Civil Remedy Notice of Insurer Violations
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Filing Number:     806714
Filing Accepted:  2/13/2025
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Complainant
Last/Business Name *  
SCOTT   First Name   ARTHUR
Street Address * 8702 WAKULLA SPRINGS RD
City, State Zip * TALLAHASSEE, FL 32305
Email Address * DEARKE@JUNO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   SCOTT   First Name   ARTHUR
Policy # * H32-251-101379-60 Claim #* 056824459-01
Attorney
Attorney is Applicable
Last Name* ALTMAN First Name * ALEXIS Initial
Street Address* 925 SOUTH FEDERAL HIGHWAY, 7TH FLOOR
City, State Zip* BOCA RATON , FL - FLORIDA 33432
Email Address * AALTMAN@KPATTORNEY.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   LIBERTY MUTUAL FIRE INSURANCE COMPANY
NAIC Company Code 23035
 
Name of individual responsible for violation (if any):* SEAN O'DELL
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unsatisfactory Settlement Offer
Claim Delay
Unfair Trade Practice
* Statutory provision(s) which the insurer allegedly violated.
 
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 insured and with due regard for her or his interests.
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.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

loss settlement provision
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Liberty Mutual Fire Insurance Company (“Carrier”) has not attempted in good faith to settle the insured’s claim 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 their interests. The carrier is required to properly investigate and adjust claims and cannot place that burden upon the insured. In fact, the carrier has intentionally under-valued the scope the insureds’ claim in an effort to maximize its profits, thereby preventing the insured from being able to restore their home to its pre-loss conditions. The carrier has engaged in these actions, despite the clear and unequivocal burden discussed in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005), wherein the Florida Supreme Court held, “The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insureds.” This claim arises from the devastation caused by tornado that ripped through Tallahassee Florida. The insured ARTHUR SCOTT property fell victim to this tornado and his home and life have been in shambles ever since. Mr. Scott immediately called their insurance company Liberty Mutual, who to this day has failed to treat the insureds with good faith claims handling. A field adjuster went to the home that was truly destroyed and weeks after reporting the claim. Thereafter a letter was received that a payment in the amount of $21,677.76 would be made. The insureds knew that this was nowhere near what was needed to bring the home back to its pre-loss condition. The insureds were devastated and hired the assistance of a public adjuster who provided Universal with an accurate and comprehensive estimate of damages in the amount of $247,976.37. In response, Liberty sent out another adjuster who wrote up an estimate that was 5 times larger than the initial field adjuster’s estimate. Pursuant to Florida Statute §624.155(1)(b)(1), Liberty has failed to settle the claim in good faith when it could and should have done so. The Insured immediately reported the Loss and the Property was presented for inspection. The damage to the Insured’s property was clearly caused by a covered peril under the Policy and was clearly extensively damaged, but the carrier has not shown a good faith intention to pay what was owed under the policy. Instead, the carrier low balled the claim in hopes that the insured will sign a release and be unable to bring their home back to pre-loss condition. Florida law mandates that insurers and adjusters do not mislead the Insured. Florida Insurance companies that fail to follow these Florida laws and regulations, designed to protect consumers, do not only breach their duties under the policy of insurance but do so in bad faith. In violation of Florida Statute §626.9541(1)(i)(3)(b), the carrier intentionally misrepresented the available coverage under the policy by not providing full coverage and instead providing a low ball payment. Liberty mislead its insured for its own financial incentive. Pursuant to Florida Statute 626.9541(1)(i)(3)(a) the carrier has Failed to adopt and implement standards for the proper investigation of claims, as the estimate is extremely deficient and improperly scoped. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the indemnity portion in the amount of $247,976.37 minus any applicable deductibles or prior payments; 2.) Pay all emergency services retained by the insureds; 3.) Pay all loss of use; 4.) Pay all contents; 5.) Pay the Insured’s attorneys’ fees and costs as they have been forced to retain counsel; 6.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. Please do not hesitate to contact the undersigned (561)-892-9988 if you have any questions or concerns. Sincerely, Alexis Altman
Comments
User Id Date Added Comment
elizabeth.tobler@libertymutual.com 04-11-2025 DFS Filing No. 806714 Complainant: Arthur Scott Claim No. 056824459 The following is Liberty Mutual Fire Insurance Company’s (“Liberty”) response to the abovereferenced Civil Remedy Notice. Liberty insured Arthur and Delois Scott (“Insureds”), under a homeowners insurance policy with effective dates September 25, 2023, through September 25, 2024. On May 13, 2024, the Insured, Delois Scott, reported a claim for Tornado related damage at the insured property located at 8702 Wakulla Springs Rd, Tallahassee, FL 32305. The date of loss was reported to be on or around May 10, 2024. On May 17, 2024, Liberty inspected the property and found significant tree damage to the roof, and it was determined that a full replacement was necessary. The interior had damaged drywall, water-stained flooring, broken light fixtures, and water damaged ceiling. Liberty prepared an estimate for all covered damages and repairs totaling $21,677.76 after application of the recoverable depreciation and $500 deductible. On June 22, 2024, Liberty sent the Insureds a copy of its coverage determination letter summarizing the outcome of its investigation and attached a copy of its estimate. On October 24, 2024, Liberty received a Letter of Representation and estimate from AAA Claim Consultants, Inc. totaling $247,976.37. Attached to the estimate was a photo report. Upon review of the documents and photos, Liberty observed that the photos showed there had been a significant progression in the extent of the previously identified damages. Specifically, the public adjuster’s documents identified significant structural damage and mold growth. On November 18, 2024, Liberty sent the Insured a Reservation of Rights Letter stating that it had received and reviewed the documentation produced by AAA Claim Consultants, Inc. and per Liberty’s review, additional information was necessary to continue its investigation of the loss. As part of its investigation, Liberty retained the services of a structural engineer to reinspect the property and determine the extent of the damage being claimed. In its Reservation of Rights Letter Liberty advised the Insureds of the mold limit and duties to protect the property from further damage. The applicable Policy form and relevant endorsements state in part: SECTION I – PROPERTY COVERAGES Additional Coverages The following Additional Coverage is added: 12. Remediation of "Mold, Fungus, Wet Rot, Dry Rot, Bacteria, or Virus" Resulting Directly From Any Covered Loss We will pay, up to the Basic Policy Limits or Option shown in the Declarations, for the “Remediation” of “Mold, Fungus, Wet Rot, Dry Rot, Bacteria, or Virus” resulting directly from any covered loss. "Remediation" means the reasonable and necessary treatment, containment, decontamination, removal or disposal of "Mold, Fungus, Wet Rot, Dry Rot, Bacteria, or Virus" as required to complete the repair or replacement of property, covered under Section I of the policy, that is damaged by any covered peril insured against, and also consists of the following: 1. The reasonable costs or expense to remove, repair, restore, and replace that property including the costs to tear out and replace any part of the building as needed to gain access to the “Mold, Fungus, Wet Rot, Dry Rot, Bacteria, or Virus”; and 2. the reasonable costs or expense for the testing or investigation necessary to detect, evaluate or measure "Mold, Fungus, Wet Rot, Dry Rot, Bacteria, or Virus"; and * * * * 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. We do not insure, however, for loss: … 2. Caused by: … e. Any of the following: (1) Wear and tear, marring, deterioration; (2) Inherent vice, latent defect, mechanical breakdown; (3) Smog, rust or other corrosion, mold, wet or dry rot; … (6) Settling, shrinking, bulging or expansion, including resultant cracking, of pavements, patios, foundations, walls, floors, roofs or ceilings; (7) Birds, vermin, rodents, or insects; or … * * * * SECTION I – EXCLUSIONS 1. We do not insure for loss caused directly or indirectly by any of the following. Such loss is excluded regardless of any other cause or event contributing concurrently or in any sequence to the loss. … e. Neglect, meaning neglect of the “insured” to use all reasonable means to save and preserve property at and after the time of a loss. … 2. We do not insure for loss to property described in Coverages A and B caused by any of the following. However, any ensuing loss to property described in Coverages A and B not excluded or excepted in this policy is covered. … c. Faulty, inadequate or defective: (1) Planning, zoning, development, surveying, siting; (2) Design, specifications, workmanship, repair, construction, renovation, remodeling, grading, compaction; (3) Materials used in repair, construction, renovation or remodeling; or (4) Maintenance; of part or all of any property whether on or off the "residence premises”. * * * * FMHO1067FL 0523 Endorsement (Homeowners) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SPECIAL PROVISIONS-FLORIDA SECTION I – CONDITIONS In Homeowners Policy, FMHO 952, Deluxe Homeowners Policy, FMHO 943, and Condominium Policy, FMHO 936, item 2. is deleted and replaced by the following: 2. Your Duties After Loss. In case of a loss to covered property, we have no duty to provide coverage under this Policy if the failure to comply with the following duties is prejudicial to us. These duties must be performed either by you, an “insured” seeking coverage, or a representative of either: a. Give prompt notice to us or your insurance agent. Except for Reasonable Emergency Measures taken under Additional Coverages 2., there is no coverage for repairs that begin before the earlier of: (1) 72 hours after we are notified of the loss; (2) The time of loss inspection by us; or (3) At the time of other approval by us; Any claim or reopened claim under an insurance policy that provides coverage for loss or damage caused by any peril is barred unless notice of the claim or reopened claim was given to us in accordance with the terms of the policy within 1 year after the date of loss. A reopened claim means a claim that we have previously closed but that has been reopened upon an "insured's" request for additional costs for loss or damage previously disclosed to us. A supplemental claim is barred unless notice of the supplemental claim was given to us in accordance with the terms of the policy within 18 months after the date of loss. A supplemental claim means a claim for additional loss or damage from the same peril which we have previously adjusted or for which costs have been incurred while completing repairs or replacement pursuant to an open claim for which timely notice was previously provided to us. For claims resulting from hurricanes, tornadoes, windstorms, severe rain or other weather-related events, the date of loss is the date that the hurricane made landfall or the tornado, windstorm, severe rain, or other weather-related event is verified by the National Oceanic and Atmospheric Administration. b. (1) to the degree reasonably possible, retain the damaged property; and (2) allow us to inspect, subject to b.(1) above, all damaged property prior to its removal from the “residence premises”; … e. Protect the covered property from further damage. The following must be performed: (1) Take reasonable emergency measures that are necessary to protect the covered property from further damage… (2) Keep an accurate record of repair expenses. f. Prepare an inventory of damaged personal property showing the quantity, description, actual cash value and amount of loss. Attach all bills, receipts and related documents that justify the figures in the inventory g. As often as we reasonably require: (1) Show the damaged property; (2) Provide us with records and documents we request and permit us to make copies; and … h. Send to us, within 60 days after our request, your signed, sworn proof of loss which sets forth the best of your knowledge and belief: (1) The time and cause of loss; (2) The interest of the "insured" and all others in the property involved and all liens on the property; (3) Other insurance which may cover the loss; (4) Changes in title or occupancy of the property during the term of the policy; (5) Specifications of damaged buildings and detailed repair estimates; (6) The inventory of damaged personal property described in 2.f. above; (7) Receipts for additional living expenses incurred and records that support the fair rental value loss; and (8) Evidence or affidavit that supports a claim under the Credit Card, Fund Transfer Card, Forgery and Counterfeit Money coverage, stating the amount and cause of loss. … * * * * The duties above apply regardless of whether you, an “insured” seeking coverage, or a representative of either retains or is assisted by a party who provides legal advice, insurance advice or expert claim advice, regarding an insurance claim under this Policy. * * * * 8. Suit Against Us. No action can be brought unless the policy provisions have been complied with and the action is started within 5 years after the date of loss. In addition, the "insured" must provide the Department of Financial Services with written notice of intent to initiate litigation at least 10 business days prior to filing any legal action against us in accordance with section 627.70152 of Florida Statutes. * * * * On November 26, 2024, Liberty issued to the Insureds and AAA Claims Consultants, Inc. the recoverable depreciation withheld totaling $12,625.31. Liberty retained Kevin Layman, P.E. of Rimkus Engineering to inspect the property. On December 3, 2024, the inspection was completed. Mr. Layman prepared a report of his findings, and with regards to the structural damage, the report concludes the following: “We concluded that the repairs necessary to repair the impact-damaged structural elements and interior finishes would be classified as a “Repair,” as described in Chapter 4 of the FBCEB2023. During our inspection, we observed four impacted roof rafters and impacted roof deck boards that were cracked or broken from the tree impact; however, there was a lack of damage to the load-bearing wood-framed walls, and there was not a reduction in the lateral load-carrying capacity or reduction in vertical support to the roof. Based on our observations and review of the FBCEB-2023, the damage to the building and required structural repairs were considered less than substantial structural damage. The FBCEB-2023, Section 406.2.1 states that for damage less than substantial structural damage, the damaged elements shall be permitted to be restored to their pre-damage condition. Furthermore, Section 406.1 states that new structural members and connections used for repair or rehabilitation shall comply with the detailing provisions of the Florida Building Code, 8th Edition (2023) for new buildings of similar structure, purpose, and location. The damage to the building was at a level below the substantial structural damage level as defined by the FBCEB2023. Therefore, repairs shall be permitted to restore the damaged elements to their predamaged condition. The new structural members used in the repair, including anchorage and connections, should comply with the detailing provisions of the Florida Building Code, 8th Edition (2023) for new buildings of similar structure, purpose, and location. Based on this repair work being classified as a “Repair” with “less than substantial structural damage,” we concluded that the damaged roof framing and roof decking can be reconstructed to their pre-damaged state using materials and strengths that existed prior to the impact-related damage.” Following receipt of the engineering report, Liberty prepared an estimate for additional covered damages and repairs totaling $119,992.92. After application of the deductible, and prior payments, a total payment of $83,194.68 was issued to the Insureds and AAA Claims Consultants, Inc. On January 2, 2025, Liberty sent a correspondence to AAA Claims Consultants, Inc advising of the outcome of its investigation and providing a breakdown of the payment. The correspondence further advised that there was a considerable amount of new damage at the property that had resulted from the continual presence of water penetrating the home due to a lack of proper mitigation and/or temporary/permanent repairs of the roof. As such, Liberty was unable to provide coverage for the damage that resulted from the prolonged seepage and leaking of water as well as damage that resulted from the failure to protect the property from further damage. Liberty again cited the applicable Policy language and relevant endorsements. Attached to Liberty’s correspondence was a copy of the updated estimate and Rimkus Report. On January 14, 2025, Liberty issued to the Insureds and AAA Claims Consultants, Inc. a payment for damaged personal property totaling $15,057.80. Liberty continues to investigate this claim and shall take into consideration any and all additional documentation provided by Insured. As to the specific statutory violations cited in the subject Civil Remedy Notice, Liberty responds as follows: 624.155(1)(b)(1): Liberty has adjusted this loss and provided Complainant with a coverage decision. Liberty continues to properly investigate this claim to evaluate Complainant’s request for payment. 624.155(1)(b)(3): Liberty has adjusted this loss and provided Complainant with a coverage decision. Liberty continues to properly investigate this claim to evaluate Complainant’s request for payment. 626.9541(1)(i)(3)(a): Liberty avers that it has and continues to properly investigate this claim. 626.9541(1)(i)(3)(c): Liberty avers that it has promptly communicated with the Complainant. 626.9541(1)(i)(3)(d): Liberty avers that it has and continues to properly investigate this claim
Acknowledgement
* 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.

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DFS-10-363
Rev. 10/14/2008