Filing Number: 811263
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| Filing Accepted: 3/14/2025 |
| Last/Business Name
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RANDALL
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First Name |
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JASON ; MARY LAUREN |
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| Street Address
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14527 MAILER BLVD., |
| City, State Zip
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ORLANDO,
FL
32828
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| Email Address
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JASON@CBSIGNSORLANDO.COM ; MARYLAUREN@CBSIGNSORLAN |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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RANDALL |
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First Name |
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JASON ; MARY LAUREN |
| Policy # * |
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01999 73 12 91A |
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Claim #* |
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019997312–801 |
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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
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FLORIDA
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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GARRISON PROPERTY AND CASUALTY 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 21253 |
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| Name of individual responsible for violation (if any):*
? ANGELA MINIOR, CLAIM ADJUSTER ON BEHALF OF GARRISON PROPERTY AND CASUALTY 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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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)(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)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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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.
POLICY FORM: HO-3RFL (09-16)
***
SECTION I PROPERTY WE COVER
COVERAGE A - Dwelling protection
We Cover
1. The dwelling on the “residence premises”
shown in the Declarations, including
structures attached to the dwelling;
***
SECTION I - LOSSES WE COVER
COVERAGE A - DWELLING PROTECTION COVERAGE AND COVERAGE B - OTHER STRUCTURES PROTECTION COVERAGE
We insure against “sudden and accidental”, direct physical loss to tangible property described in PROPERTY WE COVER…[.]
***
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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 January 1, 2025, Complainants, Jason Randall and Mary Lauren Randall (hereinafter “Complainant(s)”) suffered a loss at the address referenced above, due to a pipe leak.
On or about January 2, 2025, upon discovering the damage, Complainants retained Plumbing Wizard to conduct an inspection and mitigation work.
That same day, Complainants also retained Five Star Claims Adjusting as their Public Adjuster (hereinafter "Public Adjuster").
On or about January 4, 2025, Plumbing Wizard conducted an initial pre-inspection of the property. During this inspection, it was determined that the damages could require a complete re-plumbing of the home.
On or about January 6, 2025, Mold Check Environmental Consultants performed a mold inspection at the property. Their inspection confirmed the presence of dangerously high levels of mold.
That same day, Complainants retained ServePro to conduct water mitigation services, which commenced immediately.
On or about January 7, 2025, Complainants and their agents promptly reported the loss to Garrison Property and Casualty Insurance Company (hereinafter “Insurer”), along with Public Adjuster's Letter of Representation (“LOR”).
However, despite being in receipt of such representation, Insurer routinely attempted to seek information from Complainants directly.
Throughout Insurer’s investigation, Complainant(s) have fully cooperated with Insurer and fully performed all duties and obligations under the policy by providing all information within Complainant(s) custody, possession and control.
Insurer, however, has failed to fulfill its duties under the Policy and Florida law.
On or about January 9, 2025, Plumbing Wizard began conducting repairs.
On or about January 13, 2025, Public Adjuster conducted an initial inspection of the property and took 112 photographs.
On or about January 23, 2025, Mold Check Environmental Consultants performed an additional mold inspection at the property
That same day, Public Adjuster conducted an additional inspection and took 43 additional photographs of the damages.
On or about January 26, 2025, the mold report from Mold Check Environmental Consultants was finalized, conclusively indicating that the property remained contaminated with mold.
On or about February 11, 2025, Plumbing Wizard issued a $7,450 invoice for services rendered, which, by that time, were substantially complete.
On or about February 18, 2025, Public Adjuster produced a professional estimate totaling $100,871.16 in Actual Cash Value.
This estimate, along with the 155 photographs, were promptly submitted to Insurer.
Subsequently, on or around mid to late-February, a field adjuster conducted an inspection of the property.
On or about March 6, 2025, conveniently just two days before the statutory 60-day deadline set forth by Florida Statute 626.9541(1)(i)(4), Insurer finally issued a so-called "coverage determination letter."
Upon information and belief, Insurer intentionally delayed making a determination until it was statutorily required to do so.
The determination letter, itself, was vague, ambiguous, and completely devoid of any substantive explanation. Insurer’s sole justification for the denial consisted of the following conclusory statement:
“Your policy does not cover wear, tear, marring or deterioration.”
This flawed and improper assertion is wholly inadequate.
Rather than addressing the multiple mold reports, the Public Adjuster’s estimate, the 155 inspection photograph report, the plumbing reports, or the repeated inspections and testing that confirmed the extent of the damage, Insurer chose to disregard the supplemental information and issue a denial in coverage.
By failing to consider the new evidence presented or even slightly investigate the claim, Insurer was in clear violation of Fla. Stat. 626.9541 (1)(i)(3)(d), which prohibits insurers from denying claims without properly evaluating new information.
Instead, it issued a lackluster denial, offering nothing more than selectively quoted policy provisions without any substantive reasoning or supporting documentation.
This failure to provide a meaningful justification is not just inadequate but a blatant attempt to evade accountability. Insurer's refusal to reasonably explain the coverage denial leaves Complainants, an ordinary policyholder, without any reasonable means to assess or challenge the denial. Such conduct is a direct violation of Fla. Stat. 626.9541(1)(i)(3)(f).
Moreover, Insurer failed to even conduct a proper investigation. Insurer’s only inspection of the property was conducted by a field adjuster, a professional who is not qualified to determine the causation of structural damage, mechanical failures, or mold-related losses.
A field adjuster’s role is strictly limited to observing visible conditions and reporting factual findings, not issuing expert determinations regarding structural failures or water intrusion as outlined in Fla. Stat. 626.856.
Yet despite this, Insurer claimed causation was due to wear and tear based solely on an unqualified field adjustment's assessment. This conclusion was made despite the ample time Insurer had to obtain expert analysis or professional engineering reports.
Although Insurer had 58 days to investigate the claim, it is evident that Insurer failed to review or even acknowledge the various supplemental evidence in its possession. Here, Insurer was in clear violation of Fla. Stat. 626.9541(1)(i)(3)(c).
Insurer’s failure to investigate the claim in a proper manner is a blatant violation of Fla. Stat. 626.9541(1)(i)(3)(a), which mandates Insurer to adopt and implement reasonable standards for investigating claims.
It is evident that Complainants and their agents have routinely cooperated beyond their statutory obligation, yet, Insurer has still failed to properly handle the investigation of this claim. Upon information and belief, Insurer has purposely delayed the outcome of the claim, misrepresented pertinent facts and policy provisions and has sought to withhold rightful remedies owed to Complainant.
Complainants have suffered grave health risks due to the damage and presence of mold in the subject property. Each day Insurer fails to fulfill its contractual duty and delays the resolution of this claim, Complainants are faced with severe consequences.
Upon information and belief, Insurer has implemented an unreasonable company-wide policy to rely solely and heavily upon homeowners, most of whom have no background or knowledge in any of the trades involved in diagnosing a loss, to report losses with almost expert accuracy. This policy is not in line with Insurer’s duty a “fair and honest treatment of the claimant” as it seeks only to protect Insurer’s interests.
Overall, it is clear that Insurer wholly failed to investigate causation, having only sent adjusters who are only qualified to document the condition of the Property, and assign repair values.
Based on the events described above, it is clear that Insurer conducted an improper investigation to intentionally minimize its liability, contrary to the policy and Florida law’s requirements. Moreover, Insurer has misrepresented pertinent facts and/or insurance policy provisions relating to coverages at issue, and delayed the resolution of the claim by engaging in conduct to deny or reduce recovery to the Insureds. 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 $111,027.00, 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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