Filing Number: 803023
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| Filing Accepted: 1/23/2025 |
| Last/Business Name
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VIVIAN & GUILLERMO
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First Name |
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LOPEZ |
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| Street Address
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3822 SW 136TH AVE |
| City, State Zip
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MIAMI,
FL
33175
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| Email Address
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CRN@SHIELDLAWGP.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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LOPEZ |
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First Name |
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VIVIAN & GUILLERMO |
| Policy # * |
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SPIF0424971-02-0000 |
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Claim #* |
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35585 |
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Attorney is Applicable
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| Last Name* |
ALVAREZ
First Name *
JAMIE
Initial
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| Street Address* |
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15751 SHERIDAN ST #300 |
| City, State Zip* |
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DAVIE
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FL
33331
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| Email Address * |
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ACCTEXECB@SHIELDLAWGP.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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SAFEPOINT 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 15341 |
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| Name of individual responsible for violation (if any):*
SAFEPOINT INSURANCE COMPANY
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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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Disregarding Covered peril damage
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Other
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Placing Unreasonable Requirements on the Insured to Properly Adjust the Claim
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Other
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Failure to Respond to the Insured promptly.
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Other
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69B-220.201(3)(B) – An adjuster shall treat all claims equally.
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Other
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69B-220.201(3)(C) – An adjuster shall not approach investigations, adjustments, and settlements in
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Other
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69B-220.201(3)(E) – An adjuster shall handle every adjustment and settlement with honesty and inte
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Other
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69B-220.201(3)(F) – An adjuster, upon undertaking the handling of a claim, shall act with dispatch
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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)(1) |
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Attempting to settle claims on the basis of an application, when serving as a binder or intended to become a part of the policy, or any other material document which was altered without notice to, or knowledge or consent of, the insured.
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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)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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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)(3)(f) |
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Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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| 626.9541(1)(i)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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| 626.9541(1)(i)(3)(i) |
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Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
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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 – PERILS INSURED AGAINST
A. Coverage A – Dwelling And Coverage B –Other Structures
1. We insure against risk of direct physical loss to
property described in Coverages A and B….
SECTION I – CONDITIONS:
C. Loss Settlement
In this Condition C., the terms "cost to repair or replace" and "replacement cost" do not include the increased costs incurred to comply with the enforcement any ordinance or law, except to the extent that coverage for these increased costs is provided in E.11. Ordinance Or Law under Section
I – Property Coverages. Covered property losses are settled as follows:
1. Property of the following types:
a. Personal property;
b. Awnings, carpeting, household appliances, outdoor antennas and outdoor equipment, whether or not attached to buildings;
c. Structures that are not buildings; and
d. Grave markers, including mausoleums;
at actual cash value at the time of loss but not more than the amount required to repair or replace.
2. Buildings covered under Coverage A or B at replacement cost without deduction for depreciation, subject to the following:
a. If, at the time of loss, the amount of insurance in this policy on the damaged building is 80% or more of the full replacement cost of the building immediately before the loss, we will pay the cost to repair or replace, after application of any deductible and without deduction for depreciation, but not more than the least of the following amounts:
(1) The limit of liability under this policy that
applies to the building;
(2) The replacement cost of that part of the building damaged with material of like kind and quality and for like use; or
(3) The necessary amount actually spent to repair or replace the damaged building…
2. Buildings covered under Coverage A or B at
replacement cost without deduction for depreciation, subject to the following:
a. If, at the time of loss, the amount of insurance in this policy on the damaged building is 80% or more of the full replacement cost of the building immediately before the loss, we will pay the cost to repair or replace, after application of any deductible and without deduction for depreciation, but not more than the least of the following amounts:
(1) The limit of liability under this policy that
applies to the building;
(2) The replacement cost of that part of the building damaged with material of like kind and quality and for like use; or
(3) The necessary amount actually spent to repair or replace the damaged building
• And all other coverages available under the policy of insurance as may be applicable but not otherwise specified herein.
If the building is rebuilt at a new premises, the cost described in (2) above is limited to the cost which would have been incurred if the building had been built at the original
premises.
b. If, at the time of loss, the amount of insurance in this policy on the damaged building is less than 80% of the full replacement cost of the building immediately before the loss, we will pay the greater of the following amounts, but not more than the limit of liability under this policy that applies to the
building:
(1) The actual cash value of that part of the building damaged; or
(2) That proportion of the cost to repair or replace, after application of any deductible and without deduction for depreciation, hat part of the building damaged, which the total amount of insurance in this policy on the damaged building the building.
c. To determine the amount of insurance required to equal 80% of the full replacement
cost of the building immediately before the loss, do not include the value of: (1) Excavations, footings, foundations, piers, or any other structures or devices that support all or part of the building, which are below the undersurface of the
lowest basement floor.
(2) Those supports described in (1) above which are below the surface of the ground inside the foundation walls, if there is no basement; and
(3) Underground flues, pipes, wiring and drains.
d. We will pay no more than the actual cash value of the damage until actual repair or replacement is complete. Once actual repair or replacement is complete, we will settle the loss as noted in 2.a. and b. above.
However, if the cost to repair or replace the damage is both:
(1) Less than 5% of the amount of insurance in this policy on the building; and
(2) Less than $2,500; we will settle the loss as noted in 2.a. and b. above whether or not actual repair or replacement is complete
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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.
This notice is given in order to perfect the right to pursue the civil remedy authorized by section 624.155, Florida Statutes. In Florida, the work of adjusting insurance claims engages the public trust. The insurance company has breached this duty in the adjustment of the Insureds’ claim of loss. Insurance company has failed to create and implement adequate guidelines for proper investigation of claims handling and for training and supervision of employees resulting in statutory violations (as set forth above). Further, insurance company has failed and/or refused to thoroughly, accurately, and completely investigate, evaluate, and pay the Insured’s insurance claim for damages. Insurance company has also ignored important information that would benefit the Insureds, as described in further detail below. Though the Insureds sustained a loss that, pursuant to the terms of their policy, should be covered by SAFEPOINT, the carrier has failed to tender all monies due and owing to the Insureds for the damage caused to their property. The entire concept of insurance promises the Insured timely and prompt indemnity in exchange for their premium payments to the Insurance company.
Florida Statute section 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that the insurance company must issue payment for a covered loss in a timely manner so that the Insured may mitigate their damages and put them back in the position they were in prior to the loss as quickly as possible. Insurance company has breached this duty by refusing and failing to tender all insurance proceeds due and owing to the Insureds upon their proper and timely submission of a claim. Insurance company charged the insured a premium for coverage under the policy of insurance but refused and/or failed to fulfill its obligations per the Policy when under all circumstances it could and should have done so, had it acted fairly and honestly towards the Insureds.
Furthermore, the Insureds believe that Insurance Company repeatedly and as a standard business practice engages in this behavior to deprive its Insureds of their rightful insurance proceeds when they experience a covered loss. Insureds contend other Insureds have been refused insurance proceeds due and owing under the policy in the same or similar circumstances and have been provided inadequate insurance monies under the same or similar facts or circumstances. The Insureds further contend that Insurance company commits this standard business practice only to keep the claims adjustment process open and pending so that it does not have to pay fully on the claim. This is wrongful conduct and directly violates the purpose of insurance coverage. Insurance company’s wrongful conduct and omissions include, but are not limited to: claim delay, not conducting a full and prompt investigation, not treating the policyholder with good faith claims conduct, looking for ways to deny recovery to Insureds; not responding to the Insureds or their representatives; failing and refusing to review documents sent by the Insureds; looking for ways to delay full recovery to Insured; wrongfully denying the claim; holding back and failing to pay portions of claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the Insureds; not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholder’s interests; establishing severity control initiatives and otherwise establishing a culture of not fully and promptly paying claims following losses; and failing to pay the full amount of the Insureds’ damage despite knowing it must do so.
In Florida, the work of adjusting insurance claims engages the public trust. SAFEPOINT has breached this trust by its adjustment of the Insureds’ claim of loss by refusing to properly indemnify the Insureds for their hurricane loss per the terms of the Policy and Florida Statutes.
On or about September 10, 2017, the Insureds suffered damage to the roof and interior of their property, caused by Hurricane Irma. At the time of the loss, the Property was insured by SafePoint under an all-risk policy, which includes coverage for damages caused by hurricane/ wind loss. The Insureds promptly reported the loss to the carrier, per their Policy
Following the loss, the Insureds went to work mitigating their damages.
The Insureds also retained Master Claims Consultants, to assist them with the loss. Master Claims Consultants prepared an estimate for the total damages to the Property totaling
$116,614.51 along with extensive photographs of the damages to the Property. Despite receipt of the loss consultants ’s estimate, SafePoint continued to fail and refuse to properly adjust the loss per the Policy and Florida Statutes.
Despite inspection and receipt of extensive documentation provided by the Insureds, SafePoint has continued to fail and refuse to properly tender insurance proceeds to the Insureds for their r covered loss.
Pursuant to Florida Statute §624.155(1)(b)(1), the Insurer, SAFEPOINT, has a duty to attempt, in good faith, to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly towards the Insureds and with due regard for their interests. SAFEPOINT has breached these duties in the handling of the Claim for financial gain and profit. SAFEPOINT did so when it refused to properly adjust the claim, purposefully delayed the claim process, and ignored information from the Insureds that would assist the Insureds in resolving their claim. Consequently, SAFEPOINT has violated Florida Statute §624.155(1)(b)(1). It would seem that SAFEPOINT is indifferent to the needs of its loyal customers, whose insurance premiums it did not hesitate to collect. SAFEPOINT had the duty to investigate and settle the Insureds’ Claim in an honest manner and according to the coverage provided under the Policy. To be clear, SAFEPOINT and its representatives had a duty to investigate the Claim and pay the Insureds the benefits they would be entitled to for the repairs under the terms and conditions outlined in the Policy and under Florida law. It has not done so to date, despite the Insureds and their representatives making every effort to resolve the claim in the meantime. What SAFEPOINT did was wrongfully and intentionally deny the Claim without conducting a reasonable investigation with qualified and competent adjusters and experts, despite the fact that the evidence clearly shows the property was damaged by a covered cause of loss, resulting in significant damage. This unfair and unsupported denial of the Claim is evidence that SAFEPOINT has mishandled the Claim, and its conduct is nothing less than common bad faith claims handling practices.
Pursuant to Florida Statute §626.9541(1)(i)(3)(a), SAFEPOINT had a duty to adopt and implement standards for the proper investigation and settlement of claims. It is clear from the facts in this case that SAFEPOINT was ill-equipped to handle the Claim. The representatives sent to the Property by SAFEPOINT failed to correctly attribute the cause of loss and proper scope of damages resulting from the wind event, despite its inspection of the Property and the extent of documentation sent from the Insureds’ representatives evidencing the damages.
To date, the Insureds still have not been properly compensated for their loss. The Insureds are at a loss as to how to proceed, as SAFEPOINT has failed and refused to properly assist the Insureds with their covered loss despite its ethical, contractual, and statutory obligation to do so. SAFEPOINT has refused to review the documents sent by the Insureds’ counsel and loss consultant, as evidenced by SafePoint’s blanket denial letter.
There may be further wrongful conduct which has not yet been made known to the Insureds at this time. For example, certain conduct or actions cannot be verified without a complete review of SAFEPOINT’s claim file and claim guidelines. The Insureds therefore retains the right to address additional concerns as they become known.
SAFEPOINT improperly shifted the burden of proving the loss onto the Insureds before adequately tendering insurance proceeds (which SAFEPOINT still has not done). This completely defeats the purpose of insurance, as the insurance company should adequately compensate its Insureds for covered losses properly at the outset of a claim, not after months of being chased by and sent multiple pages of documentation by the Insureds and their representatives, fighting to have their covered loss properly compensated.
Pursuant to Florida Statutes, Section 624.155, punitive damages may be awarded against an insurance company if 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.?
It is the Insureds’ position that SAFEPOINT engages in the practice of wrongfully denying or underpaying insurance claims as a general business practice in a willful effort to increase profits and in reckless disregard for the Insured’s rights. This is wrongful conduct. This can be determined from a brief review of DFS’ Civil Remedy Notice website and the extensive filings against SafePoint for similar conduct, as well as a brief search of the Florida Court dockets which show the same behavior resulting in unnecessary litigation, which would not have occurred but for SafePoint’s mishandling of covered property losses in an effort to save itself money and deny or undervalue payment to its Insured.
Notwithstanding the above, to cure the defects outlined in this Civil Remedy Notice, SAFEPOINT must do the following:
(1) SAFEPOINT must act promptly, fairly and honestly towards the Insureds and with due regard for their interests in attempting to resolve the Insureds; claim, including payment to any and all assignment of benefits providers.
(2) SAFEPOINT must timely tender all insurance proceeds due and owing the Insureds for the fair value of their claim which is fairly owed under the insurance policy that would reasonably place the Insureds back to pre-loss condition, which is the full amount of the Insureds’ estimate previously provided in the amount of $70,102.35, less the applicable deductible.
(3) SAFEPOINT must agree to reimburse the Insureds for the unnecessary expenses incurred by having to retain legal counsel and their own experts to present their claim, which will be provided upon request to counsel based on the fees and costs accrued at the time of the request.
(4) SAFEPOINT must timely tender statutory pre-judgment interest pursuant to Florida Statute Section 627.70131 and/or Section 55.03.
The Insureds still hope that this claim can be resolved amicably. Failure to cure the defects as described herein will result in additional extra-contractual damages.
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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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