Coverage Denial Letter
Coverage Denial Letter
Coverage Denial Letter
AMEL DIAZ
8507 BARDSTON AVE
ORLANDO, FL 32809
This letter is in response to the claim you submitted to Family Security Insurance Company on the
above-referenced policy for Windstorm Other Than Hurricane damage to your property.
We reviewed the facts of your claim and based on a third-party inspection performed on 9/01/2022, no
wind or hailstorm damage or storm created opening was observed to your roofing system. An inspection
of the elevations of the property found no storm related damage to the siding, metal components,
screens, or windows of the dwelling. The inspector did observe age related wear, tear, and mechanical
damages. These types of damages are age and maintenance related and specifically excluded in your
policy.
Interior damage was observed to the interior to the Living room, master bedroom, bedroom, kitchen,
dining room, and foyer. The Special Provisions of your Policy states there must be a storm created
opening for coverage to apply to interior water damages. The inspector did not observe any storm
created opening to the roof or elevations of the Dwelling.
Based upon the facts revealed during our investigation, and after careful review, we are unable to
provide coverage as the damage(s) is/are specifically excluded by your policy. The specific policy
language is captioned further down for your reference.
Family Security Insurance Company provides your property coverage under Policy Number UHF 3443769
02: effective from (8/16/2021-8/16/2022). Please refer to Policy Form: HO 00 03 05 11 -
HOMEOWNERS 3 – SPECIAL FORM, amended in part by: Special Provisions FSIC 01 09 02 19 for
the following policy language which states in part:
(8) Rain, snow, sleet, sand or dust to the interior of a building unless a covered peril
first damages the building causing an opening in a roof or outside wall, door or
window and the rain, snow, sleet, sand or dust enters through the opening. This
exclusion applies unless the damage is caused during a “hurricane occurrence” or
“tropical storm occurrence.”
SECTION I – EXCLUSIONS
...
B. We do not insure for loss to property described in Coverages A and B caused by any of the
following. However, any ensuing loss to property described in Coverages A and B not
precluded by any other provision in this policy is covered.
...
3. Faulty, inadequate or defective:
a. Planning, zoning, development, surveying, siting;
b. Design, specifications, workmanship, repair, construction, renovation, remodeling,
grading, compaction;
c. Materials used in repair, construction, renovation or remodeling; or
d. Maintenance;
of part or all of any property whether on or off the "residence premises".
...
Please refer to Policy Form: FSIC FL 605 05 16 – Water Damage Exclusion Endorsement for the
following policy language which states in part:
Under SECTION I – EXCLUSIONS, item A.3. Water Damage is replaced by the following:
Water damage occurring subsequent to and as a direct result of damage caused by a Peril Insured
Against other than water will be covered under that peril provided that peril is not otherwise excluded
in this policy.
The covered damage will be subject to the applicable deductible stated in your policy declarations.
Direct loss by fire or explosion resulting from water damage is covered.
...
SECTION I – CONDITIONS
...
C. Duties After Loss
In case of a loss to covered property, we have no duty to provide coverage under this policy
if the failure to comply with the following duties is prejudicial to us. These duties must be
performed either by you, or an "insured" seeking coverage, or a representative of either:
...
5. Protect the covered property from further damage. The following must be performed:
a. Take reasonable emergency measures that are necessary to protect the covered
property from further damage, as provided under Additional Coverage E.2.
A reasonable emergency measure under 5.a. above 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; and
b. Keep an accurate record of repair expenses;
6. Cooperate with us in the investigation of a claim;
7. Prepare an inventory of damaged personal property showing the quantity, description,
actual cash value, and amount of loss. Attach all bills, receipts, and related documents
that justify the figures in the inventory;
8. As often as we reasonably require:
a. Show the damaged property;
b. Provide us with records and documents we request and permit us to make copies;
c. All “insureds” under this policy must:
(1) Submit to recorded statement; and
(2) In the County where the “residence premises” is located, submit to examinations
under oath, while not in the presence of another “insured”, and sign the same;
d. If you are an association, corporation or other entity; any members, officers, directors,
partners or similar representatives of the association, corporation or other entity must:
(1) Submit to recorded statements; and
(2) In the County where the “residence premises” is located, submit to examinations
under oath, while not in the presence of another “insured”, and sign the same;
e. Your agents, your representatives, including any public adjusters engaged on your
behalf, and anyone insured under this Policy other than an “insured” in 8.c. or 8.d.
above, must:
(1) Submit to recorded statements; and
(2) In the County where the “residence premises” is located, submit to examinations
under oath, while not in the presence of another “insured”, and sign the same;
...
The duties above apply regardless of whether you, an “insured” seeking coverage, or a
representative of either retains or is assisted by a party who provides legal advice, insurance
advice or expert claim advice, regarding an insurance claim under this policy.
...
We would like to thank you for your cooperation throughout the claim process. This letter is not intended
to be a full disclosure of all policy coverages, conditions, and/or exclusions. For a full disclosure, please
refer to your policy.
Should you have any additional questions or have any other information and/or documentation you
would like for us to consider regarding this claim, please contact the undersigned at the information
shown below.
Ty Reagan
Servicing Claims on Behalf of
Family Security Insurance Company
Adjuster License Number W577719
Ph: 727-201-5682
Email: [email protected]
Cc’ing:[email protected](Agent)
F.S. 817.234(1)(b) Any person who knowingly and with intent to injure, defraud, or deceive any
insurer files a statement of claim or an application containing any false, incomplete, or misleading
information is guilty of a felony of the third degree.
If this document contains an excerpt from a Family Security Insurance Company policy (“the Policy”) it
is provided here for information purposes only. This excerpt is not the official version of the Policy. The
official version of the Policy is the policy issued to the insured on the policy effective date.
In the event there is inconsistency between this document and the Policy, the Policy shall serve as the
official version.
All rights and defenses of Family Security Insurance Company and its affiliates (the “Company”) are
reserved. No act of any Company representative while investigating this claim or defending a lawsuit
shall be construed as waiving any Company rights. The Company reserves the right to deny coverage
to you or to anyone claiming coverage under this policy. The Company does not, by this letter or
otherwise, waive any rights or defenses.