Filing Number: 811626
|
| Filing Accepted: 3/18/2025 |
| Last/Business Name
*
|
|
|
AUSLANDER
|
|
First Name |
|
ROBERT |
|
| Street Address
*
|
|
1395 MONTEREY BLVD., NE |
| City, State Zip
*
|
|
ST. PETERSBURG,
FL
33704
|
| Email Address
*
|
|
ROBAUSLANDER@YAHOO.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
AUSLANDER |
|
First Name |
|
ROBERT |
| Policy # * |
|
80BZQ6750 |
|
Claim #* |
|
597SG109J |
|
Attorney is Applicable
|
| Last Name* |
FANTETTI
First Name *
KELLY
Initial
A
|
| Street Address* |
|
109 S. EDISON AVENUE |
| City, State Zip* |
|
TAMPA
,
FLORIDA
33606
|
| Email Address * |
|
KFANTETTI@STOCKHAMLAWGROUP.COM |
|
|
| Insurer Type
*
|
|
Authorized Insurer
Unauthorized Insurer
|
|
|
| Insurer Name |
|
|
| Insurer Name* |
|
STATE FARM FLORIDA INSURANCE COMPANY
|
| Insurer Name* |
|
|
| Street Address* |
|
|
| City, State Zip* |
|
,
|
|
NAIC Company Code 10739 |
|
|
| Name of individual responsible for violation (if any):*
MI’TUAN BURNEY; ETHAN SANCHEZ; NEIL OCHOA; MIKE RUSSELL
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
Unsatisfactory Settlement Offer
|
|
Claim Delay
|
|
Unfair Trade Practice
|
|
Other
:
Insufficient Investigation
|
|
|
*
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.
|
| 626.9541(1)(i)(2) |
|
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.
|
| 626.9541(1)(i)(3)(a) |
|
Failing to adopt and implement standards for the proper investigation of claims.
|
| 626.9541(1)(i)(3)(b) |
|
Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
|
| 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.
|
| 626.9541(1)(i)(3)(e) |
|
Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
|
| 626.9541(1)(i)(3)(f) |
|
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.
|
| 626.9541(1)(i)(3)(g) |
|
Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
|
|
*
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 – LOSSES INSURED
COVERAGE A – DWELLING
We will pay for accidental direct physical loss to the property described in Coverage A, unless the loss is excluded or limited in SECTION I – LOSSES NOT INSURED or otherwise excluded or limited in this policy.
SECTION I – CONDITIONS
8. 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 received payment.
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
In Florida, the work of adjusting insurance claims engages the public trust. State Farm Florida Insurance Company (“State Farm”) has breached the public’s trust by its adjustment of Robert Auslander’s (“INSURED”) claim of loss. State Farm Florida Insurance Company’s address is P.O. Box 2356, Bloomington, Illinois 61702-2356.
State Farm has failed to create and implement adequate guidelines for the proper investigation and evaluation of claims, claims handling, and for training and supervision of employees resulting in statutory violations as set forth above. State Farm has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the INSURED’S insurance claim for damages.
State Farm has failed to promptly settle the INSURED’S insurance claim when the obligation to settle the insurance claim had become reasonably clear. To date, notwithstanding the INSURED’S pleas otherwise, State Farm has continued to refuse to acknowledge its obligation to conduct a proper investigation, and to tender the full amount of insurance monies due and owing its INSURED under the policy. Rather, State Farm has partially denied and underpaid the claim without conducting a reasonable investigation of the available information.
This claim involves the INSURED’S property located at 1395 Monterey Blvd., NE, St. Petersburg, Florida 33704, which sustained significant damage from Hurricane Milton on October 9, 2024. The INSURED has damage to their roof, living room and bedroom windows, garage door, and flooring.
The claim was promptly reported to State Farm, who accepted coverage for the loss, but initially determined that the damages fell below the Insured’s deductible. Therefore, the Insured was forced to retain a public adjuster.
Thereafter, State Farm reinspected the property with the public adjuster and a roofer, and the roofer advised that the roof could not be repaired due to the nail holes from the tarps. Nevertheless, State Farm continues to reject a full roof replacement, claiming that the tarping was excessive. However, State Farm’s own policy requires the insured to perform emergency measures, such as tarping, to mitigate against further damage, and if the tarping is improper, then the policy provides that State Farm can subrogate against the tarping company.
Likewise, State Farm claimed that the water damage to the ceilings throughout the house, was caused by the improper tarping, when, in fact, the ceiling stains occurred immediately as a result of Hurricane Milton and were the reason that the roof was tarped in the first place.
Additionally, State Farm has refused to pay for the water damage to the downstairs flooring, asserting that it was damaged by flooding. In fact, there was no flooding in the area of the INSURED’s home, and the flooring damage is directly underneath the damaged windows.
Ultimately, State Farm completed a revised estimate that totaled just $35,040.16. The estimate includes $4,511.26 in depreciation, and the policy has a $21,994.00 deductible. Therefore, State Farm issued a payment of just $8,534.90. However, in the payment letter, State Farm misrepresented that the deductible was $8,654.00 and that $21,994.00 had been applied in depreciation.
Regardless, the Insured has obtained an estimate from a general contractor, CNI Concepts, which has estimated the damages at $178,243.24. This estimate has been provided to State Farm, but State Farm has refused to further adjust the claim.
The concept of insurance is that the insurer will investigate and grant timely and prompt indemnity or security against a contingent loss. Florida Statute §624.02 defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies. Inherent in that definition is the fact that payment must be made timely and promptly so that the INSURED may mitigate his damages and be put back into the position he was in prior to the loss as quickly as possible. State Farm has breached this duty.
The INSURED was, and still is, forced to expend out of pocket monies to submit his insurance claim, e.g., retaining an attorney and other experts to force State Farm to honor its obligations under the insurance policy and to pay all the insurance proceeds due and owing to him.
State Farm has refused and/or failed to tender all the insurance proceeds due and owing to the INSURED. State Farm’s refusal and/or failure to settle the insurance claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards the INSURED is wrongful conduct. Furthermore, the INSURED contends that State Farm’s adjusters and/or representatives financially benefit from such wrongful conduct.
To cure the defects outlined above, the Insurer must: (1) promptly tender all insurance proceeds due and owing to the Insured that would reasonably place the Insured back into the pre-loss condition, including the tender of accrued interest due and owing to the Insured; (2) promptly and timely communicate with the Insured’s representative(s) to complete the adjustment of the Insured’s loss by participating in good faith negotiations to reach an agreement relating to the parties’ dispute over coverage, scope and amount.
This notice is given in order to perfect the right to pursue the civil remedy authorized by Fla. Stat. §624.155.
|
|
*
|
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.
|
DFS-10-363
Rev. 10/14/2008
|