Filing Number: 797589
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| Filing Accepted: 12/19/2024 |
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RICHARDS
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First Name |
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ALEXIS |
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1600 UNIVERSITY LN. APT. 1504 |
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COCOA,
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32922
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LEXI0195@GMAIL.COM |
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Insured |
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| Last/Business Name* |
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RICHARDS |
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First Name |
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ALEXIS |
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79-EB-P146-5 |
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Claim #* |
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59-60N0-63D |
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Attorney is Applicable
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DUNNAVANT
First Name *
ERIN
Initial
E
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| Street Address* |
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901 W. SWANN AVE. |
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TAMPA
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FL
33606
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SERVICE@DANDDLAW.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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STATE FARM FLORIDA INSURANCE COMPANY
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NAIC Company Code 10739 |
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| Name of individual responsible for violation (if any):*
CLAIMS DEPARTMENT, SUPERVISORS, MANAGEMENT, AGENTS, AND ADJUSTERS, INCLUDING THE FOLLOWING REPRESENTATIVE & ADJUSTER(S) AND VENDORS SPECIFICALLY: WENDY APPLE
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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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Unfair Trade Practice
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Other
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Violation of Code of Ethics
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Other
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Litigation Strategy and Behavior
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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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| 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)(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.
The Insured does not have a certified copy of her insurance policy. However, she believes the following provisions may be applicable:
SECTION I – PROPERTY COVERAGES AND LIMITS
Coverage Limit of Liability
B Personal Property $ 20,000
C Loss of Use $ 8,000
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Personal Property Coverage
Limit of Insurance: $20,000 Loss Settlement Basis: Replacement Cost
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Checklist of Coverage (continued)
The Limit of Insurance, Deductibles, and Loss Settlement Basis apply to the following perils insured against:
(Items below marked Y (Yes) indicate coverage IS included, those marked N (No) indicate coverage is NOT included.)
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Y Accidental Discharge or Overflow of Water or Steam
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Coverage Limit of Insurance
Y Additional Living Expense $8,000
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SECTION I – PROPERTY COVERAGES
COVERAGE B – PERSONAL PROPERTY is replaced by the following:
1. Property Covered. We cover personal property owned or used by an insured while it is contained within the principal building. Personal property does not include structures whether or not attached to or otherwise forming a part of the realty.
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COVERAGE C – LOSS OF USE is replaced by the following:
Additional Living Expense. When a loss caused by a peril described in SECTION I – LOSSES INSURED causes the principal building to become uninhabitable, we will pay the reasonable and necessary increase in cost incurred by an insured to maintain their standard of living for up to 24 months. Our payment is limited to incurred costs for the shortest of:
a. the time required to repair or replace the principal building;
b. the time required for household to settle elsewhere; or
c. 24 months.
This period of time is not limited by the expiration of this policy.
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SECTION I – LOSSES INSURED
COVERAGE B – PERSONAL PROPERTY
We will pay for accidental direct physical loss to the property described in Coverage B caused by the following perils, unless the loss is excluded or limited in SECTION I – LOSSES NOT INSURED or otherwise excluded or limited in this policy. However, loss does not include and we will not pay for, any diminution in value.
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12. Abrupt and accidental discharge or overflow of water, steam or sewage from within a plumbing, heating, air conditioning, or automatic fire protective sprinkler system, or from within a household appliance.
In addition, State Farm has cited to the following policy language as being pertinent in its correspondence sent to the Insured on or about December 18, 2023:
DEFINITIONS
We define the following words and phrases for use throughout this policy. These definitions apply to the singular, plural, and possessive forms of these words and phrases. Defined words and phrases are printed in bold italics.
8. “fungus” means any type or form of fungus, including mold, mildew, mycotoxins, spores, scents, or byproducts produced or released by fungi.
SECTION I – PROPERTY COVERAGES
COVERAGE C – LOSS OF USE
The most we will pay for the sum of all losses combined under Additional Living Expense, Fair Rental Value, and Prohibited Use is the limit of liability shown in the Declarations for Coverage C – Loss of Use.
1. Additional Living Expense. When a loss caused by a peril described in SECTION I – LOSSES INSURED causes the residence premises to become uninhabitable, we will pay the reasonable and necessary increase in cost incurred by an insured to maintain their normal standard of living for up to 24 months. Our payment is limited to incurred costs for the shortest of:
a. The time required to repair or replace the premises;
b. The time required for your household to settle elsewhere; or
c. 24 months.
This period of time is not limited by the expiration of this policy.
We will not pay more than the limit of liability shown in the Declarations for Coverage C – Loss of Use. If any normal expenses are reduced or discontinued due to a loss insured, we will subtract the amount by which the expenses were reduced from any amount owed.
We will not pay for loss or expense due to cancellation of a lease or agreement.
SECTION I – LOSSES INSURED
COVERAGE B – PERSONAL PROPERTY
We will pay for accidental direct physical loss to the property described in Coverage B caused by the following perils, unless the loss is excluded or limited in SECTION I – LOSSES NOT INSURED or otherwise excluded or limited in this policy. However, loss does not include and we will not pay for, any diminution in value.
1. Fire or lightning.
2. Windstorm or hail. This peril does not include loss to property contained in a structure
caused by rain, snow, sleet, sand, or dust. This limitation does not apply when the direct force of wind or hail damages the structure causing an opening in a roof or wall and the rain, snow, sleet, sand, or dust enters through this opening.
This peril includes loss to watercraft of all types and their trailers, furnishings, equipment, and outboard motors, only while inside a building structure.
3. Explosion.
4. Riot or civil commotion.
5. Aircraft, including self-propelled missiles and spacecraft.
6. Vehicles, meaning accidental direct physical loss to covered property caused by the weight, force, power, or movement of a vehicle.
a. This includes:
(1) the impact of a vehicle;
(2) an object propelled from the tire or body of a vehicle;
(3) the upset or collision of a vehicle with a stationary object or other vehicle, including
damage to personal property carried on the exterior of the vehicle; or
(4) a vehicle door or trunk lid being closed on personal property.
b. This peril does not include loss:
1) to personal property that falls off a vehicle and strikes the ground, any other surface,
or any object;
(2) caused by shifting of the load being carried in or on a vehicle; or
(3) to the vehicle itself unless the vehicle is property covered under COVERAGE B –
PERSONAL PROPERTY and the loss is caused by the weight, force, power, or movement of another vehicle.
7. Smoke, meaning abrupt and accidental damage from smoke.
This peril does not include loss caused by smoke from agricultural smudging or industrial
operations.
8. Vandalism or malicious mischief, meaning only willful and malicious damage to or
destruction of property.
9. Theft, including attempted theft and loss of property from a known location when it is probable that the property has been stolen.
This peril does not include:
a. loss of a precious or semi-precious stone from its setting;
b. loss caused by theft:
(1) committed by an insured or by any other person regularly residing on the insured location. Property of a student who is an insured is covered while located at a residence away from the residence premises, if the theft is committed by a person who is not an insured;
(2) in or to a dwelling under construction or of materials and supplies for use in the
construction until the dwelling is completed and occupied; or
(3) from the part of a residence premises rented to others:
(a) caused by a tenant, members of the tenant’s household, or the tenant’s employees
unless the residence premises is rented, either completely or in part, for exclusive
use as a residence, for no more than 30 nights in the 12-month period prior to the
date of the loss;
(b) of money, bank notes, bullion, gold, goldware, silver, silverware, pewterware,
platinum, coins, and medals;
(c) of securities, checks, cashiers checks, travelers checks, money orders, gift
certificates, gift cards, rechargeable debit cards, phone cards, and other negotiable
instruments, accounts, deeds, evidences of debt, letters of credit, notes other than
bank notes, manuscripts, passports, tickets, and stamps; or
(d) of jewelry, watches, fur garments and garments trimmed with fur, and precious and
semi-precious stones; or
c. loss caused by theft that occurs away from the residence premises of:
(1) property while at any other residence owned, rented to, or occupied by an insured, except while an insured is temporarily residing there. Property of a student who is an insured is covered while at a residence away from the residence premises;
(2) watercraft of all types, including their furnishings, equipment, and outboard motors; or
(3) trailers and campers designed to be pulled by or carried on a vehicle.
If the residence premises is a newly acquired principal residence, property in the immediate past principal residence will not be considered property away from the residence premises for the first 30 days after the inception of this policy.
10. Falling objects. This peril does not include loss to property contained in a structure unless the roof or an exterior wall of the structure is first damaged by a falling object. Damage to the falling object itself is not included.
11. Weight of ice, snow, or sleet that causes damage to property contained in a structure.
12. Abrupt and accidental discharge or overflow of water, steam, or sewage from within a plumbing, heating, air conditioning, or automatic fire protective sprinkler system, or from within a household appliance.
This peril does not include loss:
a. to the system or appliance from which the water, steam, or sewage escaped;
b. caused by or resulting from:
(1) freezing, except as provided in SECTION I – LOSSES INSURED, Item 14. Freezing;
(2) water or sewage from outside the residence premises plumbing system that enters through sewers or drains, or water that enters into and overflows from within a sump pump, sump pump well, or any other system designed to remove subsurface water that is drained from the foundation area; or
(3) the pressure from or presence of tree, shrub, or plant roots; or
c. that occurs or develops over a period of time and is caused by or resulting from:
(1) condensation or the presence of humidity, moisture, or vapor; or
(2) seepage or leakage of water, steam, or sewage that is:
(a) continuous;
(b) repeating;
(c) gradual;
(d) intermittent;
(e) slow; or
(f) trickling.
13. Abrupt and accidental tearing asunder, cracking, burning, or bulging of a steam or hot water heating system, an air conditioning system, an automatic fire protective sprinkler system, or an appliance for heating water.
This peril does not include loss:
a. caused by or resulting from freezing; or
b. that occurs or develops over a period of time and is caused by or resulting from:
(1) condensation or the presence of humidity, moisture, or vapor; or
(2) seepage or leakage of water or steam that is:
(a) continuous;
(b) repeating;
(c) gradual;
(d) intermittent;
(e) slow; or
(f) trickling.
14. Freezing of a plumbing, heating, air conditioning, or automatic fire protective sprinkler system, or of a household appliance.
This peril does not include:
a. loss to a portable hot tub or portable spa unless you have used reasonable care to prevent freezing; or
b. loss on the residence premises unless you have used reasonable care to:
(1) maintain heat in the building structure at 55 degrees Fahrenheit or higher; or
(2) shut off the water supply and drain the system and appliances of water.
However, if the building structure is protected by an automatic fire protective sprinkler system, you must use reasonable care to continue the water supply and maintain heat in the building structure at 55 degrees Fahrenheit or higher for coverage to apply.
15. Abrupt and accidental damage to electrical appliances, devices, fixtures, and wiring from an increase or decrease of artificially generated electrical current. We will pay up to $3,000 under this peril for each damaged item described above.
16. Breakage of glass, meaning damage to personal property caused by breakage of glass that is a part of a structure on the residence premises. We will not pay for loss or damage to the glass.
17. Wild bears or deer, meaning damage caused by wild bears or deer to property located in a building structure.
18. Breakage of glass or safety glazing material that is part of a building, storm door, or storm window and is covered under SECTION I – ADDITIONAL COVERAGES, Building Additions and Alterations.
This peril does not include loss on the residence premises if the dwelling is a vacant
dwelling.
19. Sinkhole collapse, meaning settlement or collapse of the earth resulting from subterranean voids created by dissolution of limestone or dolostone by groundwater, or by subsidence as these strata are dissolved. We do not insure against loss caused by abandonment of the property covered.
SECTION I – LOSSES NOT INSURED
1. We will not pay for, under any part of this policy, any loss that would not have occurred in the absence of one or more of the following excluded events. We will not pay for such loss regardless of: (a) the cause of the excluded event; or (b) other causes of the loss; or (c) whether other causes acted concurrently or in any sequence with the excluded event to produce the loss; or (d) whether the event occurs abruptly or gradually, involves isolated or widespread damage, occurs on or off the residence premises, arises from any natural or external forces, or occurs as a result of any combination of these:
a. Ordinance or Law, meaning enforcement of any ordinance or law regulating the
construction, repair, or demolition of a building structure or other structure.
g. Fungus, including:
(1) any loss of use or delay in rebuilding, repairing, or replacing covered property, including any associated cost or expense, due to interference at the residence premises or location of the rebuilding, repair, or replacement, by fungus;
(2) any remediation of fungus, including the cost to:
(a) remove the fungus from covered property or to repair, restore, or replace that property; or
(b) tear out and replace any part of the building structure or other property as needed to gain access to the fungus; or
(3) the cost of any testing or monitoring of air or property to confirm the type, absence, presence, or level of fungus, whether performed prior to, during, or after removal, repair, restoration, or replacement of covered property.
2. We will not pay for, under any part of this policy, any loss consisting of one or more of the items below. Further, we will not pay for any loss described in paragraph 1. immediately above regardless of whether one or more of the following: (a) directly or indirectly cause, contribute to, or aggravate the loss; or (b) occur before, at the same time, or after the loss or any other cause of the loss:
a. conduct, act, failure to act, or decision of any person, group, organization, or governmental body whether intentional, wrongful, negligent, or without fault;
b. defect, weakness, inadequacy, fault, or unsoundness in:
(1) planning, zoning, development, surveying, or siting;
(2) design, specifications, workmanship, repair, construction, renovation, remodeling,
grading, or compaction;
(3) materials used in repair, construction, renovation, remodeling, grading, or compaction;
or
(4) maintenance;
of any property (including land, structures, or improvements of any kind) whether on or off the residence premises; or
c. weather conditions.
However, we will pay for any resulting loss from items 2.a., 2.b., and 2.c. unless the resulting loss is itself a Loss Not Insured as described in this Section.
SECTION I – CONDITIONS
6. Suit Against Us. No action will be brought against us unless there has been full compliance with the policy provisions. Any action by any party must be started within five years after the date of loss or damage.
RENTERS AMENDATORY ENDORSEMENT (Florida)
This endorsement modifies insurance provided under the following: RENTERS POLICY
SECTION I – CONDITIONS
Suit Against Us is replaced by the following:
Suit Against Us. No action will be brought against us unless there has been full compliance with the policy provisions. Any action by any party must be started within five years after the date of loss or damage. The insured must provide the Department of Financial Services with written notice of intent to initiate legal action at least 10 business days before filing any legal action against us in accordance with 627.70152 of Florida Statutes.
The foregoing policy provisions are in addition to the statutory violations cited herein.
VIII. TO ENABLE THE INSURER TO INVESTIGATE AND RESOLVE YOUR CLAIM, DESCRIBE THE FACTS AND CIRCUMSTANCES GIVING RISE TO THE INSURER'S VIOLATION AS YOU UNDERSTAND THEM AT THIS TIME.
In addition of the above statutory provisions alleged to have been violated, see also the following additional statutes and rules violated by Florida Peninsula:
624.155(1)(a)1 Any person may bring a civil action against an insurer when such person is damaged: (a) by violation of any of the following provisions by the insurer: (1) Section 626.9541(1)(i), (o), or (x)
69B-220.201(3)(b)(2) An adjuster shall adjust all claims strictly in accordance with the Insurance contract.
69B-220.201(3)(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
69B-220.201(3)(d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.
626.877 Every adjuster shall adjust or investigate every claim, damage, or loss made or occurring under an insurance contract, in accordance with the terms and conditions of the contract and of the applicable laws of this state.
626.878 An adjuster shall subscribe to the code of ethics specified in the rules of the department. The rules shall implement the provisions of this part and specify the terms and conditions of contracts, including a right to cancel, and require practices necessary to ensure fair dealing, prohibit conflicts of interest, and ensure preservation of the rights of the claimant to participate in the adjustment of claims.
624.155(5) No punitive damages shall be awarded under this section unless the acts giving rise to the violation occur with such frequency as to indicate a general business practice and these acts are:
(a) Willful, wanton and malicious;
(b) In reckless disregard for the rights of any insured; or
(c) In reckless disregard for the rights of a beneficiary under a life insurance contract.
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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 Property located 1600 University Ln., Apt. 1504, Cocoa, FL 32922-6556, (“the Insured Property”) previously leased to Alexis Richards (“the Insured”) sustained damage resulting from water on or about November 28, 2023. The Insured promptly reported the loss to her property insurer, State Farm Florida Insurance Company (“State Farm”). State Farm’s administrative and home address is 215 S. Monroe Street, Tallahassee, FL 32301 and its mailing address is 3903 Northdale Blvd., Ste. 112W, Tampa, FL 33624.
The Insured Property suffered a water loss resulting from an AC unit leak. The Insured reported the issue to her landlord’s property manager. A mitigation company “dried out” the water loss but her personal property was damaged as a result thereof.
The water loss consequently resulted in mold/microbial growth throughout the unit. The Insured reported this additional issue to the property manager and requested they send someone out to inspect the same. On or about December 10, 2023, she sent a follow-up email to the property manager about sending someone out to inspect the issues.
On December 12, 2023, a “technician” was sent out by the property management company. Based on this inspection, the technician determined that it was appropriate to have a general contractor inspect the Insured Property. The contractor from Y&A Building Maintenance Inc., inspected the Insured Property on December 13, 2023. This contractor determined that there was a “presence of mildew, moisture, and moldy areas in some parts of the unit…” He further concluded that “extensive work” in the unit would be required.
As a result, the Landlord rescinded the lease agreement with the Insured in order to “avoid a health hazard to occupants” and citing to the “TERMINATION OF TENANCY: OWNER OR AGENT/MANAGER” provision of the lease which states in pertinent part that the “TENANT(s) agree to vacate the premises in the event OWNER or AGENT in its sole judgment feels that either there is mold or mildew present in the dwelling unit which may pose a safety or health hazard to TENANT(s) or other persons…”
Consequently, the Insured was required to move out of the premises and incur unnecessary relocation expenses due to the uninhabitable nature of the Insured Property.
On or about December 14, 2023, the Insured reported the loss to State Farm as to her water-damaged personal property and her incurred additional living expenses. State Farm assigned claim number 59-60N0-63D and claim specialist, Wendy Apple, to the Insured’s claim.
On or about December 18, 2023, State Farm (through Ms. Apple) sent a wrongful denial of coverage letter to its Insured. The adjuster advised in the letter that “No coverage is provided [for] losses resulting from ordinance or law, mold or fungus, failure to act by any entity, defective design or materials, maintenance, or weather conditions. Due to these provisions, we are unable to cover alternate housing due to the presence of mold in your unit and the landlord’s termination of your tenancy at the property.”
However, this is a misrepresentation by Ms. Apple as the policy does, indeed, cover for loss resulting from “Abrupt and accidental discharge or overflow of water … from within a … heating, air conditioning … appliance.” A water leak from the dwelling’s AC Unit was the original source of the loss. As such, the Insured’s water-damaged personal property and her incurred Additional Living Expenses should have been covered by State Farm.
The concept of insurance is that it is the insurer's granting of timely and prompt indemnity or security against a contingent loss. Fla. Stat. § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow specified amounts or a determinable benefit upon determinable contingencies. Inherent is the fact that payment is made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. State Farm has failed to comply with its duty to indemnify the Insured.
State Farm has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s claim for damages, resulting in a wrongful denial of coverage. Based on that denial, State Farm refuses to pay insurance proceeds owed to the Insured as required by the policy and law. Refusal and/or failure to settle the Insured’s claim when under all the circumstances it could have and should have done so had it acted fairly and honestly towards the Insured is wrong.
This is proof that State Farm has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s claim for damages, and as a result, incorrectly denied coverage.
The Insured Property was damaged by a covered loss. The Insured timely reported the damage to State Farm, then the company incorrectly denied the claim. This is a breach of the contract by State Farm as to the insurance policy between it and the Insured. State Farm did not follow through with its obligations under said contract by failing to pay the claim and as a result, the Insured has come out of pocket when these amounts should have been indemnified by State Farm.
The actions taken by State Farm in the handling and adjustment of the Insured’s claim were willful, wanton, and in disregard for the rights of its Insured and occur with such a frequency as to indicate a general business practice, and further, are in violation of Florida Statutes § 624.155 and § 626.9541.
Based on the foregoing actions and omissions, State Farm has engaged in wrongful claims handling conduct, including but not limited to, the following:
1. Improper claim delay.
2. Improper claim denial.
3. Not conducting a full and fair investigation of the Insured’s claim.
4. Looking for ways to delay recovery to the Insured.
5. Looking for ways to deny recovery to the Insured.
6. Not adjusting the claim and not evaluating the loss properly, promptly, and fairly so as to provide full and prompt indemnity to its Insured.
7. Failing to implement proper standards for the adjustment and investigation of insurance claims.
8. Making misrepresentations to the insured about the cause of damages.
9. Making misrepresentations to the insured about the existence of coverage.
10. Making misrepresentations about facts.
11. Not training, supervising, or managing adjusters and independent contractors properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholders’ interests by attempting to deny or minimize payments owed.
12. Establishing severity control initiatives and otherwise establishing a culture of not fully and promptly paying claims following losses.
13. Ignoring submitted claim information and documentation from the Insured.
Therefore, to cure the defects outlined in this Civil Remedy Notice, State Farm must:
Tender the full amount of insurance monies owed to the Insured for damages resulting from the Insured’s covered water loss.
A copy of this form has been submitted to the FDFS and has been printed out and mailed to the following parties providing them notice of the filing of the Civil Remedy Notice:
State Farm Florida Insurance Company, via Certified Mail, R.R.R.
Wendy Apple, State Farm Florida Insurance Company, via Certified Mail, R.R.R.
Claims Department, State Farm Florida Insurance Company, via U.S. Mail.
Alexis Richards, via email.
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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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