Sandra Spoon
5756 N. Dixie
Odessa, Texas 79762
(432) 367-1171
April 13, 2015
IN ADDITION TO COMPLAINT FILED 4-6-2015
Complaint #2 with regard to the below named company:
State Farm Fire Claims
P.O. Box 106169
Atlanta, GA 30348-6169
844-458-4300 Phone
844-236-3646 Fax
Unfair Claims Settlement Practices
Re: Insured: Sandra Spoon
Property: 5756 N. Dixie Odessa, Texas 79762
Claim No: 43619R608
Policy No: 84-BT-N130-8
Date of Loss: March 16, 2015
Please add the following adjusters to the original complaint:
Justin Nelson Texas license number believed to be 1671844
EJ Denton Texas license number believed to be 1983130
Texas Department of Insurance:
On 3-16-15, my mother, listed above, filed a homeowner’s insurance claim with State Farm. State Farm did not contact her back by 3-18-15, so she asked me to handle on her behalf. As her son, I contacted them, and began handling the claim in the capacity of my mother, not a Public Adjuster. Since that time, I have witnessed some of the most harmful claims practices I have witnessed to date. As the Department is aware, we handle insurance claims for insureds in this great State of ours, and a few others. In all that time, even as a Premier Service Provider for State Farm, I have never seen them handle a claim, or an insured, in the way in which my mother has been treated. This is not a compliment. I helped my mother file the original complaint that is attached to this one, last week. We finally heard from Justin Nelson on Friday, April 10, 2015. He stated that he was mailing out the payment he had promised on the 30th of March, but by statute, was due five business days after they knew they owed, which began on Saturday March 21, 2015 at the time of the inspection. Almost an entire a month later...
Last week, when the original complaint was filed, both Justin Nelson and EJ Denton were sent a copy. At that time, both were made explicitly aware of the statutes governing when a payment is to be made. Yet I did not receive a single contact, until Friday April 10, 2015, in which he stated, again, that check was being mailed out. I have included text messages with time stamps, proving our conversation as well as the fact that all parties involved knew precisely what was going on, and chose to break those rules, regardless of any consequences or warnings to the contrary. This is State Farm employees, acting on their own, as if Larry Taylors Senate bill 1628 were already law, granting immunity to those who would break the law governing prompt pay, if there were even one still in place….. This is precisely the type of behavior the current statutes are supposed to prevent. As you can see, State Farm, and their employees have absolutely no respect for our laws, or our insureds. Unfortunately, this insured is my mother. I am not handling this claim in the capacity of a Public Adjuster, I am taking care of my mom, who had a heart attack shortly before this happened, and has been back again since then to install two stints.
Current Status, please review photographs and exhibits attached to this complaint. My mother is living in her back yard, in a travel trailer that we brought and put her in. The house, as evidenced by the photos, is not safe for a healthy person, much less someone who has suffered a heart attack, and then an additional procedure. At no time was State Farm unaware of her situation, or the fact that the leak was hot water, which escalated the growth of mold from the leak. The entire core of the house, pier and beam, was saturated with water. So much so, that the plumber had to actually wait for the ground to dry before being able to repair the pipe. (He turned water off from the heater to allow the area to dry.)
State Farm has issued no payments. At this point, I have spent nearly $10,000.00 of my own money to secure a place for her to go and place to store and safeguard her personal belongings, along with packing her entire house up. This was all done within one week of filing the claim. State Farm, Justin Nelson, and EJ Denton have had the entire power of State Farm behind them, yet cannot even manage the simple task of completing this claim, sending a payment, or communicating with the insured. This, along with the entire handling of this claim, has been a catastrophe, in and of itself. Having the vast experience with State Farm that I do, I will again reiterate, and offer proof if necessary, I have never once witnessed State Farm handle a claim in this manner. Which leads me to believe one thing; State Farm has singled my mother out, because she is the document center for InsuranceBusters.net, and the mother of the owner of InsuranceBusters.net. When I say I can prove it, I mean exactly that. As the owner of InsuranceBusters.net, we have kept meticulous records on every single carrier we have ever worked a claim against. Naturally, State Farm being the largest provider, we see them a lot…. We have also filed numerous complaints against State Farm with this particular department, for almost similar activities, but as I have stated, never to this degree.
Friday, April 10, 2015 I sent Justin a text, asking for an update on my mom’s claim. After I explained that she had been in the travel trailer for 3 weeks, and had still not received payment, or ALE from State Farm, his response, as attached, stated that he was sorry for my situation…. The situation was created by both Justin and EJ Denton, and allowed by State Farm. Today, I sent another text message to Justin, asking for the status. Since EJ Denton has not returned any phone calls in over 3 weeks, leaving Justin as our only point of contact, we are forced to communicate through him. When he finally text me back, he asked that I call him for details on an update. His details consisted of the exact same story that he gave me Friday, except he now claims that the supervisor over the file was off Saturday and Sunday…and oh yeah, today too! He then asked me, after knowing for certain that my mother, his insured, has not received one single dime, nor a straight answer as to what State Farm actually intends to do….. How far along she was in the rebuilding process….
This is the most telling of the whole story. State Farm, the largest insurer in the State of Texas expects my mother, and every other insured in this state, to blindly accept their word, and reach into their own pockets, to complete work that they have agreed they owe for, yet even against the state mandated statutes on governing claims, not given her one single penny….yet has the audacity to ask how far along she is in the process of rebuilding. She has not even started… She, nor I, has any clue as to what State Farm may or may not do. There is not a business person alive that would enter into an agreement that is open, in hopes that the insurance company who is responsible will actually pay what they owe, when they owe it. As you can see here, they can’t even issue the payment they agreed on 3 weeks ago. They expect her to initiate, get in the middle, and be stuck and have no options but to accept. Not going to happen.
I helped her file the first complaint. I have had her send a copy of a limited power of attorney, specifically to have me help her with this claim, as her son. I am filing this complaint on her behalf. Once sent, I will follow up with a phone call to the Department, along with several others to the news agencies who are currently covering the senate bill 1628 fiasco. This happens to insureds all the time. The department is supposed to be here to prevent that. The laws are supposed to prevent that. My mother turned to you last week, asking for help. She has received neither help nor communication from ANY of the people who are supposed to protect her. I am forced to take matters into my own hands. This proves, unequivocally what insurers do to insureds, and how they get away with it, even under current legislation that clearly says they cannot.
Please find attached Unfair Claims Settlement Practice statute, in which State Farm has violated every single one, including the simple yet clear prompt pay.
Sec. 542.003. UNFAIR CLAIM SETTLEMENT PRACTICES PROHIBITED. (a) An insurer engaging in business in this state may not engage in an unfair claim settlement practice.
(b) Any of the following acts by an insurer constitutes unfair claim settlement practices:
(1) knowingly misrepresenting to a claimant pertinent facts or policy provisions relating to coverage at issue;
(2) failing to acknowledge with reasonable promptness pertinent communications relating to a claim arising under the insurer's policy;
(3) failing to adopt and implement reasonable standards for the prompt investigation of claims arising under the insurer's policies;
(4) not attempting in good faith to effect a prompt, fair, and equitable settlement of a claim submitted in which liability has become reasonably clear;
(5) compelling a policyholder to institute a suit to recover an amount due under a policy by offering substantially less than the amount ultimately recovered in a suit brought by the policyholder;
(6) failing to maintain the information required by Section 542.005; or
(7) committing another act the commissioner determines by rule constitutes an unfair claim settlement practice.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
At this time, I will do everything in my power to make sure my mother is protected, not as a Public Adjuster, but as her son. And yes, I am VERY angry.
Original Complaint as filed on 04-07-15:
I am filing this complaint against State Farm Lloyds. Please note that I would like to be notified of any actions that may be taken on this complaint.
I had a heart attack about 6 weeks ago. When I came home from the hospital and could actually start to move around, I opened the cabinet under the sink to find mold growing. I cleaned everything and assumed that a drain line had burst in the last freeze. I called my son and we contacted a plumber. The plumber came out and inspected, stating the problem was actually a burst in the hot water supply line. He turned our hot water off, said he had to let the ground dry before he could repair. I again called my son, Cal Spoon and he has since been handling this claim for me, in the capacity of my son. Since that time, State Farm has veered from their normal procedure, as I have witnessed, day in and day out since I began working with my son. State Farm did not even come to inspect, nor contact us for five days after I filed the claim. This is not the issue, but does go against their normal procedure. When we finally spoke to an adjuster, and he met my son at my house on Saturday, March 21, 2015. We finally received a call back, Monday, March 30, 2015 stating that a partial settlement had been approved and the details had been emailed and sent via regular mail with the initial payments. On Monday, April 6, 2015 I have still not received payment from State Farm from their agreement, nor any additional funds for living expenses. Everything I own is packed in three different storage sheds and an off-site storage unit. Fortunately, my son and daughter-in-law where here to help me. They have loaned me a small fortune since this began. Money I did not have. I thought this was the very reason I purchased the insurance in the first place. Last Monday, March 30, 2015, I had to return for another procedure stemming from my heart attack. They installed two more stints. This is absolutely the most stressed I can remember being, even with my son’s help, State Farm has done absolutely nothing to honor their contract with me, nor help assist me in any way, and it has been three weeks. State Farm and their appointed representatives, Justin Nelson and EJ Denton, have as a result of their actions, proven that they do not intend to handle this claim fairly and should be held in violation of Texas Department of Insurance Code. For your convenience, I have attached the mentioned sections below.
Sec. 542.057. PAYMENT OF CLAIM. (a) Except as otherwise provided by this section, if an insurer notifies a claimant under Section 542.056 that the insurer will pay a claim or part of a claim, the insurer shall pay the claim not later than the fifth business day after the date notice is made.
(b) If payment of the claim or part of the claim is conditioned on the performance of an act by the claimant, the insurer shall pay the claim not later than the fifth business day after the date the act is performed.
(c) If the insurer is an eligible surplus lines insurer, the insurer shall pay the claim not later than the 20th business day after the notice or the date the act is performed, as applicable.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
Please notify me of any actions taken in regards to this complaint.
Sincerely,
Sandra Spoon
432-367-1171