Filing Number: 810860
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| Filing Accepted: 3/12/2025 |
| Last/Business Name
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HERRERA
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First Name |
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SEAN; DIAHANN |
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| Street Address
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13929 CHALK HILL PL, |
| City, State Zip
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RIVERVIEW,
FL
33579
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| Email Address
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SEANHERRERA@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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HERRERA |
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First Name |
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SEAN; DIAHANN |
| Policy # * |
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59BUU5928 |
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Claim #* |
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59-75G9-99M |
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Attorney is Applicable
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| Last Name* |
BRAZ
First Name *
TAMARA
Initial
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| Street Address* |
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8865 COMMODITY CIR. STE. 12 |
| City, State Zip* |
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ORLANDO
,
FL
32819
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| Email Address * |
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TBRAZ@THELAWGICALFIRM.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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STATE FARM FLORIDA 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 10739 |
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| Name of individual responsible for violation (if any):*
• QUILMEKA CREEKS, CLAIMS ADJUSTER, ON BEHALF OF STATE FARM FLORIDA INSURANCE COMPANY; • GREGORY BAKER, EMERGENCY ADJUSTER, ON BEHALF OF STATE FARM FLORIDA 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 Delay
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Claim Denial
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Other
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Improper Investigation
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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)(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)(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)(4) |
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Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
SECTION I – ADDITIONAL COVERAGES
The following Additional Coverages are subject to all the terms, provisions, exclusions, and conditions of this policy.
2. Temporary Repairs. If damage is caused by a loss insured, we will pay the reasonable and necessary cost you incur for temporary repairs to covered property to protect the property from further immediate damage or loss. This coverage does not increase the limit applying to the property being repaired.
***
SECTION I – PROPERTY COVERAGES
COVERAGE A – DWELLING
1. Dwelling. We cover the dwelling and materials and supplies located on or adjacent to the residence premises for use in the construction, alteration, or repair of the dwelling or other structures on the residence premises.
COVERAGE B – PERSONAL PROPERTY
1. Property Covered.
a. We cover personal property owned or used by an insured while it is anywhere in the world. This includes structures not permanently attached to or otherwise forming a part of the reality
***
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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.
On or about October 9, 2024, Sean Herrera and Diahann Herrera (Complainant(s)) suffered a loss to their Property, located at the address listed above. After discovering the damage, Complainant(s) promptly reported the loss to State Farm Florida Insurance Company (“Insurer”).
Throughout the Insurer’s investigation, Complainant(s) have fully cooperated with the Insurer and fully performed all duties and obligations under the policy by providing all information within Complainant(s) custody, possession and control.
The Insurer, however, has failed to fulfill its duties under the Policy and Florida law.
Upon promptly reporting the claim to Insurer, Complainant retained Birds Eye View on or about October 23, 2024 to inspect the property, assess the damages and perform any mitigation work to preserve the subject property.
Subsequently, Birds Eye View placed tarping on Complainants roof and issued an invoice of $4,000.00.
Following such, on or about October 23, 2024, Insurer assigned a field adjuster to inspect the subject property.
On or about November 1, 2024, Insurer sent Complainant a Bill of Rights Letter and a Letter informing Complainant of their duties.
In this letter Insurer stated, “If the damage is caused by a loss insured, we will pay the reasonable and necessary cost you incur for the temporary repairs to covered property to protect the property from further immediate damage or loss.”
This however was a misrepresentation made by Insurer. Complainants did oblige by their contractual duties and performed mitigation work. Insurer, however, failed to acknowledge or compensate Complainants for this mitigation work as promised in the correspondence it authored.
The same day, Insurer issued a pre-mature coverage determination letter. Insurer stated that based on the damages assessed in the pre-cursory inspection by their field adjuster, it was found that the damages incurred to Complainants home fell below the deductible and thus no coverage could be afforded.
In this letter, Insurer stated that they estimated damages to the amount of $5,039.00, however, an estimate was never produced. Here Insurer violated Fla. Stat. 70131(1)(e), by failing to produce an estimate to Complainant within 7 days of generating an estimate.
Insurer denied coverage by using a baseless amount. Insurer failed to produce any form of evidence or supplemental information to support their conclusions. By failing to provide Complainants, in writing, a reasonable explanation for its denial of a claim, Insurer has violated Fla. Stat. 626.9541(1)(i)(3)(f).
Despite denying coverage with little to no information to support its stance, Insurer issued a payment in the amount of $1,260.75 to Complainants on or about November 8, 2024.
Amidst Insurer’s mishandling of the claim, Complainant retained the Lawgical Firm as legal representation and to facilitate the claims process.
On or about December 16, 2024, a Letter of Representation was sent to Insurer on behalf of the Lawgical Firm.
On or about December 26, 2024, Complainants and their agents retained a Loss Consultant on behalf of Property Claims Consultants to inspect the property and assess the damages.
On or about December 26, 2024, the Loss Consultant inspected the subject property and found damages to the amount of $49,672.25. This was nearly 10 times as much as Insurer’s initial assessment.
On or about January 7, 2025, the Loss Consultants estimate was sent to Insurer.
Insurer, however, failed to review, acknowledge or respond to the supplemental evidence that was now in their possession, being in clear violation of Fla. Stat. 627.70131(1)(a). Till date, Insurer has failed to acknowledge this supplemental information.
On or about January 31, 2025, Complainants and their agents executed a Sworn Proof of Loss (“SPOL”), which was then subsequently sent to Insurer. Complainants routinely acted within their statutory and contractual obligation. Insurer, however, never responded, reviewed or acknowledged such SPOL. Here, Insurer has been in violation of Fla. Stat. 626.9541(1)(i)(3)(c), by failing to act promptly or acknowledge critical information regarding claims.
On or about February 22, 2025, 22 days later, Insurer sent Complainants and their agents another estimate finding damages in the amount of $28,305.22. However, Insurer determined a new estimate in damages without ever re-inspecting the property or retaining an engineer.
In addition to the estimate, Insurer sent Complainants and their agents a Summary of Loss Statement that included this new value of damages less the deductible and prior payments and issued payment of $21,482.47 to Complainants.
However, the very same day, Insurer rescinded the payment, issued a stop-pay for the amount of $21,482.47 and issued a new payment of $1,635.67.
Further, Insurer attempted to “revise” their original estimate by showing that it only found damages to the amount of $8,458.42. By deducting the prior payments and deductible, Insurer, now, without any explanation, issued a payment of a mere $1,635.67.
Here, Insurer participated in a various mishandling techniques. Upon information and belief, Insurer is misrepresenting the real damages made to the subject property and withholding the rightful remedies owed to Complainants and their agents.
Insurer is in clear violation of Fla. Stat. 624.155(1)(b)(3), by failing to settle the claim when the obligation to settle has become reasonably clear. Here, Insurer is in possession of all supplemental evidence and Insurer, itself, has identified damages in the amount of $21,482.47. However, Insurer still failed to abide by its contractual duty and has rescinded its payment with no explanation.
Insurer failed to provide any explanation as to why its estimate was revised and where it’s values originated from. Insurer has yet again made a baseless assessment of damages. By altering the estimate to reduce the benefits owed to Complainants and to satisfy an outcome that is most favorable to Insurer, Insurer is in violation of Fla. Stat. 626.9541(1)(i)(2).
Further, on or about February 24, 2025, Complainants and their agents sent a notice that 60-days have passed and Insurer has yet to issue a coverage determination letter.
Insurer, now, in possession of all supplemental evidence, has still refused to review the information. If Insurer is in need of any additional information, it has failed to request such.
Insurer is now in clear violation of Fla. Stat. 626.9541(1)(i)(4), by failing to pay the undisputed amounts owed to Complainants and their agents within the 60-day statutory requirement.
It is evident that Complainants and their agents have cooperated beyond their statutory obligation and yet Insurer has misrepresented the policy and has purposely delayed the outcome of this claim.
These tactics are believed to be the general business practices of this Insurer.
Insurer can cure its bad faith conduct by: 1) accepting the Insureds’ damage claim as compensable, and agreeing to pay the claim in accordance with the policy in the amount of $50,775.83, plus interest, prior to the expiration of the cure period, 2) reviewing and responding to all communications from the Insureds and their agents, including the request for a complete copy of the Policy.
PLEASE GOVERN YOURSELF ACCORDINGLY.
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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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