofing. On March 20, 2023, the Insurer issued a letter standing by its original determination that the damages fell below the applicable hurricane deductible.
To date, the Complainant has incurred expenses totaling $32,255.80 to perform reasonable and necessary repairs for damages associated with Hurricane Michael. In addition, the Complainant is in need of an additional $41,300.00 to complete the remaining reasonable and necessary repairs, which include a complete replacement of the roofing system and interior repairs to the kitchen, family room and three separate bedrooms.
Hurricane Michael caused substantial, direct and consequential damages, and the Insurer’s general business practice of willful, wanton, immoral, deceptive and bad faith claim handling policies, procedures, guidelines, protocol, adjusting, investigating, drawing valuations and issuing patently deficient and unduly delayed payments for the claims has caused the Complainant to suffer further harm and extra-contractual damages which have accrued, and will continue to accrue. The stated misconduct is collectively referred to as “Bad Faith,” and the specific factual and/or legal considerations in relation thereto are further outlined below for their consideration in accordance with Fla. Stat. Sec. 624.155 and the cited legal authorities associated therewith.
1.) The INSURER insures many homes throughout Florida where the Insured’s residence is located. That said, and even though INSURER knows that it has a fiduciary duty to its insureds whose residences are located in a high-risk zone for hurricane and/or other weather related damages, it failed to institute the necessary policies, procedures, guidelines, protocol, personnel and contingencies in relation to fully, promptly and equitably indemnifying its insureds who were impacted in mass by the devastating and widespread impact of Hurricane Michael. Consequently, insureds such as the Complainant were forced to: fend for themselves to mitigate damages arising from INSURER’s Bad Faith; incur out of pocket expenses (including interest on monies borrowed to perform necessary repairs) that INSURER was required to afford pursuant to the Policy; absorb the burden, expense, inconvenience and delay associated with an insurer who was not equipped (because they didn’t want to incur the expense associated therewith) to meet their contractual obligations; risk health hazards associated with the presence of moisture and/or mold due to INSURER’s failure to perform pursuant to the Policy; hire experts/professionals/counsel to force INSURER to abide by their fiduciary duty and mitigate the consequential damages associated with INSURER’s failure to perform with the interests of their insureds; etc.
2.) The INSURER knew that hurricane damages are of a nature that a thorough, nuanced and specialized investigation/adjustment of the claim needs to be promptly performed by qualified and duly prepared personnel in order to protect their insureds, satisfy their fiduciary duties, and otherwise not engage in the Bad Faith claim handling practices at issue. That said, to the detriment of its insureds and to maximize their financial interests, INSURER disregarded the obvious and known obligations by way of the following:
(a.) Not developing, maintaining and/or instituting policies, procedures, protocol or guidelines to determine whether adjusters/personnel/vendors utilized to protect their insureds were qualified and equipped to work with their “desk adjusters” in order to duly and equitably assess the scope and/or value of the loss or damages.
(b.) By way of the cited legal authorities and considerations, INSURER knew that it would have to promptly hire a significant volume of licensed roofers, contractors, uniquely qualified adjusters and/or engineers to fully, equitably and honestly assess the scope and/or value of the loss or damages suffered by their insureds. Although INSURER will promptly hire such experts to establish a lack of coverage as it relates to a specific claim in which they determine coverage may be in dispute, they choose to avoid such expense when it is deemed to not be in their own financial interest to do so at the onset of the claim.
(c.) By way of the cited legal authorities and considerations, INSURER knew that it would be in their insureds’ interests and their obligation under the insurance policy to utilize personnel/vendors to perform moisture meter assessments throughout the insured property to honestly assess the full extent of damages and losses suffered by their insureds. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, INSURER knows that it does not serve their financial interest since it will increase their financial obligations to insureds such as the Complainant. Once again though, and although INSURER will implement such methods to establish a lack of coverage as it relates to a specific claim in which they determine coverage may be in dispute, they choose to avoid such expense for self-gain when they know that the claim is covered and the comprehensive adjustment and investigation of the claim will only serve to expand their immediate liabilities to the insureds per the Policy. In the interest of limiting redundancy in relation to INSURER’s motivation and the willful nature of the general Bad Faith scheme, notice of the issues at hand (which serves to establish willfulness and eliminates any considerations of negligence or mistake) has been exhaustive provided by way of, amongst other things, civil remedies notices such as the one in question, qualified experts that the industry relies upon, qualified adjusters and lawyers that rely upon reliable authoritative sources and well recognized industry standards, etc. Nonetheless, monies are withheld for unjust business interests that they wish to advance by way of the Bad Faith practices at hand.
(d.) By way of the cited legal authorities and considerations, INSURER knew that it would be in their insureds’ interests and their obligation under the insurance policy to utilize personnel/vendors to perform thermal imaging assessments throughout the insured property to honestly assess the full extent of damages and losses suffered by their insureds. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, INSURER avoids same to maximize their financial interest for the reasons detailed.
(e.) By way of the cited legal authorities and considerations, INSURER knew that it would be in their insureds’ interest, and their obligation under the insurance policy, to utilize personnel/vendors to perform detailed, thorough, reliable and qualified assessments of any structural component of the home in which moisture made entry into the home, or per the totality of the circumstances, such structural evaluations were reasonable in order to ensure that latent conditions were promptly accounted for. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, INSURER avoids same to maximize their financial interest for the reasons detailed.
(f.) By way of the cited legal authorities and considerations, INSURER knew that it would be in their insureds’ interest, and their obligation under the insurance policy, to retain a license mold assessor to determine whether there were concealed toxic conditions within the home which necessitated mold remediation and the need for their insureds to take precautionary measures to preserve their physical health and property interests. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, INSURER avoids same to maximize their financial interest for the reasons detailed.
(g.) By way of the cited legal authorities and considerations, INSURER knew that it would be in their insureds’ interest, and their obligation under the insurance policy, to promptly issue payment for professional/qualified moisture assessments and remediation (per industry standards and/or IICRC guidelines) in order to, inter alia, avoid: the development of hazardous/toxic conditions within the residence; preclude the insured from suffering consequential and extra-contractual damages; the development of an uninhabitable residence and various risks that may develop; etc. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, INSURER avoids same to maximize their financial interest for the reasons detailed.
(h.) By way of the cited legal authorities and considerations, INSURER knew that it would be in their insureds’ interest, and their obligation under the insurance policy, to promptly agree to issue, in unabated form, payment for mold assessments and mold remediation, in order to, inter alia, avoid: a delay due financial constraints of the insureds and/or their lack of specialized knowledge; the development of hazardous/toxic conditions within the residence; preclude the insured from suffering consequential and extra-contractual damages; the development of an uninhabitable residence and various risks that may develop; etc. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, INSURER avoids same to maximize their financial interest for the reasons detailed.
(i.) By way of the cited legal authorities and considerations, INSURER knew that it would be in their insureds’ interest, and their obligation under the insurance policy, to utilize a license mold remediator to consider a licensed mold assessor’s assessments and protocol (pre and post remediation) in order to honestly determine the true scope and value of damages and/or the losses, which includes: the scope of rebuild that needs to be performed therewith; extending coverage for additional living expenses that are subject to being incurred in association therewith and the various other considerations set forth herein; assessing and extending coverage for personal property that may be either damaged due to latent conditions, or subject to being accounted for in relation to moving, storage and resetting costs associated therewith; etc. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, INSURER avoids same to maximize their financial interest for the reasons detailed.
(j.) By way of the cited legal authorities and considerations, INSURER knew that it would be in their insureds’ interest, and their obligation under the insurance policy, to carefully consider all policy terms that afford coverage for losses and damages as the obligation to pay was made reasonably clear, and thereafter utilize counsel when an adjuster is in doubt to advise them on a claim by claim basis whether in fact they are duly indemnifying their insureds. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, INSURER avoids same to maximize their financial interest for the reasons detailed.
(k.) By way of the cited legal authorities and considerations, INSURER knew that it would be in their insureds’ interest, and their obligation under the insurance policy, to carefully evaluate on a claim by claim basis whether any amounts appropriated for “depreciation” are based on sufficient facts and data, reliable principles and methods, and/or the application of reliable principles and methods. In reality, INSURER knows that it is arbitrarily, capriciously, deceptively, willfully and wantonly appropriating depreciation without any claim/item specific consideration to justify same. In the aggregate, and unbeknownst to its insureds, this sham Bad Faith practice allows INSURER to unjustly avoid millions of dollars in benefits owed to its insureds who are consequently placed in a position wherein they are financially coerced and/or deceptively induced to: accept a coerced and unjust settlement offer; leave their home in a state of disrepair, or alternatively, resort to handymen and/or non-licensed vendors to perform makeshift repairs which create secondary risks and potential damages that INSURER will deny coverage for when they arise; abandon claims due to a lack of specialized knowledge; etc.
(l.) By way of the cited legal authorities and considerations, INSURER knew that it would be in their insureds’ interests and their obligation under the insurance policy to carefully evaluate on a claim by claim basis, and only after equitably and fully investigating/adjusting claim, the amounts owed to the insured for: overhead and profit associated with the insured’s reasonable need to utilize a general contractor; taxes associated with the repairs; permit costs associated with the repair; costs associated with various licensed trades that will be needed to effectuate the repairs; whether benefits are owed to the insured for loss of use and/or additional living expenses; personal property that may have been affected by toxic/mold/moisture conditions that developed in the home; costs associated with maintaining the continuity of the finish/appearance for pairs or sets such as cabinets, flooring, roof covering/tile/shingles, walls, ceilings; etc.
(m.) By way of the cited legal authorities and considerations, INSURER knew that it had an obligation to ensure that software programs, data bases and adjusting practices utilized to estimate the scope and value of the loss were being utilized in form that: honestly and fully delineated the line item repairs or costs that needed to be performed; pricing corresponded with licensed professionals - as opposed to handyman or non-licensed professionals; accounted for consideration of actual expenditures incurred by the insureds or otherwise compensable expenses on a repair/replacement cost basis; etc. Ultimately, INSURER knows that the adjusting practices are guided towards unlawfully depriving their insureds of benefits owed under the insurance policy, which in the aggregate, serves to facilitate the non-payment of millions of dollars that would be owed to its insureds who reasonably, but ultimately mistakenly, rely upon the representations of their insurer who is legally obliged to act in their insured’s best interest due to the specialized nature of fairly and lawfully adjusting a claim.
(n.) By way of the cited legal authorities and considerations, INSURER knew that it had an obligation to honestly, promptly, in continuity, reliably and fairly communicate with its insured in relation to their rights and obligations under the policy, evidentiary/factual basis for payment and/or nonpayment, policy conditions and/or exclusions which are being considered in relation to payment and/or non-payment; etc. Not only has INSURER disregarded said duty, they know that it serves their financial interest to not provide delineated and detailed disclosures, since the lack of clarity working in combination with delay tactics serves (i.e. using policy conditions as an inequitable shield) to deter a large volume of insureds from lawfully pursuing claims to conclusion and/or in full.
(o.) By way of the cited legal authorities and considerations, INSURER knew that it had an obligation to treat all insureds equally and honestly. However, and for their own financial interest, they will only start to fully consider their obligations as stated herein if the insured retains legal representation and pursues a legal action which exposes them to liabilities and costs associated with, inter alia, Fla. Stat. Secs. 627.428 (and/or 626.9373), 54.071 and 624.155. Even then, and knowingly, they will withhold monies owed in an unjust effort to limit/delay their liabilities in relation to the statutory considerations and otherwise
(p.) By way of the cited legal authorities and considerations, and even after litigation ensues, INSURER knows that it has a continuous and ongoing duty to not engage in the Bad Faith conduct that is the subject of this Complaint. However, and to advance their own financial interest and avoid the liabilities pursuant to the above cited statutory authorities, they will direct and utilize non-qualified counsel to delay the equitable and prompt payment of the claim via litigation practices (i.e. formulaic defenses, inequitable defense that rely upon technical, misleading, non-consequential considerations of policy conditions, etc.) that are not driven to promptly advance the adjudication of the claim on its merits. Moreover, they will insist upon the insured’s non-compliance with post-loss obligations, when in reality, INSURER was the one that did not comply with its own post-loss obligations and therefore forfeited per the breach of the policy its ability to demand the insureds compliance.
(q.) By way of the cited legal authorities and considerations, INSURER knows that it has to assess the application of the policy deductible on a case by case basis, and only after the claim is fully adjusted and investigated. This practice is necessary to protect the interests of the insureds since, pursuant to binding precedent and the policy, the deductible is subject to being absorbed by losses and/or damages that exceed a limitation of coverage under a certain section of the policy.
(r.) By way of the cited legal authorities and considerations, INSURER knows that it has a duty to duly assess whether benefits are owed to the insured in relation to porous and semi-porous personal property that it knows has been exposed to moisture, contaminants and mold. It is widely accepted in the industry that said personal property must be inventoried, assessed, and then adjusted and paid per considerations of specialized cleaning costs and/or the value thereof per the policy’s loss payment provisions. Such practice is a simple, efficient and industry wide accepted means of protecting their insureds, however, INSURER avoids same to maximize their financial interest for the reasons detailed.
(s.) By way of the cited legal authorities and considerations, INSURER knows that it has duty to issue payment for interest owed in relation to payments that were untimely issued per governing authorities. With that said, and to the detriment of the insureds, it foregoes and/or delays such considerations in order to maximize its financial interests.
(t.) By way of the cited legal authorities and considerations, INSURER knows that it has a duty to consider the specific circumstances which served to create damages to the insured property. Although Hurricane Michael had in certain areas a fairly-consistent and wide spread impact, they fail to account for readily available weather data, consideration of the surrounding terrain (i.e. open body of water or field that increases the wind speeds, the number of surrounding residences which reveal significant wind speeds and damages), and a slew of other considerations in order to fairly and honestly determine whether specialized testing needs to be performed to duly assess whether a structural component has been compromised in a form that may not be readily observable. For example, and amongst other things, a roof and/or junction point between a window and wall may only reveal that it is compromised when exposed to heavy winds and rain. Such concealed conditions can slowly serve to destroy the residence by way of toxic conditions, rot, etc., and/or are of a nature that if they are claimed months or years later the insurer will assert that they are not covered pursuant to certain policy conditions or exclusion. Thus, causing progressive, unknown and substantial injury/damages to their insured and a potential inability to: insure the residence; sell the home; reside in the home; maintain a safe environment within the home; assess the necessary scope of repair; etc.
(u.) Although from the onset of a covered loss INSURER will have no good faith basis to deny coverage in part and/or in whole for a loss/damage, they will delay notifying the insured that coverage has been accepted, and/or otherwise delay performing, in order to: maximize their financial interests; unlawfully and deceptively withhold monies for their own use; utilize policy conditions to deflect and misdirect; utilize policy conditions at later date to further delay payment when the insured demands performance under the policy; and/or so as to otherwise implement a deceptive and immoral scheme to deprive insureds of benefits owed under the policy.
(v.) Although INSURER knows that it has a duty to treat all insureds/assignees equally, it will consistently act inconsistently in relation to: the application of policy limits; the manner in which valuations and/or the scope of repair is assessed; the manner in which an insured is required to comply with policy conditions; the application and/or consideration of policy conditions and/or exclusions to bar coverage; the timing and/or circumstances upon which undisputed payments will be made pre-suit and post-suit; etc. The lack of consistency and organization ultimately serves to deprive insureds of their rights under a policy and otherwise creates an inherently dishonest, immoral and unfair means of adjusting and investigating claim.
(w.) INSURER knows that once the claim is fully and fairly investigated and adjusted, it then has to determine whether certain benefits are owed to the insured for the cost of insurance in relation to the construction/repairs that need to be performed. These costs are avoided by INSURER by engaging in the Bad Faith conduct described herein.
(x.) INSURER knows that once the claim is fully and fairly investigated and adjusted, it is required to further assess whether certain benefits are owed to the insured for the repairs that naturally commence thereafter and the cost of engineering fees in association therewith. These costs are avoided by engaging in the Bad Faith conduct described herein.
(y.) INSURER knows that once the claim is fully and fairly investigated and adjusted, it is required to further assess the means, methods and timing upon which payment will be issued to the insureds for withheld depreciation and/or the difference between the cost of repair and the adjusted value of the claim. It is without refute that millions of dollars are saved by INSURER as a consequence of this Bad Faith practice.
(z.) INSURER’s Bad Faith conduct as described places the insured in a position of being forced into incurring expert fees to secure judicial relief by way of a legal action. Moreover, and as part of the Bad Faith practice, INSURER will await the insured’s post-suit retention of an expert to retain a designated/pre-disposed (due to financial biases) experts to further delay their obligations to their insureds and the consequential liabilities that the legislature has imposed to deter INSURER from engaging in the Bad Faith practice.
INSURER’s “tool box” of Bad Faith claims handling practices as described above leaves insureds, the insured’s counsel, the insurer’s counsel and even the judiciary guessing as to when and how INSURER will duly perform. The continuously vacillating positions and cherry picking of the described Bad Faith conduct not only serves to maximize INSURER’s prospective financial gains by being able to avoid paying benefits, it also serves to minimize INSURER’s lost adjusting expense as they see fit and to the invariable detriment of its insureds, the Complainant, and ultimately the tax paying citizens of this State that bear the expense of the judicial system which needs to unravel the tangled web created by INSURER. The lives, health and overall well-being of their insureds are placed at high risk on a daily basis due to the Bad Faith practices, but the personnel who act on their behalf have been left desensitized as a consequence of the systemic and ongoing nature of the misconduct.
To cure the above stated immoral, deceptive, unlawful and collectively defined general business practice of Bad Faith claims handling practices that are knowingly, willfully, wantonly and/or with a reckless disregard for the Complainant’s interests being implemented, INSURER must perform as follows within 60 days of receiving this Complaint.
(1. Issue immediate payment to the Complainant in the amount of $70,315.80, representing the combination of the Complainant’s incurred repair expenses to date, plus the estimated cost of remaining repairs, subtracting the applicable hurricane deductible;
(2. Take corrective action in association with the Bad Faith claims handling practices by way of rectifying same and thereafter duly adjusting, investigating and issuing payment for all benefits owed to the Complainant (including any assignee who the Complainant has a financial interest in satisfying);
(3. Stipulate to the Complainant’s and/or their counsel’s entitlement to attorney’s fees and costs pursuant to, inter alia, Fla. Stat. Sec. 627.428 (and/or 626.9373) and 54.071; and
(4. As it relates to any claims/benefits that may remain in dispute or undetermined, fairly, honestly, specifically, meaningfully and substantively disclosing to the Complainant’s counsel the basis therefor and the means to promptly reach resolution.
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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
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DFS-10-363
Rev. 10/14/2008
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