Filing Number: 810044
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| Filing Accepted: 3/7/2025 |
| Last/Business Name
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RAMIREZ
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First Name |
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OSCAR & MURIEL |
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| Street Address
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291 S. BEL AIR DRIVE |
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PLANTATION,
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33317
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| Email Address
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291CASA@GMAIL.COM |
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Insured |
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| Last/Business Name* |
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RAMIREZ |
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First Name |
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OSCAR & MURIEL |
| Policy # * |
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12-1046440-04 |
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Claim #* |
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12-3029839-25 |
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Attorney is Applicable
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| Last Name* |
CHAVIN
First Name *
VALORIE
Initial
S
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| Street Address* |
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12955 BISCAYNE BLVD., SUITE 201 |
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NORTH MIAMI
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FL
33181
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| Email Address * |
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VCHAVIN@CMSLAWGROUP.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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TYPTAP 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 15885 |
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| Name of individual responsible for violation (if any):*
KRYSTA JOHNSON AND FIELD ADJUSTER (NAME 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 Denial
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Unfair Trade Practice
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Other
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Violation of Florida Administrative Code 69B-220.201
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Claim Delay
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
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| 626.9541(1)(i)(2) |
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A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
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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)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
TypTap Insurance Company (the “Insurance Company” or the “Carrier”) abandoned its responsibilities to fully, timely and properly compensate its Insureds for significant damage to their home caused by a covered loss. Oscar and Muriel Ramirez (the “Insureds”) purchased a policy of insurance with the Carrier bearing policy number 12-1046440-04 (the “Policy”), which provides coverage for damages to the Insureds’ home located at 291 S. Bel Air Drive, Plantation, Florida (the “Property”), including significant damage sustained as the result of a sudden and accidental escape of water from the plumbing system. Rather than properly compensating the Insureds for the damage suffered, the Insurance Company elevated its own interests over those of its Insureds by refusing to acknowledge coverage for the loss and misrepresenting pertinent facts and the available coverages under the Policy as a means of denying payment to its Insureds. The way the Insurance Company handled this claim is an example of how it has been handling all of its insureds’ water damage claims in order to avoid fully and fairly compensating its insureds and the consumers of the State of Florida for what would otherwise be covered water damage to their properties.
The Insureds believe the following Policy language may be at issue:
HOMEOWNERS 3 – SPECIAL FORM
SECTION I – PROPERTY COVERAGES
A. Coverage A – Dwelling.
1. We cover:
a. The dwelling on the "residence premises" shown in the Declarations, including structures attached to the dwelling
. . .
D. Coverage D – Loss of Use.
. . .
1. Additional Living Expense.
If a loss covered under Section I makes that part of the "residence premises" where you reside not fit to live in, we cover any necessary increase in living expenses incurred by you so that your household can maintain its normal standard of living.
. . .
E. 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 the 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 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.
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 necessary to protect the covered property against further damage.
c. If however, form HO 03 51 is part of your Policy and a covered loss occurs during a hurricane as described in form HO 03 51, the amount we pay under this additional coverage is not limited to the amount in a. above.
d. A reasonable measure under this Additional Coverage 2. 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 us to inspect.
e. This coverage does not:
(1) Increase the limit of liability that applies to the covered property; or
(2) Relieve you of your duties, in case of a loss to covered property, described in C.5. under Section I – Conditions.
(3) Pay for property not covered, or for repairs resulting from a peril not covered, or for loss excluded in this policy.
. . .
13. "Fungi", Wet or Dry Rot, or Bacteria.
a. We will pay up to $10,000 for:
(1) The total of all loss payable under Section I – Property Coverages caused by "fungi", wet or dry rot, or bacteria;
(2) The cost to remove "fungi", 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", 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", 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", wet or dry rot, or bacteria.
b. The coverage described in a. 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. $10,000 is the most we will pay for the total of all loss or costs payable under this Additional Coverage regardless of the:
(1) Number of locations insured; or
(2) Number of claims made.
d. If there is covered loss or damage to covered property not caused, in whole or in part, by "fungi", 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", wet or dry rot, or bacteria cause 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 applying to the damaged covered property.
. . .
SECTION I – PERILS INSURED AGAINST
A. Coverage A – Dwelling and Coverage B – Other Structures.
We insure against direct physical loss to property described in Coverages A and B.
We do not insure, however, for loss:
1. Excluded under Section I – Exclusions;
. . .
3. Caused by:
. . .
e. Accidental discharge or overflow of water or steam; unless loss to property covered under Coverage
A or B results from an accidental discharge or overflow of water or steam from within a plumbing, heating, air conditioning or automatic fire protective sprinkler system or household appliance on the "residence premises."
Loss to property covered under Coverage A or B that results from an accidental discharge or overflow of water or steam from within a plumbing, heating, air conditioning or automatic fire protective sprinkler system or household appliance on the “residence premises” includes the cost to tear out and repair only that part or portion of the building, or other structure covered under Coverage A or B, on the "residence premises," necessary to access the system or appliance.
The cost that we will pay for the tear out and repair of the part or portion of the building or other structure covered under Coverage A or B as specified above is limited to only that part or portion of the covered building or other structure which is necessary to provide access to the part or portion of the system or appliance that caused the covered loss, whether the system or appliance or any part or portion of the system or appliance, is repairable or not.
In no event will we pay for the repair or the replacement of the system or appliance that caused the
covered loss.
We do not cover loss:
(1) To the system or appliance from which this water or steam escaped;
(2) On the “residence premises” caused by accidental discharge or overflow which occurs off the “residence premises”;
(3) Caused by constant or repeated seepage or leakage of water or steam or the presence or condensation of humidity, moisture or vapor, over a period of weeks, months or years, unless such seepage or leakage of water or the presence or condensation of humidity, moisture or vapor and the resulting damage is unknown to all "insureds" and is hidden within the walls or ceilings or beneath the floors or above the ceilings of a structure;
(4) To a plumbing system, whether above or below the ground, caused by:
(a) Age, collapse, obsolescence, wear, tear;
(b) Fading, oxidization, weathering;
(c) Deterioration, decay, marring, delamination, crumbling, settling, cracking;
(d) Shifting, bulging, racking, sagging, bowing, bending, leaning;
(e) Shrinkage, expansion, contraction, bellying, corrosion;
(f) The unavailability or discontinuation of a part or component of the system; or
(g) Any other age or maintenance related issue;
(5) To a plumbing system, whether above or below the ground, caused by the impairment, state or condition of the system, which prohibits repair or replacement including access, necessary to connect the adjoining parts of appliances, pipes or system; or
(6) Loss otherwise excluded or limited elsewhere in the policy.
For purposes of this provision, a plumbing system or household appliance does not include a sump, sump pump, irrigation system or related equipment or a roof drain, gutter, down spout or similar fixtures or equipment.
f. Any of the following:
(1) Wear and tear, marring, deterioration, decay;
(2) Mechanical breakdown, latent defect, inherent vice or any quality in property that causes it to damage or destroy itself;
(3) Smog, rust or other corrosion;
. . .
If any of these cause water damage not otherwise excluded or limited elsewhere in the Policy, from a plumbing, heating, air conditioning or automatic fire protective sprinkler system or household appliance, we cover loss caused by the water including the cost to tear out and repair only that part or portion of the building or other structure covered under Coverage A or B, on the “residence premises” necessary to access the system or appliance.
The cost that we will pay for the tear out and repair of the part or portion of the building or other structure covered under Coverage A or B as specified above is limited to only that part or portion of the covered building or other structure which is necessary to provide access to the part or portion of the system or appliance that caused the covered loss, whether the system or appliance, or any part or portion of the system or appliance, is repairable or not.
In no event will we pay for the repair or the replacement of the system or appliance that caused the covered loss.
We do not cover loss to the system or appliance from which this water or steam escaped.
For purposes of this provision, a plumbing system or household appliance does not include a sump, sump pump, irrigation system or related equipment or a roof drain, gutter, downspout or similar fixtures or equipment.
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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 Insureds’ property was severely damaged on July 19, 2025, as the result of a failed plumbing component that allowed a sudden and accidental escape of sewage water to damage the Property. While the shower was being used by one Insured and the toilet was flushed by the other, sewage water quickly rushed up and escaped out from around the base of the toilet in the bathroom. The loss was discovered when the Insured finished using the shower and stepped onto the bathroom rug and found it saturated with water. The Insureds took action immediately upon discovering the loss and did their best to mitigate the immediate damage, drying the area to the best of their ability and ceasing use of the master bathroom. However, the Insureds quickly realized that a similar escape of sewage water occurred each time the guest bathroom was used, and was causing water to not only escape from around the toilet, but to overflow into the shower. The Insureds documented the damage with photographs and videos showing sewage water coming through the pipes and damaging the Property each time the bathrooms were used. They contacted a plumber, but were advised the plumber would not be available for 4-5 days. While they awaited the plumber’s assistance, the Insureds submitted a claim to their Insurance Company on or about January 22, 2025. The Insurance Company acknowledged receipt of the loss and assigned a field adjuster to inspect the Property on or about January 23, 2025. Unfortunately, the Insurance Company relied upon an unqualified, outcome-oriented field adjuster who approached the loss with an eye towards denial. The field adjuster conducted nothing more than a cursory visit to the Property, taking photographs of the master bathroom but failing to conduct any other more substantive investigation. During the superficial inspection, the field adjuster refused to go into any other room in the home, although the Insureds advised that the same issue occurred in the guest bathroom. The field adjuster left, advising the Insureds that a desk adjuster would be in touch.
The following day, on or about January 24, 2025, the Insurance Company sent a mitigation company to dry out the Property. The mitigation company removed the baseboards around the toilet area in the master bathroom and set up fans that were left in place for one week. When the mitigation company returned a week later, its moisture meter still indicated a high concentration of water in the affected area, which prompted the company to drill holes into the walls to assist in the dry out. Fans were left in place for 2-3 additional days but were thereafter removed even though the moisture meter still indicated some saturation. The Insureds implored the mitigation company to check the moisture readings in the other bathrooms, since the Carrier’s field adjuster had failed to inspect those areas. The mitigation company revealed elevated moisture levels in the guest bathroom, as well. Yet, no remediation equipment was used to dry the area. The Insureds anxiously awaited word from the Carrier, as they were left with an only a partially dried home, unrepaired holes drilled in the walls, and unusable bathrooms.
Next, the Insureds retained A1 Underground & Plumbing Service, LLC on or about January 28, 2025, to conduct an inspection of the plumbing lines. A1 identified cracks in the cast iron piping below the foundation that caused the drainage issues and allowed the escape of sewage water to damage the Property and leach into the soil below. A1 issued a recommendation to replace the cast iron drains.
Concerned with the field adjuster’s lack of thoroughness, especially given the incomplete dry out performed by the mitigation company, the plumber’s identification of cracks in the drain lines, and video taken by the Insureds on or about February 3, 2025, showing sewage water rising from the pipes in the shower and pouring out from under the toilet in the bathroom, the Insureds made the decision to retain a public adjuster to assess the full extent of the damage to the Property and provide the Carrier with a clear picture of the totality of the loss. The Insureds retained Sharp Adjusting and Consulting Services on or about February 1, 2025. The Public Adjuster completed a thorough inspection of the Property and prepared an estimate detailing the total repairs necessary to restore the Property back to its pre-loss condition. In completing the estimate, the Public Adjuster consulted with Kunes Plumbing, LLC, a plumber retained by the Insureds to provide a proposal to access and replace the damaged cast iron drain lines. Kunes prepared two proposals to address the plumbing failure(s) – the first to access and replace the plumbing lines by tunneling under the foundation of the home, and the second to complete the work by trenching through the slab of the home to directly access the failed line(s). The Public Adjuster incorporated Kunes’ data into the estimate to restore the Property from the July 19, 2024, water loss. The estimate addresses necessary repairs to the master bathroom, master bedroom, master closet, and bathroom 3, all of which were severely damaged by the dirty water loss. The estimate also acknowledges that water from the bathrooms migrated to the garage and resulted in water staining and damage and affected the kitchen cabinetry by saturating the area with sewage water. Finally, the estimate includes replacing tile floor covering throughout the Property, as the flooring will be damaged from trenching to repair the plumbing lines. In total, the estimate recognizes $172,125.36 in repairs necessary to restore the Property to its pre-loss condition.
Astonishingly, despite being provided video and photographic evidence of the active water loss showing damage to the Property caused by the escape of sewage water, the Insurance Company took a wholly unsupported and baseless position on February 5, 2025, when it issued its coverage determination letter denying coverage for the loss. The Insurance Company relied entirely on its unqualified field adjuster’s opinion rendered after only a single, hasty visit to the Property wherein the field adjuster failed to set foot in any other room except the master bathroom. Without conducting any meaningful inspection of the Property, the field adjuster surprisingly and unjustifiably concluded that “no physical damage was observed to covered property.” The Insurance Company accepted that the Property did not suffer any “physical damage,” and even went so far as to conclude that “the property was successfully mitigated” – although the mitigation company acknowledged an elevated moisture reading – even after days of remediation – and left the Insureds with unrepaired holes drilled into the walls of their Home. The Insurance Company cites to the Policy exclusions that exclude coverage for “any building deficiencies consisting of wear and tear, deterioration, or mechanical breakdown,” but misrepresents the Policy’s terms by failing to acknowledge that the Policy affords coverage for any resulting ensuing loss to the Property. The Policy expressly provides coverage for damage that results from an accidental discharge of water from within a plumbing system and specifically includes an additional coverage for the cost to tear out and repair the part of the Property necessary to access the damaged system. The Carrier intentionally misrepresented these available coverages to deny payment to its Insureds.
The Insureds immediately voiced disagreement with the Carrier’s determination and took issue with its outright reliance on its own ill-equipped, outcome-oriented field adjuster’s conclusion without any consideration of the photographs and video depicting the loss, the plumbers’ reports and proposals outlining the necessary repairs, the unrepaired holes in the walls left by the mitigation company, the Public Adjuster’s opinion as to the reasonable scope and value of the loss, or the Policy’s provision of coverage for ensuing damage and access to the damaged plumbing system. Nevertheless, the Carrier refused to reevaluate its position or to conduct any further investigation into the claim.
The Insurance Company’s unfounded denial and refusal to accept coverage and issue payment for the loss has caused an excessive delay in the Insureds’ ability to repair their home, leaving the property vulnerable to additional, exacerbated damage, and leaving the Insureds and their two young children in an unsanitary environment. The Insureds have done everything possible to assist in the Carrier’s investigation – giving notice of the loss as soon as they first became aware of the damage, providing video evidence of the active water loss damaging the Property, furnishing the Public Adjuster’s comprehensive report, estimate and photographs indicating the extent of the damage, sending the plumbers’ reports and proposals indicating the work necessary to repair the Property, and allowing the Carrier every opportunity to inspect the loss even though its field adjuster failed to conduct a sufficient investigation. Still, the Carrier has failed to uphold its contractual obligations to its Insureds and has elevated its interests over those of the Insureds by misrepresenting the relevant facts and Policy’s terms to justify a denial of coverage.
As a direct and proximate result of the Insurance Company’s improper handling and adjustment of the Insureds’ claim, its baseless and unsupported denial, and refusal to acknowledge coverage and issue payment, its intentional, material misrepresentation of the relevant facts and coverages available under the Policy for the purpose and with the intent of denying coverage based on less favorable terms than those provided in the Policy, and its bad faith conduct, the Insureds have been forced to first hire a public adjuster and then retain counsel to force the Insurance Company to compensate them fully and fairly for their significant loss. The Insureds have and will continue to incur and unnecessarily suffer damages, including costs to prosecute their claim, attorney’s fees, and delay damages if the Insurance Company does not retain competent, qualified, and unbiased representatives, participate in good faith adjustment practices, acknowledge coverage for the loss and communicate with the Insureds’ representative(s) to negotiate a fair compromise of the claim within 60 days of the filing of this Civil Remedy Notice.
The failure of the Insurance Company to fully and completely compensate the Insureds demonstrates either inexcusable negligence or an intentional decision to elevate its own interests over those of its Insured. The Insurance Company’s refusal to properly investigate, adjust, and fully compensate the Insureds for the claim evidences the Insurance Company’s violation of sections 626.9541(1)(i)(3)(a) and (d), Florida Statutes, which require the Insurance Company to “adopt and implement standards for the proper investigation of claims” and to conduct “reasonable investigations based upon available information.” The Insurance Company made material misrepresentations to its Insureds regarding relevant facts and coverage for the loss for the purpose and with the intent to deny coverage for the claim based on less favorable terms than those provided for in the policy, constituting a violation of section 626.9541(1)(i)(2) and 626.9541(1)(i)(3)(b). Further, the Insurance Company’s unreasonable delay and failure to promptly settle the Insureds’ claim establishes violations of sections 626.9541(1)(i)(4), 624.155(1)(b)(1), 624.155(1)(b)(3), and 627.70131(7)(a).
The actions taken by the Insurance Company in the handling and adjustment of the Insureds’ claim giving rise to the violations addressed herein, including the established pattern of refusing to acknowledge coverage for the loss, relying on an unqualified outcome-oriented adjuster for his unsupported opinions on the loss, refusing to conduct a proper investigation and adjustment of the loss, ignoring facts that support coverage, and misrepresenting pertinent facts and insurance Policy provisions relating to coverages at issue to deny its Insureds due payment occur with such frequency as to indicate a general business practice and these acts are willful, wanton, and in gross disregard for the rights of its Insureds.
The Insurance Company’s actions amount to, but are not limited to:
A. “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 her or his interests;” (Fla. Stat. 624.155(1)(b)(1);
B. “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;” (Fla. Stat. sec. 624.155(1)(b)(3))
C. Claim Delay;
D. Claim Denial; and
D. Unfair Trade Practices
The Insurance Company’s actions further amount to unfair claim settlement practices:
1. A material misrepresentation made to an Insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy; (Fla. Stat. 626.9541(1)(i)(2)).
2. Committing or performing with such frequency as to indicate a general business practice any of the following:
a. Failing to adopt and implement standards for the proper investigation of claims; (Fla. Stat. 626.9541(1)(i)(3)(a))
b. Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; (Fla. Stat. 626.9541(1)(i)(3)(b))
c. Failing to acknowledge and act promptly upon communications with respect to claims; (Fla. Stat. 626.9541(1)(i)(3)(c))
d. Failing to promptly provide a reasonable explanation in writing to the Insureds 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; (Fla. Stat. 626.9541(1)(i)(3)(f)).
In addition to the above statutory violations, the Insurance Company’s adjuster violated the following ethical requirements of Florida Administrative Code 69B-220.201:
(3) Code of Ethics . . . An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance. The following are standards of conduct that define ethical behavior, and shall constitute a code of ethics that shall be binding on all adjusters:
(b) An adjuster shall treat all claimants equally.
2. An adjuster shall adjust all claims strictly in accordance with the insurance contract.
(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
(d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.
(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.
(f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim.
(o) 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.
In Florida, the work of adjusting insurance claims engages the public trust. During the adjustment of the Insureds’ claim, the Insurance Company breached this duty by failing to adhere to and comply with the above referenced obligations. To cure the defects outlined above, the Insurance Company must:
A. Immediately acknowledge coverage for the Insureds’ loss;
B. Tender all insurance proceeds due and owing to the Insureds that would reasonably place the Insureds back into a pre-loss condition;
C. Timely communicate with the Insureds’ representative(s) to complete the adjustment of the Insureds’ loss by participating in good faith negotiations to reach an agreement relating to the parties’ dispute over coverage, scope and amount;
D. Immediately issue payment for statutory interest for any late payments and owed profit/overhead;
E. Act fairly and honestly towards the Insureds and with due regard for their interests;
F. Hire fair, unbiased, and qualified adjuster(s) and expert(s) to properly assess the Insureds’ damages;
G. Timely adjust the claim with the Insureds and avoid/limit any additional delay, costs, and prejudice that the Insurance Company’s conduct above has caused and continues to cause the Insureds; and
H. Participate in good faith claims adjustment to avoid the Insureds incurring unnecessary costs of litigation.
This Civil Remedy Notice is given to perfect the right to pursue the civil remedy authorized by this section.
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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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