Filing Number: 802998
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| Filing Accepted: 1/23/2025 |
| Last/Business Name
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RUPERT
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First Name |
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MELCHIZEDEK |
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| Street Address
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8810 SW 13TH STREET |
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PEMBROKE PINES,,
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33025
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| Email Address
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MPEDRAZA@PEDRAZALAW.NET |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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RUPERT |
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First Name |
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MELCHIZEDEK |
| Policy # * |
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2MR07441605388 |
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Claim #* |
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00104122402 |
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Attorney is Applicable
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| Last Name* |
PEDRAZA
First Name *
MALCOLM
Initial
R
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| Street Address* |
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200 S. ANDREWS AVE., SUITE 504 |
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FT. LAUDERDALE
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FLORIDA
33301
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| Email Address * |
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MPEDRAZA@PEDRAZALAW.NET |
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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):*
WOODY DORLEAN AND TAYLOR ERDEMAN
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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 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)(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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| 626.9541(1)(i)(3)(e) |
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Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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| 626.9541(1)(i)(4) |
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Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
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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.
Florida Admin Code:
69B-220.201(3)(b) An adjuster shall treat all claimants equally.
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)(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.
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.
69B-220.201(3)(k) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise.
69J-166.031 Selectively and detrimentally choosing which alternative dispute resolution to utilize.
Governed by the cited authorities, the subject policy provides coverage for sudden and accidental losses and damages arising from the direct physical loss to a plumbing system and the ensuing damages resulting therefrom. The loss payment provision and governing law provides that the insurer has a fiduciary duty to in good faith promptly investigate, adjust, and issue payment of the undisputed amount of the loss and damages and once reasonable proof of same has been provided. Furthermore, the policy provides coverage for, inter alia, assessments in relation to remediation, as well as the amount necessary to perform remediation.
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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, MELCHIZEDEK RUPERT (collectively referred to as “Complainant”), maintained a homeowner’s policy of insurance (“Policy”) with AMERICAN SECURITY INSURANCE COMPANY (“INSURER”) which provided coverage for the insured’s sudden and accidental damages associated with the direct physical loss to a plumbing system which occurred on or about July 10, 2023 and resulted in ensuing water damages and losses (“Loss”). The Complainant submitted an estimate in the amount of $30,025.48. The Loss 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 payment for claims has caused the Complainant /Insured 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. Due to the INSURER’S bad faith general business practices as set forth above and further detailed below, the INSURER grossly undervalued the scope and value of damages for the covered loss, tendering payment on or about August 22, 2023 in the amount of $4,217.78.
1. INSURER adjusts, investigates and issues payment on thousands of water loss claims per year, and notwithstanding its specialized knowledge and fiduciary duty to its insureds, it has failed to institute the necessary policies, procedures, guidelines, protocol, personnel and contingencies in relation to fully, promptly and equitably indemnifying its insureds who sustain a loss and damages due to a water loss that can in days create various health hazards for its insureds.
2. Consequently, insured such as the Complainant are forced to: fend for themselves to mitigate damages arising from INSURER’s Bad Faith; incur out of pocket expenses 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; subjects the insured to health risk and hazards associated with the development, presence and proliferation of moisture, toxic conditions and/or mold due to INSURER’s failure to perform pursuant to the Policy; the Insured has be placed in situation where they have to incur the costs associated with hiring experts/professionals/counsel to force INSURER to abide by their fiduciary duty and avoid the consequential damages associated with the INSURER’s failure to perform pursuant to the Policy and/or governing Florida Law; etc.
3. If not acting with a reckless disregard for the interests of its insureds, INSURER knows (“knows” as used herein includes knowledge that would have existed if not acting with a reckless disregard for the truth) that water damages are of a nature that a thorough, nuanced and specialized investigation/adjustment of the claim needs to be promptly performed by qualified and prepared personnel to protect its insureds, satisfy its 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 its financial interests, INSURER disregards the obvious and known obligations by way of the Bad Faith general business practices that are further delineated, described and specified as follows:
(a.) Not developing, maintaining and/or instituting policies, procedures, protocol or guidelines to determine whether adjusters/personnel/vendors utilized to protect its insureds were even qualified and trained to duly assess the scope, cause and/or value of the loss;
(b.) By way of the cited legal authorities and considerations, INSURER knows that in order to duly adjust, investigate and issue payment for a water loss it needs to retain vendors that: are licensed and qualified to perform necessary mold assessments, and then institute a mold remediation protocol in order to develop the necessary predicate for establishing the true scope and value of the loss; are certified and qualified to perform necessary moisture assessments, and then institute a reasonable moisture remediation protocol to develop the necessary predicate to secure the true scope and value of the loss; licensed and qualified to adjust the scope, cause and/or value of the loss per reliable principles and methods, and only after, the necessary underlying considerations of the reasonable and necessary moisture assessment and/or mold remediation protocols are considered; licensed and qualified to assess the cause of the plumbing system failure and the necessary scope and value of the repair; etc.;
(c.) Although INSURER will arbitrarily and without fixed protocol hire 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 for self-gain when they know that doing so will serve to increase the amount to be paid on a per claim basis;
(d.) By way of the cited legal authorities and considerations, INSURER knows 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 its insureds. Like the other duties and actions described herein, such practice is a basic, inexpensive, efficient and industry wide accepted means of protecting its insureds, however, INSURER knows that it does not serve its financial interest since it will increase its financial obligations to insureds such as the Complainant;
(e.) By way of the cited legal authorities and considerations, INSURER knows 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, or for that matter, secondary cause of losses that may exist and thereby extend the loss and damages to be claimed by insureds such as the Complainant;
(f.) By way of the cited legal authorities and considerations, INSURER knows that it would be in their insureds’ interests and their obligation under the insurance policy to utilize personnel/vendors to perform detailed, thorough, reliable and qualified assessments of the materials within the home which were exposed to moisture and subject to losing their structural integrity and/or developing toxic conditions;
(g.) By way of the cited legal authorities and considerations, INSURER knows that it would be in their insureds’ interests and their obligation under the insurance policy to adjust and issue payment of the claim in consideration of an authoritative source such as the Institute of Inspection Cleaning and Restoration Certification, which dictates, amongst other things, the form and means upon which damages in relation to a water loss are to be duly assessed and repaired even if the conditions at issue may not be visible. The INSURER instead chooses to ignore the fact that water damages by nature are not readily visible, and thereby, acting in the best interest of its insureds payments need to be issued in accordance with said understanding and the fact that damages need to be presumed to exist when certain areas/materials are exposed to moisture;
(h.) By way of the cited legal authorities and considerations, INSURER knows that it would be in their insureds’ interests and their obligation under the insurance policy to promptly adjust and issue unencumbered payment for professional/qualified moisture assessments and remediation 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 health risks that may develop; deterring insureds from performing necessary remedial measures to protect their home; etc.;
(i.) By way of the cited legal authorities and considerations, INSURER knows that it would be in their insureds’ interests and their obligation under the insurance policy to promptly adjust and issue unencumbered payment for professional/qualified/licensed mold assessments and mold remediation 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 health risks that may develop; deterring insureds from performing necessary remedial measures to protect their home; etc.;
(j.) By way of the cited legal authorities and considerations, INSURER knew that it would be in their insureds’ interests and its obligation under the insurance policy to test for bacterial contaminants associated with the plumbing loss in order to honestly determine the true scope and value of damages and/or the loss;
(k.) By way of the cited legal authorities and considerations, INSURER knows that it would be in its insureds’ interests and its obligation under the insurance policy to carefully consider all policy terms that afford coverage for direct physical loss to the plumbing system, ensuing damages and remedial measures, and thereafter utilize counsel when an adjuster is in doubt to honestly advise insureds on a claim by claim basis whether in fact they are duly indemnifying their insureds as a matter of law. Such practice is a basic, inexpensive, efficient and industry wide accepted means of protecting their insureds by maintain a consistent and fair approach, however, INSURER knows that it does not serve their financial interest since it will increase its financial obligations to insureds such as the Complainant;
(l.) By way of the cited legal authorities and considerations, INSURER knows that it would be in the insureds’ interests and its obligation under the insurance policy to fully establish the true scope and value of the loss, and then, 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. Based on historical and voluminous examples, the 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 practice allows the 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 into choosing whether to leave their home in state of disrepair, or alternatively, searching for a handyman 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;
(m.) By way of the cited legal authorities and considerations, INSURER knows that it would be in its insureds’ interest and its 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 insureds’ reasonable need to utilize a general contractor; taxes associated with the repairs; permit costs associated with the repair; base service charges for costs associated with various licensed trades that will be needed to effectuate the repairs; whether benefits are subject to being 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, walls, ceilings, etc.;
(n.) By way of the cited legal authorities and considerations, INSURER knows that it has an obligation to ensure that software programs, data bases and adjusting practices utilized to estimate the scope and value of the loss are being utilized in form that: honestly and fully delineates the line item repairs or costs related to the claim; pricing corresponds with licensed professionals - as opposed to handyman or non-licensed professionals; accounts for consideration of actual expenditures incurred by the insureds and/or are otherwise compensable expenses on a repair cost basis; etc. Ultimately, the INSURER knows that the adjusting practices are guided to unlawfully depriving its insureds of benefits owed under the insurance policy, which in the aggregate, serves to maximize its profits to the detriment of insureds such as the Complainant;
(o.) By way of the cited legal authorities and considerations, INSURER knows 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 insurance policy, 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 the INSURER disregarded said duty, it knows that it serves its financial interest by ultimately deterring a large volume of insureds from lawfully obtaining benefits that would be owed if the claim was adjusted in strict consideration of the insurance policy;
(p.) By way of the cited legal authorities and considerations, INSURER knows that it has an obligation to treat all insureds equally and honestly. However, and for financial gain, it will only start to fully and fairly consider its legal obligations as stated herein if the insured retains legal representation and/or pursues a legal action which exposes them to liabilities and costs associated with, inter alia, Fla. Stat. Secs. 627.428, 54.071 and 624.155. Even then, they will withhold undisputed monies owed in an unjust effort to limit/delay their liabilities in relation to the referenced statutory considerations and otherwise;
(q.) 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 adjust, issue payment for amounts owed and not otherwise engage in the Bad Faith conduct that is the subject of this Complaint. However, and to advance its own financial interest and avoid the liabilities pursuant to the above cited statutory authorities, they will direct and utilize non-qualified counsel (due to a high volume case load, unfair litigation guidelines and limitations, lack of expertise in the area of law, etc.) to delay the equitable and prompt payment of the claim via formulaic litigation tactics and otherwise not implementing policies, procedures and/or guidelines to ensure that their duties are fulfilled during the course of litigation. Moreover, they will insist upon the insureds to fulfill its own obligations by imposing upon them the burden to establish the basis for full entitlement to benefits for which they know, or should know if not acting with a reckless disregard for the insureds’ interests, are owed or subject to further assessments and considerations for the reasons set forth herein;
(r.) By way of the cited legal authorities and considerations, INSURER knows that it needs to assess the application of the policy deductible on a case by case basis and only after the claim is fully adjusted, investigated and considered per the terms of the insurance policy. For example, any claims associated with losses that are capped (i.e. reductions/caps for mold and additional coverages for remedial work to protect the property) or subject to reduction (i.e. ACV reductions) per the policy, are to be applied in full to the deductible. This adjusting practice is necessary to protect the interests of the insureds such as the Complainant, since pursuant to binding precedent, the policy deductible is subject to being fully absorbed by the total amount of the losses and/or damages that are capped or subject to reductions. In the aggregate, the INSURER knows that these type of adjusting practices serve to deprive its insureds of millions of dollars in benefits;
(s.) By way of the cited legal authorities and considerations, INSURER knows that it has duty to duly assess whether benefits are owed to the insured in relation to the costs associated with removing and resetting personal property in relation to repairs and/or remediation work that needs to be performed. This duty is ignored by the INSURER to maximize its own financial interests. Further, the INSURER has a duty to assess whether the personal property has been contaminated by way of toxic conditions that developed due to the loss and consequential damages that may arise over the course of time and even after the initial adjustment and/or payment of the claim;
(t.) 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 insureds such as the Complainant, it foregoes and/or delays such considerations to maximize its financial interests;
(u.) Although from the onset of the Loss INSURER will have no good faith and/or reliable basis to deny coverage in part and/or in whole for a losses and damages, it will capriciously and arbitrarily delay notifying the insured that coverage is subject to being accepted, and/or otherwise delay performing, in order to: maximize its financial interests; unlawfully and deceptively withhold monies for its own use; utilize policy conditions as a shield in litigation and/or to otherwise deceptively delay payment of the claim and/or induce a reduce settlement; utilize policy conditions at a later date to further delay payment when the insured demands performance under the insurance policy; and/or so as to otherwise implement a deceptive and immoral scheme to deprive insureds of benefits the are immediately owed under the policy once reasonable proof of the claim has been provided;
(v.) Although the 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/caps for certain coverages; 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 in part and/or in whole; 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, deceptive, unlawful and unfair means of adjusting, investigating and paying claims;
(w.) INSURER knows that once the claim is fully and fairly investigated and adjusted, it then needs 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 generally avoided by the INSURER by engaging in the Bad Faith conduct described herein;
(x.) INSURER knows that once the claim is fully and fairly investigated, it then needs to determine whether certain benefits are owed to the insured for the cost of engineering or architectural fees 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;
(y.) INSURER’s Bad Faith conduct as described places the insured in a position of having to unnecessarily incur expert fees, litigation costs and attorneys’ 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 experts to retain a designated/pre-disposed (due to financial biases and/or limited information provided) experts to further delay its obligations to the insured and the consequential liabilities that the legislature has imposed to deter the INSURER from engaging in the Bad Faith claims handling practices;
(z.) In relation to experts and/or adjusters retained by the INSURER to assess the scope and value of the loss, and in the interest of limiting loss adjusting expenses and otherwise maximizing its own profits, the INSURER fails to implement policies, procedures and guidelines to ensure that data and/or facts are initially and/or continually provided to the relied upon vendor to ensure that any findings and/or opinions are duly and fairly evaluated as information is gathered;
The 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 the INSURER will duly perform. The continuously vacillating positions and cherry picking of the generally described Bad Faith claims handling practices not only serves as vehicle of maximizing the INSURER’s prospective financial gains by being able to avoid paying benefits owed in full to insureds such as the Complainant, it also serves to minimize the INSURER’s overall loss 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 and burden upon 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 insured’s interests being implemented as a general business practice, the INSURER must perform as follows within 60 days of receiving this Complaint.
(1. 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;
(2. To the extent verified after duly performing under the Policy pursuant to cited authorities and considerations, confess judgment in relation to the pending breach of contract action brought forth by the Complainant;
(3. To the extent verified after duly performing under the Policy pursuant to cited authorities and considerations, confessing judgment in relation to the pending declaratory action that was brought forth by the Complainant;
(4. To the extent verified after duly performing under the Policy pursuant to cited authorities and considerations, issuing any, and all, payments owed to the Complaint for interest on benefits that were untimely paid;
(5. 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 57.041;
(6. After exercising good faith efforts to resolve the claim, issuing payment to the Complainant’s counsel for any attorneys’ fees and/or costs that it cannot reasonably dispute are due and owing;
(7. 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; and/or
(8. In light of its specialized knowledge, otherwise fulfilling any, and all, obligations under the Policy that it knows, or should know, remain to be performed.
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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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