Civil Remedy Notice of Insurer Violations
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Filing Number:     794328
Filing Accepted:  11/26/2024
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Complainant
Last/Business Name *  
BARNES   First Name   SHEILA
Street Address * 8561 CONCORD CT
City, State Zip * JACKSONVILLE, FL 32208
Email Address * HELLOSHEILA@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   BARNES   First Name   SHEILA
Policy # * P003600365 Claim #* 233907
Attorney
Attorney is Applicable
Last Name* PLATT First Name * HOPE Initial
Street Address* 800 EAST BROWARD BLVD SUITE 500
City, State Zip* FT. LAUDERDALE , FL 33301
Email Address * HBP@WEKLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   SECURITY FIRST INSURANCE COMPANY
NAIC Company Code 10117
 
Name of individual responsible for violation (if any):* GILBERTO RIVERA
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(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.
624.401(4)(b)(1) However, any person acting as an insurer without a valid certificate of authority who violates this section commits insurance fraud, punishable as provided in this paragraph. If the amount of any insurance premium collected with respect to any violation of this section is less than $20,000, the offender commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084, and the offender shall be sentenced to a minimum term of imprisonment of 1 year.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
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)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Please refer to your policy: SECTION I – PERILS INSURED AGAINST, COVERAGE A – DWELLING, 2. g., h. (1), h. (5). COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES We insure against risk of direct loss to property described in Coverages A and B only if that loss is a physical loss to property. We do not insure, however, for loss: 2. Caused by: g. Rain, snow, sleet, sand or dust to the interior of a building unless a covered peril first damages the building causing an opening in a roof or outside wall, door or window and the rain, snow, sleet, sand or dust enters through this opening. This exclusion applies unless the damage is caused during a “hurricane loss”; h. Any of the following: Wear and tear, marring, deterioration; (1) Inherent vice, latent defect, mechanical breakdown; (5) Settling, shrinking, bulging or expansion, including resultant cracking, of pavements, patios, foundations, walls, floors, roofs or ceilings;
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Sheila Barnes ("Insured") purchased an insurance policy ("Policy") from Security First Insurance Company ("Security First" or “Carrier”) with effective coverage on the date of loss, on or about May 21, 2022, and Policy number P003600365 to insure their property located at 8561 Concord Ct, Jacksonville, FL 32208 (the "Property").??With effective dates from February 6, 2022, to February 6, 2023. On or about May 21, 2022, the Property suffered roof and interior damage from a storm/hail event which caused damage to the Property, including but not limited to the roof and exterior of the home which caused an opening in the structure to allow for interior water entry and damage to the interior of the home. ("Loss"). After the storm, the roof was leaking into her home, specifically, the laundry room, garage, sun room i.e. Florida room and there was damage to the exterior fence and window screens. In order to prevent further damage to her home after the storm, the Insured put down buckets to catch the water and contacted a handy man to help her stop the leak. In an attempt to fix the leak, the handy man made repairs to the roof. However, it became obvious that the roof was damaged more than she originally realized and needed to proceed with an insurance claim. Security First sent a Field Adjuster, Gilberto Rivera to inspect the subject property. The Field Adjuster took pictures of the roof and noted his observations of the damage to the roof. There were obvious marks on the roof which showed that the roof was damaged from the storm. However, during his deposition testimony he testified that he had no memory of the claim or the damages that he was there to inspect. Specifically, he was very particular in the fact that because the claim was two years old that he did not have any knowledge of the damages and a review of his photographs did not refresh his recollection. Additionally, the Insureds hired 5th Element Adjusting to assist them with the claim. 5th Element inspected the Insureds roof and determined that the roof was damaged from the May 21, 2022, storm. 5th Element has provided Security First with an estimate for the cost to replace the roof and repair the interior damage in the amount of $59,691.78. However, Security First has chosen to ignore this information and still refused to fully indemnify the Insureds. 5th element also provided Security First with a Hail Impact Report, which showed that there was hail in the area of the insureds home on the date of loss. Additionally, there were hail marks and wind damage to her main roof and flat roof which could have only been caused by wind. Security First has chosen to ignore this information. Security First sent out leak Detection and a roofer to inspect the insureds home. While at the home of the Insured, both representatives told and pointed out to the Insured that there was wind damage to her roof. However, when the report was provided to Security First, they failed to put that information in the report. Therefore, Security First hired and relied on representatives who were not open and honest about their evaluation of the insureds home. Security First, authored a letter on December 20, 2022, to the Insured (“Coverage letter”). They opened coverage for the privacy fence but claimed that the replacement of the fence would be less than her deductible of $1,000, which is not the case. Additionally, they improperly denied coverage for the roof damage and the interior damage, as they stated that the water entry was not a result of a peril created opening. However, there was no roof leak at the insureds home prior to the May 21, 2022 storm. Nowhere in the letter does Security First state that they were unable to conduct or complete an investigation of the damages and necessary repairs to the Property. The Insured has complied with her post loss duties and the Carrier needs to fulfill its obligations. After being provided plenty of evidence (including photos, estimates, and access to the property, showing that the storm event caused damage at the property, Security First continues to refuse to provide additional money in order to begin these repairs. The Carrier is trying to avoid finding any further information that would increase the amount of coverage available on this claim despite being aware that additional costs would need to be incurred by the Insured to repair their home. The Insured has fully complied with all applicable Policy provisions requiring cooperation with the?investigation;?however, the Carrier has unequivocally failed to properly adjust this Claim, as further elaborated above. Rather than paying the actual damages and/or trying to settle with the Insured, the Carrier has continued its pre-suit failures to act in good faith into litigation by delaying the prompt resolution of the claim. The Carrier has not attempted, in good faith, to settle this claim when, under the circumstances, it could and should have done so had it acted fairly and honestly toward the policyholder and with due regard to the policyholder's interests.? Rather, The Carrier has acted with only its own profit and shareholders in mind. As a direct consequence of the Carrier’s failure to adjust this Loss in good faith and make any supplemental payment, the Insured continues to be without adequate compensation for the damages sustained at the Insured's Property more than two and a half years ago and has been forced to continue to live in a damaged home. By stating the above detailed?facts,?it is clear that the Carrier has violated the following Florida statutes:? • 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 Insureds and with due regard for their interest. • 624.155(1)(b)(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. • 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the?proper investigation of?claims; • 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)(i) Unfair claim settlement practices To date, The Carrier has in bad faith failed to provide sufficient coverage under the Policy to the Insured. The Insured is without the funds to replace her damaged roof and bring it back to its pre-loss condition. As a direct result of The Carrier’s failure to pay the Claim and breach of the Florida Statutes, the Insured was forced to seek the?help of licensed professionals to assist her, including legal counsel.?Due to the amount of time that has passed since the date of loss and the information discussed above, there is irrefutable evidence that The Carrier knowingly and intentionally, and in bad faith delayed the settlement process in order to further disadvantage the Insured. The financial detriment caused to the Insured is a direct result of The Carrier’s reckless treatment of the claims process. The Insured submitted all documents requested in a timely fashion, made their property available for inspection immediately after the discovery of the loss, submitted an estimate, and satisfied all requests. However, The Carrier failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim.? Upon information and belief, the aforementioned actions complained of, among others, were made by The Carrier so often?as to constitute a general business practice, evidencing a motive to enhance The Carrier’s profits, and designed to cause a detrimental effect to its policyholders. The above clearly depicts that The Carrier adjusted this claim in bad faith, continue to act in bad faith towards its Insured, and that The Carrier is in direct violation of Unfair Claims Practices.?? This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should The Carrier fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, The Carrier must: (1) Immediately tender all proceeds due and owing to the Insured that are fairly owed to the Insured under the insurance policy that would reasonably compensate the Insured in order to put the loss property back to its pre-loss condition in the amount of $59,691.78; (2) Immediately afford coverage for the repairs to the subject property necessary to put the property back into its pre-loss condition (3) Agree to reimburse the Insured's reasonable attorneys’ fees and costs for having to become involved to resolve the claim; and (4) Agree to reimburse the Insured for interest on the amount of benefits that was found to be?due and owing to the Insured, relating back to the date of loss.
Comments
User Id Date Added Comment
acaula@wickersmith.com 01-10-2025 Security First Insurance Company (hereinafter “Security First”) is in receipt of the Civil Remedy Notice of Insurer Violations (hereinafter “CRN”) from Complainant, Sheila Barnes. This will serve as Security First’s timely response to the CRN. The CRN alleges that Security First violated multiple statutory provisions of §624.155 and §626.9541 of the Florida Statutes, as well as more generalized allegations of breaches of various duties owed to its insured. Security First generally and specifically denies it has violated any of the referenced Florida Statutes during the adjustment and/or settlement of the claim. Additionally, Security First asserts that it acted in good faith at all times relevant to the CRN. Security First wholly denies all other general allegations in the CRN, and asserts that it did not breach any of the applicable Policy provisions, duties, standards, or codes. Security First at all times during the handling of this claim acted in good faith. Security First wholly denies all allegations of wrongdoing, unfair claim denial, claim delay, unsatisfactory settlement offer, and Unfair Trade Practice with respect to the subject claim. Security First has not breached any duty owed to the insured, Sheila Barnes. The alleged violation arises from a dispute regarding a claim for roof and interior damage to the property’s main dwelling, as well as damage to a privacy fence, related to alleged storm damage. This claim was first reported by the insured to Security First on September 9, 2022 (111 days after the alleged date of loss), at which time the cause of loss was reported as wind. Security first performed a diligent and reasonable investigation of this claim. Security First sent a field adjuster who inspected the subject property, took photographs, and reported back to Security First. It then continued its investigation by sending out an independent adjuster who also inspected the insured’s property, took photographs, and reported back to Security First. In addition, Security First also sent a leak detection vendor to the insured’s property to diagnosis the sources of any potential leaks to the roof. Following its investigation, Security First provided the insured a coverage determination letter on December 20, 2022 in which it acknowledged coverage for the damage to the insured’s privacy fence, but denied all damages claimed to the main dwelling. As grounds for the denial of coverage for the damage to the main dwelling, the coverage determination letter alluded to Section I-P of the subject homeowner’s insurance policy and noted that Security First’s investigation revealed no evidence of wind storm damage to the roof, that the roof had evidence of prior repairs, and that the interior leaks to the main dwelling were the result of rain entry through the areas of prior repairs. The coverage determination letter sent to the insured advised that the estimated repair costs for the privacy fence was below the applicable $1,000.00 deductible, and as such no payment was issued. Despite performing a diligent and reasonable investigation of this claim, upon receipt of an estimate from the insured’s public adjuster, Security First retained an engineer to further investigate this claim and determined that neither hail nor wind caused or contributed to any damages claimed to the main dwelling’s roof or exterior building components. The engineer further concluded that the damages observed to the main dwelling’s roof shingles and roll membranes were the result of manufacturing defects, mechanical damage, abrasions, fastener penetrations and/or normal wear/tear of the roof covering over years. In addition, the engineer also concluded that previous repairs made to the roof limited Mr. Morrison’s ability to assess some of the damages, but he was still able to conclude that observed moisture related damage along the ceiling and underlying wall components at the Florida room was the result of rainwater infiltration, past deterioration, and/or inadequate roof flashings, and none of the damages observed were the result of any single weather or water intrusion event. Furthermore, Security First states that any attempt to file suit against Security First for bad faith under the above statutes is premature. No final determination of liability and/or damages on the insurance contract claim has been made due to the active lawsuit styled: Shiela Barnes v. Security First Insurance Company, Case No.: 2023-CA-008694. See Vest v. Travelers Insurance Co., 753 So. 2d 1270 (Fla. 2000); see also Imhof v. Nationwide Mut. Ins. Co., 643 So. 2d 617 (Fla. 1994). Security First responds to each of the alleged allegations raised by the insured as follows: Statutory Allegation: 624.155(1)(b)(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. Security First’s Response: 624.155(1)(b)(3) – Security First denies this allegation. Security First, in good faith, performed a reasonable investigation into the claim. In addition, Security First timely reviewed, adjusted, and made its coverage determination based on specific language in the subject policy of insurance and applicable industry standards. Security First conducted, in good faith, a complete, thorough, and timely investigation of the claim based on the information reasonably available to Security First. Furthermore, Security First was prejudiced by the insured’s unreasonable delay of 111 days in reporting the subject claim, during which time the insured made repairs to the subject roof which has prejudiced Security First’s ability to fully investigate this claim. Security First conducted all actions and aspects of handling the claim in good faith at all times, and remained in complete compliance with any and all applicable laws and standards at all times relevant to this claim. Statutory Allegation: 624.401(4)(b)(1) – However, any person acting as an insurer without a valid certificate of authority who violates this section commits insurance fraud, punishable as provided in this paragraph. If the amount of any insurance premium collected with respect to any violation of this section is less than $20,000, the offender commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084, and the offender shall be sentenced to a minimum term of imprisonment of 1 year. Security First’s Response: Security First denies this allegation. Security First, in good faith, performed a reasonable investigation into the claim. In addition, Security First timely reviewed, adjusted, and made its coverage determination based on specific language in the subject policy of insurance and applicable industry standards. Security First conducted, in good faith, a complete, thorough, and timely investigation of the claim based on the information reasonably available to Security First. Furthermore, Security First was prejudiced by the insured’s unreasonable delay of 111 days in reporting the subject claim, during which time the insured made repairs to the subject roof which has prejudiced Security First’s ability to fully investigate this claim. Security First conducted all actions and aspects of handling the claim in good faith at all times, and remained in complete compliance with any and all applicable laws and standards at all times relevant to this claim. Statutory Allegation: 626.9541(1)(i)(3)(a) – Failing to adopt and implement standards for the proper investigation of claims. Security First’s Response: The standards and methods utilized by Security First in examining its claims have met and exceeded its obligations and industry standards. Security First has conducted the handling of this claim according to such standards. Additionally, the Complainants failed to allege any factual support or offer any evidence that Security First has committed or performed this alleged violation with such frequency as to indicate a general business practice, other than a self-serving statement regarding same. Furthermore, Security First denies this allegation. Security First denies that it failed to adopt and implement standards for the proper investigation of claims. Security First conducted a complete, thorough and timely investigation into the loss, utilizing a field adjuster, independent adjuster, leak detection vendor, and engineer. Security First adjusted the claim in complete fairness and honesty, with a full appreciation of the insured’s interests. Security First conducted all actions and aspects of handling the claim in good faith at all times, and remained in complete compliance with any and all applicable laws and standards at all times relevant to this claim. Statutory Allegation: 626.9541(1)(i)(3)(c) – Failing to acknowledge and act promptly upon communications with respect to claims. Security First’s Response: Security First denies this allegation. Security First made all communications with the insured and her representatives in a prompt and appropriate manner. Additionally, Security First informed the insured and her representatives regarding all such communications and continued to keep the insured and her representatives thoroughly informed of the handling of the claim. Furthermore, Security First conducted, in good faith, a complete, thorough, and timely investigation of the claim based on the information reasonably available to Security First. Security First adjusted the claim in complete fairness and honesty, with a full appreciation of the insured interests. Security First conducted all actions and aspects of handling the claim in good faith at all times, and remained in complete compliance with any and all applicable laws and standards at all times relevant to this claim. Statutory Allegation: 626.9541(1)(i)(3)(d) – Denying claims without conducting reasonable investigations based upon available information. Security First’s Response: Security First denies that it failed to conduct a reasonable investigation or that it made its coverage determination without utilizing information available. Security First, in good faith, performed a reasonable investigation into the claim. In addition, Security First timely reviewed, adjusted, and made its coverage determination based on specific language in the subject policy of insurance and applicable industry standards. Security First conducted, in good faith, a complete, thorough, and timely investigation of the claim based on the information reasonably available to Security First. Furthermore, Security First was prejudiced by the insured’s unreasonable delay of 111 days in reporting the subject claim, during which time the insured made repairs to the subject roof which has prejudiced Security First’s ability to fully investigate this claim. Security First conducted all actions and aspects of handling the claim in good faith at all times, and remained in complete compliance with any and all applicable laws and standards at all times relevant to this claim. Statutory Allegation: 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. Security First’s Response: Security First denies that it failed to promptly provide a reasonable explanation in writing which its coverage determination. Security First, after performing a diligent and reasonable investigation of this claim, provided the insured with a coverage determination letter that thoroughly explained the basis for its denial of the damages claimed to the main dwelling, including alluding to specific provisions in the subject insurance policy. Statutory Allegation: 626.9541(1)(i)(3)(i) – Unfair claim settlement practices. Security First’s Response: Security First denies that it engaged in any unfair claim settlement practices. Additionally, the Complainants failed to allege any factual support or offer any evidence that Security First has committed or performed this alleged violation with such frequency as to indicate a general business practice, other than a self-serving statement regarding same. Security First conducted a complete, thorough and timely investigation into the loss, utilizing a field adjuster, independent adjuster, leak detection vendor, and an engineer. Security First adjusted the claim in complete fairness and honesty, with a full appreciation of the insured’s interests. Security First conducted all actions and aspects of handling the claim in good faith at all times, and did not engage in any unfair claim settlement practices. Statutory Allegation: 626.9541(1)(i)(3)(i) – Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b). Security First’s Response: Security First denies that the insured has at any time relevant hereto raised any claims for personal injury protection related to the date of loss of May 21, 2022, and demands strict proof thereof. The damages alleged by the insured to date have been limited to property damage to the main dwelling’s roof and interior, as well as damage to a privacy fence. Additionally, the Complainants failed to allege any factual support or offer any evidence that she placed Security First on notice of a personal injury protection claim, or that Security First after receiving such alleged notice failed to investigate and/or pay on such a claim. Conclusion: Security First has, at all times, acted in good faith toward the Insured and has always comported itself fairly and honestly toward the Insured, despite the allegations in the CRN. Security First responded promptly to the claim notice. Security First conducted all actions and aspects of handling the claim in good faith at all times, and remained in complete compliance with any and all applicable laws and standards at all times relevant to this claim. Nothing herein this response shall be construed as a waiver of any of Security First’s rights under the terms and conditions of the subject policy of insurance. In addition, neither this response, nor any action or inaction by Security First, shall be construed as a waiver of any of its affirmative defenses.
Acknowledgement
* 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.

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DFS-10-363
Rev. 10/14/2008