Filing Number: 794535
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| Filing Accepted: 11/27/2024 |
| Last/Business Name
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| Street Address
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442 CART CT |
| City, State Zip
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KISSIMMEE,
FL
34759
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| Email Address
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PF@WEKLAW.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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URREGO |
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First Name |
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MARIA |
| Policy # * |
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P000308417 |
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Claim #* |
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234321 |
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Attorney is Applicable
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| Last Name* |
FERNANDEZ
First Name *
PATRICIA
Initial
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| Street Address* |
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800 E BROWARD BLVD, SUITE 510 |
| City, State Zip* |
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FORT LAUDERDALE
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FL
33301
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| Email Address * |
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PF@WEKLAW.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):*
WYLIE BARRIENTOS
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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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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 –EXCLUSIONS
2. We do not insure for loss to property described in Coverages A and B caused by any of the following. However, any ensuing loss to property described in Coverages A and B not excluded or excepted in this policy is covered. a. Weather conditions. However, this exclusion only applies if weather conditions contribute in any way with a cause or event excluded in paragraph 1. above to produce the loss;
b. Acts or decisions, including the failure to act or decide, of any person, group, organization or governmental body;
c. Faulty, inadequate or defective: SFI FL HO3 03 20 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 17 of 31
(1) Planning, zoning, development, surveying, siting;
(2) Design, specifications, workmanship, repair, construction, renovation, remodeling, grading, compaction;
(3) Materials used in repair, construction, renovation or remodeling; or
(4) Maintenance;
of part or all of any property whether on or off the "residence premises."
SECTION I – PERILS INSURED AGAINST
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:
(1) Inherent vice, latent defect, mechanical breakdown;
(2) Smog, rust or other corrosion, “fungi”, mold, wet or dry rot;
(3) Smoke from agricultural smudging or industrial operations;
(4) Discharge, dispersal, seepage, migration, release or escape of “pollutants” unless the discharge, dispersal, seepage, migration, release or escape is itself caused by a Peril Insured Against under Coverage C of this policy.
(5) Settling, shrinking, bulging or expansion, including resultant cracking, of pavements, patios, foundations, walls, floors, roofs or ceilings;
(6) Birds, vermin, rodents, marsupials, animals, reptiles, fish, insects, or pests, including but not limited to, termites, snails, squirrels, racoons, opossums, armadillos, flies, bed bugs, lice, ticks, locusts, cockroaches, ants, bats, bees, wasps and fleas;
Wear and tear, marring, deterioration;
(7) Animals owned or kept by an "insured"; or
(8) Pressure from or presence of tree, shrub, or plant roots
If any of these cause water damage not otherwise excluded or limited elsewhere in the policy, from a plumbing, heating, air conditioning or automatic fire protective sprinkler system or household appliance, we cover loss caused by the water, including the cost to tear out and repair only that part or portion of a building or other structure covered under Coverage A or B, on the “residence premises”, necessary to access the system or appliance.
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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.
Maria Urrego ("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 July 30, 2022, and Policy number P000308417 to insure their property located at 442 Cart Ct., Kissimmee, FL 34759 (the "Property").??
On or about July 30, 2022, the Property sustained damage as a result of wind which caused ensuing water damage to the Property, including but not limited to the roof, living room, master bedroom, and patio ("Loss"). Security First was notified of the Loss immediately upon discovery and was granted access to the property in order to complete their inspection. Security First acknowledged the claim and assigned claim number? 234321 ("Claim") to the Loss.
Security First inspected the subject property and determined that the roof was damaged by a covered peril, but denied payment for the interior damages. Security First’s coverage determination are illogical and it’s obvious that Security First is intentionally trying to avoid paying what is rightfully owed to the Insured pursuant to the insurance policy for which they paid premiums.
After being provided plenty of evidence (including photos, estimates, access to the property, and proof of mitigation efforts) showing that wind caused damage to the roof and interior of the property that will require repairs, Security First continues to refuse to provide additional money in order to begin these repairs. Security First has the resources to repair this home, based in part off of the premiums that the Insureds have been paying, but instead forced the Insureds to pursue legal recourses for the money due under the contract of insurance.
The Insured has fully complied with all applicable Policy provisions requiring cooperation with the?investigation;?however, Security First 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, Security First has continued its pre-suit failures to act in good faith into litigation by delaying the prompt resolution of the claim. Security First 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, Security First has acted with only its own profit and shareholders in mind.
As a direct consequence of Security First’s failure to adjust this Loss in good faith and make any supplemental payment, the Insureds continue to be without adequate compensation for the damages sustained at the Insureds’ Property more than a year ago and has been forced to continue to live in a water damaged property.??
By stating the above detailed?facts,?it is clear that Security First 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)(d) Denying claims without conducting reasonable investigations based upon available information;
To date, Security First has acted in bad faith failed to provide sufficient coverage under the Policy to the Insureds. The Insureds’ property continues to be in disarray as the Insureds are without the funds to put their property back to its pre-loss condition. As a direct result of Security First’s underpayment of the Claim and breach of the Florida Statutes, the Insureds were forced to retain 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 Security First knowingly and intentionally, and in bad faith, delayed the settlement process in order to further disadvantage the Insureds. The financial detriment caused to the Insureds is a direct result of Security First’s reckless treatment of the claims process. The Insureds submitted all documents requested in a timely fashion, made their property available for inspection after the discovery of the loss, submitted an estimate, mitigated their damages, and satisfied all requests. However, Security First failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim.?
To deny the Insureds the benefit clearly due and owing under the Policy, for which they have time and time again been making premium payments for and after they have satisfied all of their obligations is morally and ethically reprehensible, and reeks of Unfair Claims Practice and Bad Faith. Upon information and belief, the aforementioned actions complained of, among others, were made by Security First so often?as to constitute a general business practice, evidencing a motive to enhance Security First’s profits, and designed to cause a detrimental effect to its policyholders. The above clearly depicts that Security First adjusted this claim in bad faith, continue to act in bad faith towards its Insureds, and that Security First is in direct violation of Unfair Claims Practices.??
This notice is given to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should Security First 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, Security First must: (1) Immediately tender all proceeds due and owing to the Insureds that are fairly owed to the Insureds under the insurance policy that would reasonably compensate the Insureds in order to put the loss property back to its pre-loss condition; (2) Agree to reimburse the Insureds' reasonable attorneys’ fees and costs for having to become involved to resolve the claim; and (3) Agree to reimburse the Insureds 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.
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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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