Filing Number: 806600
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| Filing Accepted: 2/12/2025 |
| Last/Business Name
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| Street Address
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1136 BRENTON MANOR DRIVE |
| City, State Zip
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WINTER HAVEN,
FL
33881
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| Email Address
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RL@WEKLAW.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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GOMEZ |
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First Name |
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VICTOR |
| Policy # * |
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P004292246 |
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Claim #* |
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244685 |
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Attorney is Applicable
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| Last Name* |
LEWIS
First Name *
REBECCA
Initial
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| Street Address* |
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708 E. COLONIAL DR., SUITE 103 |
| City, State Zip* |
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ORLANDO
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FL
32803
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| Email Address * |
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RL@WEKLAW.COM |
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| Insurer Type
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Authorized Insurer
Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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SECURITY FIRST INSURANCE COMPANY
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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 10117 |
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| Name of individual responsible for violation (if any):*
UNKNOWN
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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)(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)(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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
AGREEMENT
In reliance on the information you have given us, we agree to provide the insurance coverages indicated in the Policy Declarations. In return, you must pay the premium when due and comply with the policy terms and conditions and inform us within 60 days of any change of ownership, title, use or occupancy of the “residence premises.”
DEFINITIONS
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4. "Insured location" means: a. The "residence premises"; b. The part of other premises, other structures and grounds used by you as a residence and: (1) Which is shown in the Declarations; or (2) Which is acquired by you during the policy period for your use as a residence;
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5. "Occurrence" means an accident, including continuous or repeated exposure to substantially the same general harmful conditions, which results, during the policy period, in: a. "Bodily injury"; or b. "Property damage."
6. "Property damage" means physical injury to, destruction of, or loss of use of tangible property.
SECTION I – PROPERTY COVERAGES COVERAGE A– Dwelling
We cover:
1. The dwelling on the "residence premises" used mainly as your private residence, including attached structures and attached wall-to-wall carpeting if damage to the dwelling is caused by a covered loss; and
2. Materials and supplies located on or next to the "residence premises" used to construct, alter or repair the dwelling or other structures on the "residence premises." This coverage does not apply to land, including land on which the dwelling is located.
COVERAGE B – Other Structures
We cover other structures on the “residence premises” set apart from the dwelling by clear space. This includes structures connected to the dwelling by only a fence, utility line, or similar connection. This coverage does not apply to land, including land on which the other structures are located.
We do not cover other structures:
1. Used in whole or in part for “business”; or
2. Rented or held for rental to any person not a tenant of the dwelling, unless used solely as a private garage.
The limit of liability for this coverage will not be more than the limit shown on the Declarations page for Coverage B. Use of this coverage does not reduce the Coverage A limit of liability.
SECTION I – PERILS INSURED AGAINST COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES
We insure against risk of direct loss to property described in Coverages A and B only if that loss is a physical loss to property.
ADDITIONAL COVERAGES
2. Reasonable Emergency Measures.
a. We will pay up to the greater of $3,000 or 1% of your Coverage A limit of liability for the reasonable costs incurred by you for necessary measures taken solely to protect covered property from further damage, when the damage or loss is caused by a Peril Insured Against.
b. We will not pay more than the amount in a. above, unless we provide you with approval within 48 hours of your request to us to exceed the limit in a. above. In such circumstance, we will pay only up to the additional amount for the measures we authorize.
c. If we fail to respond to you within 48 hours of your request to us and the damage or loss is caused by a Peril Insured Against, you may exceed the amount in a. above only up to the cost incurred by you for the reasonable emergency measures taken solely to protect the covered property from further damage.
d. If however, your policy includes coverage for “hurricane loss” and a covered loss occurs during a hurricane that causes damage to your covered property, the amount we pay under this additional coverage will be the reasonable cost incurred by you for necessary measures taken solely to protect the property from further damage and is not limited to the amount in a. above. Includes copyrighted material of Insurance Services Office, Inc., with its permission.
e. A reasonable measure under this Additional Coverage may include a permanent repair when necessary to protect the covered property from further damage or to prevent unwanted entry to the property. To the degree reasonably possible, the damaged property must be retained for our inspection, testing, and analysis. For purposes of this Additional Coverage, the cost of testing of air or property to confirm the absence, presence or level of fungi, mold, wet or dry rot, or bacteria is not considered a Reasonable Emergency Measure . This coverage does not relieve you of your duties, in case of a loss to covered property, as set forth in Section I – Condition 2.d.
This coverage does not increase the limit of liability applying to the damaged covered property.
13. “Fungi”, Mold, Wet or Dry Rot, Or Bacteria
a. We will pay up to the amount stated in the Declarations for Limit of Liability for “Fungi” Coverage for:
(1) The total of all loss payable under Section I – Property Coverages caused by or resulting directly or indirectly from “fungi”, mold, wet or dry rot, or bacteria;
(2) The cost to remove “fungi”, mold, wet or dry rot, or bacteria from property covered under Section I – Property Coverages;
(3) The cost to tear out and replace any part of the building or other covered property as needed to gain access to the “fungi”, mold, wet or dry rot, or bacteria; and
(4) The cost of testing of air or property to confirm the absence, presence or level of “fungi”, mold, wet or dry rot, or bacteria whether performed prior to, during or after removal, repair, restoration or replacement. The cost of such testing will be provided only to the extent that there is a reason to believe that there is the presence of “fungi”, mold, wet or dry rot, or bacteria. b. The coverage described in a. above only applies when such loss or costs are a result of a Peril Insured Against that occurs during the policy period and only if all reasonable means were used to save and preserve the property from further damage at and after the time the Peril Insured Against occurred. c. The Each Covered Loss amount shown on the declarations for this coverage is the most we will pay for the total of all loss or costs payable under this Additional Coverage resulting from any one covered loss; and The Policy Aggregate amount shown on the declarations for this coverage is the most we will pay for the total of all loss or costs payable under this Additional Coverage for all covered losses, regardless of the number of locations insured under this policy or number of claims made. d. If there is covered loss or damage to covered property, not caused, in whole or in part, by “fungi”, mold, wet or dry rot, or bacteria, loss payment will not be limited by the terms of this Additional Coverage, except to the extent that “fungi”, mold, wet or dry rot or bacteria causes an increase in the loss. Any such increase in the loss will be subject to the terms of this Additional Coverage. This coverage does not increase the limit of liability that applies to the damaged property.
10. Loss Payment. We will adjust all losses with you. We will pay you unless some other person is named in the policy or is legally entitled to receive payment. Loss will be paid upon the earliest of the following:
a. 20 days after we receive your written proof of loss and reach a written executed agreement of settlement with you according to the terms of the written agreement; or
b. 60 days after we receive your written proof of loss and:
(1) There is an entry of a final judgment or, in the case of an appeal from such judgment, within60 days from and after the affirmance of the same by the appellate court; or
(2) There is a written executed mediation settlement agreement with you according to the terms of the written mediation settlement; or
c. Within 90 days after we receive written notice of an initial claim, “reopened claim” or “supplemental claim” from you, we will pay or deny such claim or a portion of the claim unless the failure to pay such claim or portion of claim is caused by factors beyond our control which reasonably prevent such payment.
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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.
Maribel Gomez and Victor Gomez ("Insureds") purchased an insurance policy ("Policy") from Security First Insurance Company ("Security First" or “Carrier”) with effective coverage on the date of loss, on or about September 27, 2022, and Policy number P004292246 to insure their property located 1136 Brenton Manor Dr., Winter Haven, FL 33881(the "Property").
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On or about December 16, 2022, the Property suffered from extensive damages due to a sudden and accidental water loss ("Loss"). Security First was notified of the Loss immediately upon discovery and was granted access to the property in order to complete their inspection. Security First acknowledged the claim and assigned claim 244685 ("Claim") to the Loss.
After receiving notice of the Loss, Security First assigned an adjuster to investigate the loss. As a result of the adjuster’s inspection, on February 6, 2023, Security First issued its claims decision for the Loss. As evidenced by an estimate sent to the Insureds, dated February 3, 2023, Security First determined the total value of the loss was $ 9,676.45.
At the same time, the Insureds through their representatives obtained an estimate for the necessary repairs related to the loss, and that estimate totaled $33,880.50. The Insureds, realizing that the adjustment offered by Security First was not an accurate representation of the damage, reached out to Security First in order to have it reconsider its position. Despite being provided plenty of evidence (including photographs, repair estimates, a sworn proof of loss, and near immediate access to the property upon discovery of the loss) showing that the scope and the costs of the repairs exceeded Security First’s valuation of the claim, Security First refused to change its position.
Further, the Insureds hired companies to perform services to protect the property from further damage water mitigation, and mold testing and remediation, and Security First has refused to make payment pursuant to the terms of the Policy.
Security First’s adjustment of the loss was not a fair or an honest adjustment of the loss. Security First’s adjustment of the loss was intended to provide the illusion of a fair adjustment, to avoid full payment to the Insureds. Security First knows or should know that its adjustment of the Loss is not a fair or honest assessment of the Loss, yet Security First has refused to attempt to settle the Loss with the Insureds and their representatives. Security First has made the practice of undervaluing claims to avoid having to fairly and honestly adjust and pay for losses.
Further, Security First failed to assign an adequate adjusting team (field adjuster, contractor consultants, and desk adjusters) to handle the size and scope of the loss. Security First does not have appropriate standards in place to be able to investigate claims such as the Loss at the Insureds’ Property. Security First’s failure to have appropriate standards led to the assignment of an inadequate adjusting team, which ultimately led to Security First’s unfair and dishonest adjustment of the Loss. The Insureds, at their own expense, retained a qualified adjusting team to investigate the Loss. The experienced adjusting team arrived at a drastically different conclusion than Security First’s inadequate adjustment team – specifically, Security First determined the total value of the loss to be $9,676.45, whereas the experienced and qualified adjusting team retained by the Insureds determined the total value of the Loss to be $33,880.50.
To date, Security First has failed to accept and fully perform its obligations under the operable insurance contract. The Property remains damaged because the Insureds have not been paid the necessary, covered insurance proceeds sufficient to return the Property to its pre-loss condition.
By stating the above detailed facts, it is clear that Security First has violated the following Florida statutes:
• 624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its Insureds and with due regard for their interest;
• 624.155(1)(b)(3) Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage;
• 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims;
• 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims, by failing to respond to the Insureds’ public adjuster, and Insureds’ counsel with respect to supplemental requests for payments;
• 626.9541(1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the Insureds and/or their public adjuster of the basis in the insurance policy, in relation to the facts or applicable law, for the offer of a compromise settlement;
In total, and has exhibited above, Security First has implemented a strategy and approach to the Loss that is unfair, and Security First is unfairly attempting to settle the Loss.
This notice is given to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should Security First fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, Security First must: (1) Immediately tender all proceeds due and owing to the Insured that are fairly owed to the Insured under the insurance policy that would reasonably compensate the Insured in order to put the loss property back to its pre-loss condition in the sum of $33,880.50 (minus any prior payment and the deductible); (2) Agree to reimburse the Insured's reasonable attorneys’ fees and costs for having to become involved to resolve the claim; and (3) Agree to reimburse the Insured for interest on the amount of benefits that was found to be due and owing to the Insured, relating back to the date of loss.
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The submitter hereby states that this notice is given in order to perfect the rights of the
person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.
Before submitting a Notice using this system, please verify that all text has been entered
correctly and completely. Once the Notice has been submitted, the text cannot be changed
or deleted.
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DFS-10-363
Rev. 10/14/2008
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