Filing Number: 798080
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| Filing Accepted: 12/23/2024 |
| Last/Business Name
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ALFREDO CUEVAS, DE LAJARA
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First Name |
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PETER, MARLENYS |
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| Street Address
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1590 LAKESIDE DR |
| City, State Zip
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BARTOW,
FL
33830
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| Email Address
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SUPER-19-12@HOTMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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ALFREDO CUEVAS, DE LAJARA |
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First Name |
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PETER, MARLENYS |
| Policy # * |
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2MR108664702 |
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Claim #* |
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00104576646 |
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Attorney is Applicable
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| Last Name* |
SULISUFAY
First Name *
LAURA
Initial
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| Street Address* |
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3411 W. FLETCHER AVE. STE B |
| City, State Zip* |
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TAMPA
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FL
33618
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| Email Address * |
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PRESUIT@SULILAW.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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AMERICAN SECURITY 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 42978 |
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| Name of individual responsible for violation (if any):*
MIKE CARSON AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, AMERICAN SECURITY INSURANCE COMPANY, WHO WAS INVOLVED IN THE CLAIM.
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Unfair Trade Practice
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Other
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Violation of Code of Ethics
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Other
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Not treating the Insured with good faith claims conduct
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Other
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Looking for ways to deny full recovery to the Insured
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Other
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Failing to properly investigate the Insured’s loss
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Other
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Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
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Other
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Not training, supervising, or managing adjusters properly so that prompt and full payments are made
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Other
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Not adjusting claims and evaluating loss properly
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Other
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Shifting the burden of insuring the loss to the Insured
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Other
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Failing to implement proper standards for the adjustment and investigation of claims
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
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| 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.
HE POLICY LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE LOSS PAYMENT AND COVERAGE PROVISIONS OF POLICY NUMBER 2MR108664702, INCLUDING THE DECLARATIONS PAGE AND ALL ENDORSEMENTS TO THE POLICY, WITH RESPECT TO COVERAGES A, B, C, AND D. ADDITIONALLY, ANY SECTIONS RELIED UPON BY THE INSURER IN ITS FAILURE TO FULLY PAY THE CLAIM, INCLUDING THE DUTIES IN THE EVENT OF LOSS PROVISIONS AND THE POLICY'S EXCLUSION OF COVERAGE PROVISIONS. THE VIOLATIONS ALLEGED ARE ALSO STATUTORILY BASED AND DO NOT RELY ON ANY SPECIFIC POLICY LANGUAGE.
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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.
American Security Insurance Company has committed the following in handling the insured’s claim:
1. Failing to act in due diligence and good faith to resolve claims
2. Placing the financial interest of the Carrier before that of the Insured
3. Looking for ways to deny benefit payments and otherwise “low ball” or “stone wall” claims.
4. Not adjusting the claims promptly and fairly
5. Not attempting in good faith to settle claims
6. Conducting Inadequate investigations
7. Failing to employ policies and procedures to conduct adequate investigations
8. Failing to provide an estimate that complies with the Florida Building Codes.
9. Shifting the burden of investigating the loss onto the Insured.
10. Misrepresenting the terms of the insurance policy.
11. Failing to provide a copy of the insurance policy within 30 days.
12. Failing to provide a loss run statement within 15 days.
Peter Alfredo Cuevas and Marlenys De Lajara are homeowners with an all-risks insurance policy issued by American Security Insurance Company (hereinafter “Carrier” ),. On or about July 17, 2024, while the policy was in full force and effect, the Insured’s property located at 1590 Lakeside Dr Bartow, FL 33830 sustained significant damage as a result of Water. The insured promptly reported the claim and fully cooperated with the carrier’s investigation. The Carrier assigned claim number 00104576646 to the loss. After reporting the claim, Carrier retained an unqualified and biased field adjuster to adjust the loss. This adjuster had a financial incentive to adjust the loss in a manner that would minimize Carrier’s losses. Instead of adjusting the claim fairly, honestly, in good faith, and with due regard for the Insured’s interest, the adjuster made a conscious effort to ignore evidence of covered losses to the property. Then in a letter dated September 30th, 2024, the carrier notified the Insured that it had completed its investigation into the loss and concluded the property does not exceed the policy deductible of $2,500.00.
Given the vastly underestimated cost of repairs, the Insured’s disagreement with the coverage decision, and the scope and nature of the damage resulting from the loss, the Insured through its retained representatives disputed the coverage determination and submitted an estimate prepared by Ask An Adjuster for $9, 714.53 which was a fair and reasonable assessment of the loss.
Worst still, Carrier failed to retain qualified experts necessary to identify the repairs necessary to restore the property to its pre-loss condition within a reasonable time.
Under the circumstances surrounding this claim, had Carrier acted fairly and honestly toward the Insured and with due regard for the Insured’s interests, Carrier could and should have attempted in good faith to settle this claim. Carrier did not and, instead, dishonestly and unfairly placed its own interests well ahead of those of the Insured. In doing so, Carrier violated Section 624.155(1)(b)(1), Florida Statutes.
Carrier’s use of unqualified and bias adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition evidence Carrier’s failure to adopt and implement standards for the proper investigation of claims in violation of Section 626.9541(1)(i)(3)(a), Florida Statutes.
Carrier’s use of unqualified and bias adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to conduct a reasonable investigation based upon available information.
When applying the facts present here to Florida law, it is clear that Carrier is acting in bad faith. Florida Statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit based on determinable contingencies. Inherent is the fact that payment must be 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. Carrier has breached this duty by refusing to properly and timely adjust the loss.
Moreover, Section 69B-220.201 of the Florida Administrative Code defines Carrier’s adjusters conduct here as an unfair claims settlement practice. Specifically, Section 69B-220.201(3) provides that “[a]n adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured” and that “[a]n adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.” As detailed above, Carrier’s investigation and adjustment of this claim was done in a manner prejudicial to Insured, was incomplete, and lacked truthful and unbiased reports of the facts.
Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. However, when the Insurer conducted its inspection of the insured property, the Insurer’s representatives failed to conduct a thorough and adequate investigation, or the representatives intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss.
The conduct outlined above is done within the Insurer’s routine course of the business.
There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer’s claim file and standards and procedures for the adjustment and investigation of claims.
In short, the Insurer is not acting with due regard for the Insured’s interests or safety. In Florida, the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully denied full coverage for the claim. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer’s actions and inactions have continued to frustrate and delay the resolution of the Insured claim.
The Insurer’s actions amount to but are not limited to the following:
1. Claim Delay: The Carrier has delayed processing the claim, causing frustration and inconvenience to the Insured.
2. Lack of Good Faith Conduct: The Carrier has not treated the Insured with good faith conduct expected when handling claims.
3. Attempt to Reduce Recovery: The Carrier has actively sought ways to minimize the amount owed to the Insured under the policy.
4. Attempt to Deny Recovery: The Carrier has looked for reasons to deny coverage altogether, rather than fulfill its obligations under the policy.
5. Failure to Property Evaluate Loss: Claims have not been assessed accurately or promptly, resulting in delays and incomplete indemnity for the Insured.
6. Inadequate Training and Supervision of Adjusters: The Carrier has not ensured its adjusters are adequately trained to handle claims promptly and fairly.
7. Placing Company Interests over Insured Interests: The Carrier has prioritized its financial interests over the health and safety of the Insured.
8. Failure to Provide Complaint Estimates: Estimates provided by the Carrier do not comply with Florida Building Codes.
9. Shifting Investigation Burden to Insured: The Carrier has unfairly placed the burden of investigating the claim onto the Insured.
10. Conducting Inadequate Investigations: The Carrier’s Investigation into the claim has been insufficient or cursory.
Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must:
1. Admit full coverage for the Insured’s loss and tender all additional amounts owed under the Policy for the covered loss to the insured property.
Please email any responses to this civil remedy notice to presuit@sulilaw.com
A copy of this form submitted to the FDFS has been sent via email to the following parties, providing them notice of the filing of the civil remedy notice:
• American Security Insurance Company via DFS Filing
• Claims Department, American Security Insurance Company, via email; myclaiminfo@assurant.com
• Peter Alfredo Cuevas and Marlenys De Lajara via email super-19-12@hotmail.com
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The submitter hereby states that this notice is given in order to perfect the rights of the
person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.
Before submitting a Notice using this system, please verify that all text has been entered
correctly and completely. Once the Notice has been submitted, the text cannot be changed
or deleted.
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DFS-10-363
Rev. 10/14/2008
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