Filing Number: 813547
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| Filing Accepted: 3/27/2025 |
| Last/Business Name
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CARGILL
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First Name |
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RICHARDETTE |
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| Street Address
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19122 SW 55TH ST |
| City, State Zip
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MIRAMAR,
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33029
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| Email Address
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RECORDS@LAROCHELEGAL.COM |
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Insured |
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| Last/Business Name* |
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CARGILL |
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First Name |
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RICHARDETTE |
| Policy # * |
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80-CK-G322-6 |
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Claim #* |
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59-77D5-79D |
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Attorney is Applicable
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| Last Name* |
LAROCHE
First Name *
NIXON
Initial
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| Street Address* |
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7971 RIVIERA BLVD #108 |
| City, State Zip* |
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MIRAMAR
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FL
33023
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| Email Address * |
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NIXON@LAROCHELEGAL.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 FIRE AND CASUALTY 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 25143 |
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| Name of individual responsible for violation (if any):*
BRANDON ROBB
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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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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Statutory provision(s) which the insurer allegedly violated.
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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)(e) |
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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.
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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.
Governed by the cited authorities, the insurance policy (“Policy”) provides coverage on an “all risk” basis, which clearly, unambiguously and per well-settled Florida Supreme Court case law, requires the insurer, with limited exception as detailed below, to issue payment for all losses and damages that arise during the Policy period as a consequence of direct physical loss to property. The only exceptions being: fraud; intentional damage; and/or the evidentiary determination that a Policy exclusion or limitation applies. That said, and in order to lawfully assert any exclusion and/or limitation, the insurer must have a good faith basis to conclude that it can prove the application thereof by a preponderance of the evidence gathered while at the same time fulfilling its legal duty to promptly investigate and adjust the claim.
At a very minimum, the insurer is required to issue payment for any losses or damages for which such exceptions and/or limitations cannot be promptly verified per the evidentiary considerations referenced, and for an amount that corresponds with the actual cash value of the loss, or the amount necessary to perform repairs in relation to the losses or damages.
F.A.C. 69B-220.201(3): Code of Ethics. The work of adjusting insurance claims engages the public trust. 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:
69B-220.201(3)(b): An adjuster shall treat all claimants equally.
F.A.C. 69B-220.201(3)(b)2.: An adjuster shall adjust all claims strictly in accordance with the insurance contract.
F.A.C. 69B-220.201(3)(c): An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
F.A.C. 69B-220.201(3)(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.A.C. 69B-220.201(3)(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.
F.A.C. 69B-220.201(3)(j): An adjuster shall not knowingly fail to advise a claimant of the claimant’s claim options in accordance with the terms and conditions of the insurance contract.
F.A.C. 69B-220.201(3)(k): 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.
F.A.C. 69B-220.201(3)(m): An adjuster shall not knowingly fail to advise a claimant of the claimant’s claim rights in accordance with the terms and conditions of the contract and of the applicable laws of this state. An adjuster shall exercise care not to engage in the unlicensed practice of law as prescribed by the Florida Bar.
F.A.C. 69B-220.201(3)(m)69B-220.201(3)(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.
69J-166.031 Selectively and detrimentally choosing which alternative dispute resolution to utilize.
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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 Complainant and insured RICHARDETTE CARGILL (“including their authorized representative and collectively referred to as “Complainant”), maintained a homeowner’s policy of insurance (“Policy”) with STATEFARM INSURANCE COMPANY (SFIC), which generally and broadly provided coverage for any direct physical loss to the property (“Insured Property”) that occurred during the Policy period. The only exceptions being, for which SFIC carries the evidentiary burden to prove by a preponderance of the evidence, are: fraud; intentional damage; and/or the qualification of a Policy exclusion or limitation that is specified and disclosed to the Complainant. That said, and although many days have passed since the claims for losses and damages were presented for payment under the Policy, SFIC has failed to specify and disclose the evidentiary considerations to support the basis for not fully compensating the losses and damages as presented in various forms.
In terms of providing further background, there were damages and losses that arose due to the following event (referred to as the “Covered Loss”), which was acknowledged and identified by SFIC as follows.
1. Identified by Claim Number 59-77D5-79D, a wind and rain event associated with Hurricane Milton, which made landfall on or about October 9, 2024, including ensuing damages arising from the substantially compromised structure/roof.
By the very nature of the subject claim, SFIC was well-aware from the onset of the overlapping damages and the fact that they did not possess competent and substantial evidence to qualify a policy exclusion or limitation so as to avoid the liabilities that could be clearly and promptly assessed (provided that SFIC had complied with honest and ethical methods and means of so doing as described in great detail below). Point in fact, SFIC has breached its duty to issue payment for the losses and damages in various forms, including, but not limited to failing to disclose a singular expert opinion or duly qualified evidentiary consideration to substantiate the refusal to perform as demanded by the Complainant; through admission and/or omission of its authorized representatives, evidencing that there was no lawful basis to delay payment as demanded, or for that matter, comply with its duty to set forth all reliable findings of fact that serve to bar and/or limit payment pursuant to specific policy provisions associated therewith.
The Covered Loss caused substantial, direct and consequential damages, and SFIC’s general business practice of willful, wanton, immoral, deceptive and bad faith claim handling policies, procedures, guidelines, protocol, adjusting, investigating, drawing valuations and issuing patently deficient and unduly delayed payments for the claims has caused the Complainant to suffer further harm and extra-contractual damages which have accrued, and will continue to accrue. The stated misconduct is collectively referred to as “Bad Faith,” and the specific factual and/or legal considerations in relation thereto are further outlined below for their consideration in accordance with Fla. Stat. Sec. 624.155 and the cited legal authorities associated therewith.
1.) SFIC insures many homes throughout the South Florida area wherein the Insured’s residence is located. That said, and even though SFIC knows that it has a fiduciary duty to its insureds whose residences are located in a high-risk zone for hurricane and/or other weather related damages, it failed to institute the necessary policies, procedures, guidelines, protocol, personnel and contingencies in relation to fully, promptly and equitably indemnifying its insureds who were impacted in mass by the devastating and widespread impact of Hurricane Milton. Consequently, insureds such as the Complainant were forced to: fend for themselves to mitigate damages arising from SFIC’s Bad Faith; incur out of pocket expenses (including interest on monies borrowed to perform necessary repairs) that SFIC was required to afford pursuant to the Policy; absorb the burden, expense, inconvenience and delay associated with an insurer who was not equipped (because they didn’t want to incur the expense associated therewith) to meet their contractual obligations; risk health hazards associated with the presence of moisture and/or mold due to SFIC’s failure to perform pursuant to the Policy; hire experts/professionals/counsel to force SFIC to abide by their fiduciary duty and mitigate the consequential damages associated with SFIC’s failure to perform with the interests of their insureds; etc.
2.) SFIC knew that hurricane damages are of a nature that a thorough, nuanced and specialized investigation/adjustment of the claim needs to be promptly performed by qualified and duly prepared personnel in order to protect their insureds, satisfy their fiduciary duties, and otherwise not engage in the Bad Faith claim handling practices at issue. That said, to the detriment of its insureds and to maximize their financial interests, SFIC disregarded the obvious and known obligations by way of the following:
(a.) Not developing, maintaining and/or instituting policies, procedures, protocol or guidelines to determine whether adjusters/personnel/vendors utilized to protect their insureds were qualified and equipped to work with their “desk adjusters” in order to duly and equitably assess the scope and/or value of the loss or damages.
(b.) By way of the cited legal authorities and considerations, SFIC knew that it would have to promptly hire a significant volume of licensed roofers, contractors, uniquely qualified adjusters and/or engineers to fully, equitably and honestly assess the scope and/or value of the loss or damages suffered by their insureds. Although SFIC will promptly hire such experts to establish a lack of coverage as it relates to a specific claim in which they determine coverage may be in dispute, they choose to avoid such expense when it is deemed to not be in their own financial interest to do so at the onset of the claim.
(c.) By way of the cited legal authorities and considerations, SFIC knew that it would be in their insureds’ interests and their obligation under the insurance policy to utilize personnel/vendors to perform moisture meter assessments throughout the insured property to honestly assess the full extent of damages and losses suffered by their insureds. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, SFIC knows that it does not serve their financial interest since it will increase their financial obligations to insureds such as the Complainant. Once again though, and although SFIC will implement such methods to establish a lack of coverage as it relates to a specific claim in which they determine coverage may be in dispute, they choose to avoid such expense for self-gain when they know that the claim is covered and the comprehensive adjustment and investigation of the claim will only serve to expand their immediate liabilities to the insureds per the Policy. In the interest of limiting redundancy in relation to SFIC’s motivation and the willful nature of the general Bad Faith scheme, notice of the issues at hand (which serves to establish willfulness and eliminates any considerations of negligence or mistake) has been exhaustive provided by way of, amongst other things, civil remedies notices such as the one in question, qualified experts that the industry relies upon, qualified adjusters and lawyers that rely upon reliable authoritative sources and well recognized industry standards, etc. Nonetheless, monies are withheld for unjust business interests that they wish to advance by way of the Bad Faith practices at hand.
(d.) By way of the cited legal authorities and considerations, SFIC knew that it would be in their insureds’ interests and their obligation under the insurance policy to utilize personnel/vendors to perform thermal imaging assessments throughout the insured property to honestly assess the full extent of damages and losses suffered by their insureds. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, SFIC avoids same to maximize their financial interest for the reasons detailed.
(e.) By way of the cited legal authorities and considerations, SFIC knew that it would be in their insureds’ interest, and their obligation under the insurance policy, to utilize personnel/vendors to perform detailed, thorough, reliable and qualified assessments of any structural component of the home in which moisture made entry into the home, or per the totality of the circumstances, such structural evaluations were reasonable in order to ensure that latent conditions were promptly accounted for. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, SFIC avoids same to maximize their financial interest for the reasons detailed.
(f.) By way of the cited legal authorities and considerations, SFIC knew that it would be in their insureds’ interest, and their obligation under the insurance policy, to retain a license mold assessor to determine whether there were concealed toxic conditions within the home which necessitated mold remediation and the need for their insureds to take precautionary measures to preserve their physical health and property interests. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, SFIC avoids same to maximize their financial interest for the reasons detailed.
(g.) By way of the cited legal authorities and considerations, SFIC knew that it would be in their insureds’ interest, and their obligation under the insurance policy, to promptly issue payment for professional/qualified moisture assessments and remediation (per industry standards and/or IICRC guidelines) in order to, inter alia, avoid: the development of hazardous/toxic conditions within the residence; preclude the insured from suffering consequential and extra-contractual damages; the development of an uninhabitable residence and various risks that may develop; etc. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, SFIC avoids same to maximize their financial interest for the reasons detailed.
(h.) By way of the cited legal authorities and considerations, SFIC knew that it would be in their insureds’ interest, and their obligation under the insurance policy, to promptly agree to issue, in unabated form, payment for mold assessments and mold remediation, in order to, inter alia, avoid: a delay due financial constraints of the insureds and/or their lack of specialized knowledge; the development of hazardous/toxic conditions within the residence; preclude the insured from suffering consequential and extra-contractual damages; the development of an uninhabitable residence and various risks that may develop; etc. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, SFIC avoids same to maximize their financial interest for the reasons detailed.
(i.) By way of the cited legal authorities and considerations, SFIC knew that it would be in their insureds’ interest, and their obligation under the insurance policy, to utilize a license mold remediator to consider a licensed mold assessor’s assessments and protocol (pre and post remediation) in order to honestly determine the true scope and value of damages and/or the losses, which includes: the scope of rebuild that needs to be performed therewith; extending coverage for additional living expenses that are subject to being incurred in association therewith and the various other considerations set forth herein; assessing and extending coverage for personal property that may be either damaged due to latent conditions, or subject to being accounted for in relation to moving, storage and resetting costs associated therewith; etc. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, SFIC avoids same to maximize their financial interest for the reasons detailed.
(j.) By way of the cited legal authorities and considerations, SFIC knew that it would be in their insureds’ interest, and their obligation under the insurance policy, to carefully consider all policy terms that afford coverage for losses and damages as the obligation to pay was made reasonably clear, and thereafter utilize counsel when an adjuster is in doubt to advise them on a claim by claim basis whether in fact they are duly indemnifying their insureds. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, SFIC avoids same to maximize their financial interest for the reasons detailed.
(k.) By way of the cited legal authorities and considerations, SFIC knew that it would be in their insureds’ interest, and their obligation under the insurance policy, to carefully evaluate on a claim by claim basis whether any amounts appropriated for “depreciation” are based on sufficient facts and data, reliable principles and methods, and/or the application of reliable principles and methods. In reality, SFIC knows that it is arbitrarily, capriciously, deceptively, willfully and wantonly appropriating depreciation without any claim/item specific consideration to justify same. In the aggregate, and unbeknownst to its insureds, this sham Bad Faith practice allows SFIC to unjustly avoid millions of dollars in benefits owed to its insureds who are consequently placed in a position wherein they are financially coerced and/or deceptively induced to: accept a coerced and unjust settlement offer; leave their home in a state of disrepair, or alternatively, resort to handymen and/or non-licensed vendors to perform makeshift repairs which create secondary risks and potential damages that SFIC will deny coverage for when they arise; abandon claims due to a lack of specialized knowledge; etc.
(l.) By way of the cited legal authorities and considerations, SFIC knew that it would be in their insureds’ interests and their obligation under the insurance policy to carefully evaluate on a claim by claim basis, and only after equitably and fully investigating/adjusting claim, the amounts owed to the insured for: overhead and profit associated with the insured’s reasonable need to utilize a general contractor; taxes associated with the repairs; permit costs associated with the repair; costs associated with various licensed trades that will be needed to effectuate the repairs; whether benefits are owed to the insured for loss of use and/or additional living expenses; personal property that may have been affected by toxic/mold/moisture conditions that developed in the home; costs associated with maintaining the continuity of the finish/appearance for pairs or sets such as cabinets, flooring, roof covering/tile/shingles, walls, ceilings; etc.
(m.) By way of the cited legal authorities and considerations, SFIC knew that it had an obligation to ensure that software programs, data bases and adjusting practices utilized to estimate the scope and value of the loss were being utilized in form that: honestly and fully delineated the line item repairs or costs that needed to be performed; pricing corresponded with licensed professionals - as opposed to handyman or non-licensed professionals; accounted for consideration of actual expenditures incurred by the insureds or otherwise compensable expenses on a repair/replacement cost basis; etc. Ultimately, SFIC knows that the adjusting practices are guided towards unlawfully depriving their insureds of benefits owed under the insurance policy, which in the aggregate, serves to facilitate the non-payment of millions of dollars that would be owed to its insureds who reasonably, but ultimately mistakenly, rely upon the representations of their insurer who is legally obliged to act in their insured’s best interest due to the specialized nature of fairly and lawfully adjusting a claim.
(n.) By way of the cited legal authorities and considerations, SFIC knew that it had an obligation to honestly, promptly, in continuity, reliably and fairly communicate with its insured in relation to their rights and obligations under the policy, evidentiary/factual basis for payment and/or nonpayment, policy conditions and/or exclusions which are being considered in relation to payment and/or non-payment; etc. Not only has SFIC disregarded said duty, they know that it serves their financial interest to not provide delineated and detailed disclosures, since the lack of clarity working in combination with delay tactics serves (i.e. using policy conditions as an inequitable shield) to deter a large volume of insureds from lawfully pursuing claims to conclusion and/or in full.
(o.) By way of the cited legal authorities and considerations, SFIC knew that it had an obligation to treat all insureds equally and honestly. However, and for their own financial interest, they will only start to fully consider their obligations as stated herein if the insured retains legal representation and pursues a legal action which exposes them to liabilities and costs associated with, inter alia, Fla. Stat. Secs. 627.428 (and/or 626.9373), 54.071 and 624.155. Even then, and knowingly, they will withhold monies owed in an unjust effort to limit/delay their liabilities in relation to the statutory considerations and otherwise
(p.) By way of the cited legal authorities and considerations, and even after litigation ensues, SFIC knows that it has a continuous and ongoing duty to not engage in the Bad Faith conduct that is the subject of this Complaint. However, and to advance their own financial interest and avoid the liabilities pursuant to the above cited statutory authorities, they will direct and utilize non-qualified counsel to delay the equitable and prompt payment of the claim via litigation practices (i.e. formulaic defenses, inequitable defense that rely upon technical, misleading, non-consequential considerations of policy conditions, etc.) that are not driven to promptly advance the adjudication of the claim on its merits. Moreover, they will insist upon the insured’s non-compliance with post-loss obligations, when in reality, SFIC was the one that did not comply with its own post-loss obligations and therefore forfeited per the breach of the policy its ability to demand the insureds compliance.
(q.) By way of the cited legal authorities and considerations, SFIC knows that it has to assess the application of the policy deductible on a case by case basis, and only after the claim is fully adjusted and investigated. This practice is necessary to protect the interests of the insureds since, pursuant to binding precedent and the policy, the deductible is subject to being absorbed by losses and/or damages that exceed a limitation of coverage under a certain section of the policy.
(r.) By way of the cited legal authorities and considerations, SFIC knows that it has a duty to duly assess whether benefits are owed to the insured in relation to porous and semi-porous personal property that it knows has been exposed to moisture, contaminants and mold. It is widely accepted in the industry that said personal property must be inventoried, assessed, and then adjusted and paid per considerations of specialized cleaning costs and/or the value thereof per the policy’s loss payment provisions. Such practice is a simple, efficient and industry wide accepted means of protecting their insureds, however, SFIC avoids same to maximize their financial interest for the reasons detailed.
(s.) By way of the cited legal authorities and considerations, SFIC knows that it has duty to issue payment for interest owed in relation to payments that were untimely issued per governing authorities. With that said, and to the detriment of the insureds, it foregoes and/or delays such considerations in order to maximize its financial interests.
(t.) By way of the cited legal authorities and considerations, SFIC knows that it has a duty to consider the specific circumstances which served to create damages to the insured property. Although Hurricane Milton had in certain areas a fairly-consistent and wide spread impact, they fail to account for readily available weather data, consideration of the surrounding terrain (i.e. open body of water or field that increases the wind speeds, the number of surrounding residences which reveal significant wind speeds and damages), and a slew of other considerations in order to fairly and honestly determine whether specialized testing needs to be performed to duly assess whether a structural component has been compromised in a form that may not be readily observable. For example, and amongst other things, a roof and/or junction point between a window and wall may only reveal that it is compromised when exposed to heavy winds and rain. Such concealed conditions can slowly serve to destroy the residence by way of toxic conditions, rot, etc., and/or are of a nature that if they are claimed months or years later the insurer will assert that they are not covered pursuant to certain policy conditions or exclusion. Thus, causing progressive, unknown and substantial injury/damages to their insured and a potential inability to: insure the residence; sell the home; reside in the home; maintain a safe environment within the home; assess the necessary scope of repair; etc.
(u.) Although from the onset of a covered loss SFIC will have no good faith basis to deny coverage in part and/or in whole for a loss/damage, they will delay notifying the insured that coverage has been accepted, and/or otherwise delay performing, in order to: maximize their financial interests; unlawfully and deceptively withhold monies for their own use; utilize policy conditions to deflect and misdirect; utilize policy conditions at later date to further delay payment when the insured demands performance under the policy; and/or so as to otherwise implement a deceptive and immoral scheme to deprive insureds of benefits owed under the policy.
(v.) Although SFIC knows that it has a duty to treat all insureds/assignees equally, it will consistently act inconsistently in relation to: the application of policy limits; the manner in which valuations and/or the scope of repair is assessed; the manner in which an insured is required to comply with policy conditions; the application and/or consideration of policy conditions and/or exclusions to bar coverage; the timing and/or circumstances upon which undisputed payments will be made pre-suit and post-suit; etc. The lack of consistency and organization ultimately serves to deprive insureds of their rights under a policy and otherwise creates an inherently dishonest, immoral and unfair means of adjusting and investigating claim.
(w.) SFIC knows that once the claim is fully and fairly investigated and adjusted, it then has to determine whether certain benefits are owed to the insured for the cost of insurance in relation to the construction/repairs that need to be performed. These costs are avoided by SFIC by engaging in the Bad Faith conduct described herein.
(x.) SFIC knows that once the claim is fully and fairly investigated and adjusted, it is required to further assess whether certain benefits are owed to the insured for the repairs that naturally commence thereafter and the cost of engineering fees in association therewith. These costs are avoided by engaging in the Bad Faith conduct described herein.
(y.) SFIC knows that once the claim is fully and fairly investigated and adjusted, it is required to further assess the means, methods and timing upon which payment will be issued to the insureds for withheld depreciation and/or the difference between the cost of repair and the adjusted value of the claim. It is without refute that millions of dollars are saved by SFIC as a consequence of this Bad Faith practice.
(z.) SFIC’s Bad Faith conduct as described places the insured in a position of being forced into incurring expert fees to secure judicial relief by way of a legal action. Moreover, and as part of the Bad Faith practice, SFIC will await the insured’s post-suit retention of an expert to retain a designated/pre-disposed (due to financial biases) experts to further delay their obligations to their insureds and the consequential liabilities that the legislature has imposed to deter SFIC from engaging in the Bad Faith practice.
SFIC’s “tool box” of Bad Faith claims handling practices as described above leaves insureds, the insured’s counsel, the insurer’s counsel and even the judiciary guessing as to when and how SFIC will duly perform. The continuously vacillating positions and cherry picking of the described Bad Faith conduct not only serves to maximize SFIC’s prospective financial gains by being able to avoid paying benefits, it also serves to minimize SFIC’s lost adjusting expense as they see fit and to the invariable detriment of its insureds, the Complainant, and ultimately the tax paying citizens of this State that bear the expense of the judicial system which needs to unravel the tangled web created by SFIC. The lives, health and overall well-being of their insureds are placed at high risk on a daily basis due to the Bad Faith practices, but the personnel who act on their behalf have been left desensitized as a consequence of the systemic and ongoing nature of the misconduct.
In closing, it is important to emphasize that the SFIC knows that the insurance policy and their corresponding adjusting practices must conform and reform to the rules and laws governing same, and for the afore-stated reasons, they have not fulfilled their contractual obligations to the Complainant. More specifically, and amongst others, the Bad Faith claims handling practices are violative of the following rules and laws.
Fla. Stat. Sec. 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.
Fla. Stat. Sec. 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.
Fla. Stat. Sec. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims.
Fla. Stat. Sec. 626.9541(1)(i)(3)(b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
Fla. Stat. Sec. 626.9541(1)(i)(3)(d): Denying claims without conducting reasonable investigations based upon available information.
Fla. Stat. Sec. 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.
Fla. Stat. Sec. 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.
Fla. Stat. Sec. 626.9541(1)(i)(3)(i): Unfair claim settlement practices
F.A.C. 69B-220.201(3): Code of Ethics. The work of adjusting insurance claims engages the public trust. 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:
69B-220.201(3)(b): An adjuster shall treat all claimants equally.
F.A.C. 69B-220.201(3)(b)2.: An adjuster shall adjust all claims strictly in accordance with the insurance contract.
F.A.C. 69B-220.201(3)(c): An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
F.A.C. 69B-220.201(3)(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.A.C. 69B-220.201(3)(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.
F.A.C. 69B-220.201(3)(j): An adjuster shall not knowingly fail to advise a claimant of the claimant’s claim options in accordance with the terms and conditions of the insurance contract.
F.A.C. 69B-220.201(3)(k): 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.
F.A.C. 69B-220.201(3)(m): An adjuster shall not knowingly fail to advise a claimant of the claimant’s claim rights in accordance with the terms and conditions of the contract and of the applicable laws of this state. An adjuster shall exercise care not to engage in the unlicensed practice of law as prescribed by the Florida Bar.
F.A.C. 69B-220.201(3)(m)69B-220.201(3)(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.
69J-166.031 Selectively and detrimentally choosing which alternative dispute resolution to utilize.
To cure the above stated immoral, deceptive, unlawful and collectively defined general business practice of Bad Faith claims handling practices that are knowingly, willfully, wantonly and/or with a reckless disregard for the Complainant’s interests being implemented, SFIC must perform as follows within 60 days of receiving this Complaint.
(1. Take corrective action in association with the Bad Faith claims handling practices by way of rectifying same and thereafter duly adjusting, investigating and issuing payment for all benefits owed to the Complainant (including any assignee who the Complainant has a financial interest in satisfying);
(2. To the extent verified after duly performing under the policy pursuant to cited authorities and considerations, confess judgment in relation to the pending breach of contract action brought forth by the Complainant (including any assignee who the Complainant has a financial interest in satisfying);
(3. To the extent verified after duly performing under the policy pursuant to cited authorities and considerations, confessing judgment in relation to the pending declaratory action that was brought forth by the Complainant (including any assignee who the Complainant has a financial interest in satisfying);
(4. To the extent verified after duly performing under the policy pursuant to cited authorities and considerations, issuing any and all payments owed to the Complaint (including any assignee who the Complainant has a financial interest in satisfying) for interest on benefits that were untimely paid;
(5. Stipulate to the Complainant’s and/or their counsel’s entitlement to attorney’s fees and costs pursuant to, inter alia, Fla. Stat. Sec. 627.428 (and/or 626.9373) and 54.071;
(6. After exercising good faith efforts to resolve the claim, issuing payment to the Complainant’s counsel for any attorney’s fees and/or costs that it cannot dispute are due and owing;
(7. As it relates to any claims/benefits that may remain in dispute or undetermined, fairly, honestly, specifically, meaningfully and substantively disclosing to the Complainant’s counsel the basis therefor and the means to promptly reach resolution; and/or
(8. Otherwise fulfilling any and all obligations under the policy that it knows, or should know, remain to be performed.
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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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