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  • FRANCES NORD, ET AL. VS STATE FARM GENERAL INSURANCE COMPANY, ET AL. Insurance Coverage (not complex) (General Jurisdiction) document preview
  • FRANCES NORD, ET AL. VS STATE FARM GENERAL INSURANCE COMPANY, ET AL. Insurance Coverage (not complex) (General Jurisdiction) document preview
  • FRANCES NORD, ET AL. VS STATE FARM GENERAL INSURANCE COMPANY, ET AL. Insurance Coverage (not complex) (General Jurisdiction) document preview
  • FRANCES NORD, ET AL. VS STATE FARM GENERAL INSURANCE COMPANY, ET AL. Insurance Coverage (not complex) (General Jurisdiction) document preview
  • FRANCES NORD, ET AL. VS STATE FARM GENERAL INSURANCE COMPANY, ET AL. Insurance Coverage (not complex) (General Jurisdiction) document preview
  • FRANCES NORD, ET AL. VS STATE FARM GENERAL INSURANCE COMPANY, ET AL. Insurance Coverage (not complex) (General Jurisdiction) document preview
  • FRANCES NORD, ET AL. VS STATE FARM GENERAL INSURANCE COMPANY, ET AL. Insurance Coverage (not complex) (General Jurisdiction) document preview
  • FRANCES NORD, ET AL. VS STATE FARM GENERAL INSURANCE COMPANY, ET AL. Insurance Coverage (not complex) (General Jurisdiction) document preview
						
                                

Preview

1 Boris Treyzon, Esq. (SBN 188893) btreyzon@actslaw.com 2 Sara A. McClain, Esq. (SBN 268429) smcclain@actslaw.com 3 ABIR COHEN TREY ZON SALO, LLP 16001 Ventura Blvd., Ste. 200 4 Encino, CA 91436 Telephone: (424) 288-4367 5 Facsimile: (424) 288-4368 6 Attorneys for Plaintiffs DOUGLAS NORD and FRANCES NORD 7 8 SUPERIOR COURT OF THE STATE OF CALIFORNIA 9 IN AND FOR THE COUNTY OF LOS ANGELES – NORTHWEST DISTRICT 10 DOUGLAS NORD, an individual; and ) Case No.: FRANCES NORD, an individual, ) 11 ) COMPLAINT FOR DAMAGES Plaintiffs, ) 12 ) 1. Breach of Contract; vs. ) 13 ) 2. Breach of the Implied Covenant of STATE FARM GENERAL INSURANCE ) Good Faith and Fair Dealing; 14 COMPANY, an Illinois corporation; ROMEL ) CARLO SANTIAGO, an individual, and ) 3. Violation of Bus. & Prof. Code, § 15 DOES 1 THROUGH 20, inclusive, ) 17200, et seq.; ) 16 Defendants. ) 4. Financial Elder Abuse (Welf. & Inst. ) Code, § 15610.30); and 17 ) ) 5. Negligent Misrepresentation 18 ) ) DEMAND FOR JURY TRIAL 19 ) ) UNLIMITED JURISDICTION 20 ) 21 COME NOW plaintiffs DOUGLAS NORD and FRANCES NORD (collectively, “Plaintiffs”) 22 who hereby allege as follows: 23 GENERAL ALLEGATIONS 24 1. Plaintiffs are, and at all times mentioned herein were, citizens of the State of California 25 and residents of the County of Los Angeles. 26 2. Defendant STATE FARM GENERAL INSURANCE COMPANY (“State Farm”) is, 27 and at all times mentioned herein was, a corporation duly organized and existing under the laws of the 28 /// 1 PLAINTIFFS’ COMPLAINT FOR DAMAGES AND DEMAND FOR JURY TRIAL 1 State of Illinois and authorized to do business and engage in the business of writing and selling 2 insurance in the State of California. 3 3. Defendant ROMEL CARLO SANTIAGO (“Santiago”) is, and at all times mentioned 4 herein was, a citizen of the State of California and resident of the County of Los Angeles. 5 4. Plaintiffs do not know the true names and capacities of the defendants sued as Does 1 6 through 20, inclusive. Plaintiffs therefore sue these defendants by fictitious names under Code of 7 Civil Procedure section 474. Plaintiffs will amend this Complaint to state the true names and 8 capacities of these fictitiously named defendants when their true identities are ascertained. Plaintiffs 9 are informed and believe, and thereon allege, that each of the fictitiously named defendants is legally 10 responsible in some manner for the events and damages under the causes of action alleged. 11 5. Plaintiffs are informed and believe, and thereon allege, each of the named defendants 12 and each of the DOE defendants identified were the agents, partners, co-joint venturers, associates, 13 and/or employees of one or more of the other defendants and was acting in the course and scope of 14 such agency, partnership, joint venture, association or employment when the acts giving rise to the 15 causes of action occurred. 16 FACTUAL BACKGROUND 17 6. Plaintiffs are, and at all times mentioned herein were, the owners of a single family 18 residence located in Tarzana, California (the “Property”). 19 7. At all times relevant herein, Plaintiffs were insured for the risk of damage or loss to the 20 Property under a homeowners’ insurance policy bearing policy number 71-S1-6758-7 issued by State 21 Farm (the “Policy”). 22 8. On or about February 28, 2021, a windstorm caused a massive tree located next door 23 to the Property to fall on the Property. As the tree fell, it knocked down several other trees in its path. 24 These trees fell on the Property and crashed through the roof of Plaintiffs’ home, knocking Mr. Nord 25 to the floor and causing him to sustain physical injuries. The tree fall also caused significant damage 26 to the Property and its contents (the “Loss.”) 27 9. Plaintiffs promptly notified State Farm of the Loss and State Farm assigned claim no. 28 75-16Z1-37B (the “Claim”). 2 PLAINTIFFS’ COMPLAINT FOR DAMAGES AND DEMAND FOR JURY TRIAL 1 10. On or about April 27, 2021, representatives from EFI Global, Inc. (“EFI”), which had 2 been retained by State Farm, inspected the Property. The purpose of EFI’s inspection was to determine 3 the extent of structural damage the Property sustained as a result of the collapsed trees and to provide 4 a repair protocol. EFI’s report indicates that the damage caused by the collapsed tree is concentrated 5 to the northeast corner of the Property. EFI’s report fails to establish or consider the magnitude of the 6 impact of the collapsed trees or the predominate cause of property damage outside of the localized 7 area of impact. In sum, EFI searched for evidence to deny coverage instead of supporting coverage, 8 and State Farm’s reliance on EFI’s report was unreasonable. 9 11. Plaintiffs initially retained a public adjuster to assist them with the Claim; however, 10 after several weeks passed without any payment from State Farm, Plaintiffs were forced to retain 11 counsel in or around May 2021. 12 12. At counsel’s insistence, State Farm agreed to provide adequate temporary housing as 13 the Property was rendered uninhabitable by the Loss. In the meantime, State Farm delayed numerous 14 payments necessary for repairs, thereby delaying the repair process. Moreover, despite knowing of 15 the requirements for repairs, which included approved structural drawings, State Farm arbitrarily and 16 unreasonably cutoff payment for temporary housing. State Farm knew repairs were not complete and 17 that its own conduct was the primary reason for any delay in commencing and completing repairs. 18 State Farm also knew when it ended temporary housing that Plaintiffs were elderly and still recovering 19 from injuries suffered from the fallen trees. 20 13. When Plaintiffs were able to move back home, albeit with repairs only partially 21 completed, they were told by Santiago that the security deposit issued by State Farm for temporary 22 housing was paid out of their personal property claim and therefore, Plaintiffs should keep any refund 23 on the deposit. 24 14. Plaintiffs made countless attempts to demonstrate to State Farm that it had failed to 25 make adequate payments for dwelling and contents damages, including but not limited to numerous 26 subcontractor bids, opinions from experts, and several inspections of the Property. State Farm refused 27 to acknowledge the true extent of its liability and instead relied on incomplete and inaccurate 28 assessments of the damage to delay and deny payment to Plaintiffs. 3 PLAINTIFFS’ COMPLAINT FOR DAMAGES AND DEMAND FOR JURY TRIAL 1 15. Months have passed without any communication from State Farm, additional payment 2 of policy benefits, or any claim decision or other explanation for why State Farm refuses to issue 3 payment for additional policy benefits. State Farm’s failure to adjust the Claim, failure to 4 communicate with its insureds, and failure to make any decision on the Claim is tantamount to a denial 5 of the Claim. 6 FIRST CAUSE OF ACTION 7 (Breach of Contract Against 8 Defendants State Farm General Insurance Company and DOES 1-10) 9 16. Plaintiffs incorporate by reference paragraphs 1 through 15, inclusive, as though set 10 forth in full herein. 11 17. The Policy obligated State Farm to indemnify Plaintiffs for certain losses to the 12 Property, including the Loss. 13 18. Plaintiffs promptly notified State Farm of the Loss and complied with all requirements 14 under the Policy which they were obligated to perform, except for those obligations, if any, which they 15 were prevented or excused from performing. 16 19. State Farm failed to indemnify Plaintiffs for the Loss as required under the terms of the 17 Policy. In doing so, State Farm breached the terms of the Policy by failing to issue policy benefits to 18 which Plaintiffs were, and are, contractually entitled. 19 20. As a direct and proximate result of State Farm’s breach of the insurance contract, 20 Plaintiffs have suffered legally compensable damages, including unpaid policy benefits, interest on 21 contract amounts owed, and other out-of-pocket expenses, as well as consequential damages, in a sum 22 exceeding the applicable jurisdictional threshold. The exact amount of such damages will be proven 23 at time of trial. 24 SECOND CAUSE OF ACTION 25 (Breach of the Implied Covenant of Good Faith and Fair Dealing Against 26 Defendants State Farm General Insurance Company and DOES 1-10) 27 21. Plaintiffs incorporate by reference paragraphs 1 through 20, inclusive, as though set 28 forth in full herein. 4 PLAINTIFFS’ COMPLAINT FOR DAMAGES AND DEMAND FOR JURY TRIAL 1 22. State Farm owed Plaintiffs a duty of good faith and fair dealing regarding all 2 transactions and relationships arising under or in connection with the Policy. 3 23. In the handling and adjustment of the Claim, State Farm and its representatives elevated 4 the interests of State Farm above those of Plaintiffs and subordinated Plaintiffs’ interests to those of 5 State Farm by engaging in improper, wrongful, abusive, fraudulent, unreasonable and tortious conduct 6 in connection with the Claim. 7 24. State Farm breached the implied covenant of good faith and fair dealing by, among 8 other things: 9 a. Failing to conduct a full, fair, prompt, and thorough investigation of the Claim; 10 b. Failing to evaluate the Claim objectively; 11 c. Not attempting in good faith to effectuate a prompt, fair and equitable settlement of the 12 Claim; 13 d. Compelling Plaintiff to institute litigation to recover amounts due under the Policy; 14 e. Deliberately denying benefits State Farm knew were owed under the Policy in 15 conscious disregard of Plaintiffs’ known rights and established California case law; 16 f. Failing to respond in writing to status requests by Plaintiffs in the manner and within 17 the time periods required by the California Fair Claims Settlement Practices Regulations (10 Cal. Code 18 Regs. sections 2695.5 et seq.); and 19 g. Failing to properly explain the factual and legal bases for denial. 20 25. State Farm misinterpreted policy language, misrepresented the facts of the Loss, and 21 drafted correspondence to Plaintiffs setting forth the inaccurate, misplaced and misleading facts and 22 conclusions in order to deny further payment on the Claim. This affirmative action sought to minimize 23 the coverage that should have been afforded to Plaintiffs. 24 26. As a direct result of its breach of contract, breach of the implied covenant of good faith 25 and fair dealing, and breach of regulations promulgated by the California Department of Insurance for 26 the protection of policyholders as described above, State Farm has waived and/or is estopped from 27 asserting any right to contest either coverage or the amount of benefits claimed by Plaintiffs. 28 /// 5 PLAINTIFFS’ COMPLAINT FOR DAMAGES AND DEMAND FOR JURY TRIAL 1 27. Because of the wrongful and tortious conduct of State Farm and its representatives, and 2 each of them, Plaintiff has suffered legally compensable special and general damages in amounts to 3 be shown at time of trial, including but not limited to, loss of use of policy benefits, loss of use and 4 enjoyment of the family home, and emotional distress. 5 28. As a direct and proximate result of the conduct of State Farm and its representatives, 6 consultants and employees, Plaintiffs had to engage the services of legal counsel to pursue litigation 7 and obtain policy benefits. Plaintiffs have incurred, and will continue to incur, costs and attorneys’ 8 fees in an amount to be determined according to proof. Plaintiffs claim these costs and fees as a 9 distinct item of damage under Brandt v. Superior Court (1985) 37 Cal.App.3d 813. 10 29. Plaintiffs are informed and believe, and thereon allege, the conduct of State Farm 11 described above is part of a long-established pattern and practice designed to force claimants to 12 abandon their claims or accept benefits less than those owed in order to minimize the financial 13 exposure and risk to State Farm. State Farm actively and knowingly encouraged its claim department 14 personnel to engage in fraud, unfair conduct, and abuse of legitimate claimants such as Plaintiffs. 15 These programs were authorized and ratified by the officers, directors, or managing agents of State 16 Farm and implemented to reward employees to achieve the financial goals of State Farm at the expense 17 of policyholders and claimants, including Plaintiffs. 18 30. Plaintiffs are further informed and believe, and thereon allege, State Farm adopted a 19 policy to delay payment on legitimate claims—such as the Claim—and to support such denials by 20 creating phony “genuine issues” regarding coverage and contract liability based on deliberately 21 misrepresenting and misinterpreting the facts of the Loss and provisions of the Policy. 22 31. The acts and omissions of State Farm and its employees and/or representatives, 23 described above, are established corporate practices and procedures, and were authorized, directed, 24 approved, and/or ratified by the company’s officers, directors, or managing agents. 25 32. In committing the acts described herein, State Farm and its employees and/or 26 representatives acted intentionally, with a conscious disregard for Plaintiffs’ known rights, and did so 27 in a fraudulent and oppressive manner. The acts and omissions described above warrant the imposition 28 /// 6 PLAINTIFFS’ COMPLAINT FOR DAMAGES AND DEMAND FOR JURY TRIAL 1 of exemplary damages under Civil Code section 3294 in an amount sufficient to punish and deter State 2 Farm from engaging in similar conduct in the future. 3 33. As a direct result of Defendants’ breach of contract, breach of the implied covenant of 4 good faith and fair dealing, and breach of regulations promulgated by the California Department of 5 Insurance for the protection of policyholders as described above, Defendants, and each of them, have 6 waived and/or are estopped from asserting any right to contest either coverage or the amount of 7 benefits claimed by Plaintiffs or as shown in Plaintiffs’ proofs of claim submitted to Defendants, and 8 each of them. 9 THIRD CAUSE OF ACTION 10 (Violation of Bus. & Prof. Code, § 17200, et seq. Against 11 Defendants State Farm General Insurance Company and DOES 1-10) 12 34. Plaintiffs incorporates by reference paragraphs 1 through 33, inclusive, as though set 13 forth in full herein. 14 35. Plaintiffs are informed and believe and thereon allege that the acts and omissions 15 described above constitute the standard and ongoing business practices of State Farm. These acts and 16 omissions constitute unlawful, unfair and/or fraudulent business acts or practices within the meaning 17 of Bus. & Prof. Code, § 17200, et seq. 18 36. Plaintiffs have suffered a direct injury as a result of the acts and omissions described 19 above, including mental and emotional pain, suffering, worry, and anxiety. 20 37. In addition to the direct physical injuries stated above, Plaintiffs lost money and 21 property, as a result of the unlawful, unfair and fraudulent business acts, practices and conduct of State 22 Farm. Plaintiffs will continue to be injured by these business practices because the Property is still 23 insured by State Farm. 24 38. Plaintiffs seek an Order enjoining all of the named and fictitiously designated 25 Defendants, and each of them, from engaging in further unlawful, unfair or fraudulent business acts 26 and practices within the State of California. 27 /// 28 /// 7 PLAINTIFFS’ COMPLAINT FOR DAMAGES AND DEMAND FOR JURY TRIAL 1 FOURTH CAUSE OF ACTION 2 (Financial Elder Abuse under Wel. & Inst. Code, § 15610.30 et seq. 3 Against Defendants State Farm General Insurance Company and DOES 1 through 10) 4 39. Plaintiffs incorporate by reference paragraphs 1 through 38, inclusive, as though set 5 forth in full herein. 6 40. At all times mentioned herein, Plaintiffs were individuals older than sixty-five years of 7 age. 8 41. The definition of “personal property” under Civ. Code, § 14 includes money, chattels, 9 things in action and evidences of debt. 10 42. Upon occurrence of the Loss, Plaintiffs had a vested interest in all policy benefits due 11 and owing as a result thereof. 12 43. State Farm acted unreasonably by wrongfully withholding policy benefits thereby 13 effectively denying the Claim. Accordingly, pursuant to the terms of Welf. & Inst. Code § 15610.30 14 et seq., the Elder Abuse and Dependent Adult Civil Protection Act, State Farm wrongfully retained 15 property belonging to Plaintiffs. 16 44. State Farm knowingly retained Plaintiffs’ property for its own financial gain, and with 17 the intent to deprive them of their property. 18 45. State Farm knew, or should have known, the wrongful withholding of policy benefits 19 due and owing would cause harm to Plaintiffs, and they did in fact suffer harm as result of the wrongful 20 withholding of policy benefits. 21 46. As elderly persons with health issues, including a traumatic brain injury caused by the 22 fallen trees, Plaintiffs are substantially more vulnerable than other members of the public. State 23 Farm’s wrongful and unreasonable withholding of policy benefits due and owing to Plaintiffs has 24 created housing instability and insecurity and has exacerbated Plaintiffs’ severe emotional distress and 25 caused economic losses. State Farm is fully aware of Plaintiffs’ plight. In refusing to issue further 26 policy benefits, State Farm acted intentionally and with a conscious disregard for Plaintiffs’ known 27 rights and did so in a fraudulent and oppressive manner. 28 /// 8 PLAINTIFFS’ COMPLAINT FOR DAMAGES AND DEMAND FOR JURY TRIAL 1 47. Plaintiffs have suffered injury as a result of State Farm’s acts and omissions described 2 above, including financial, mental and emotional pain, suffering, worry, and anxiety. The exact 3 amount of such damages will be proven at time of trial. 4 48. As a direct and proximate result of State Farm’s conduct, Plaintiffs have suffered 5 damages, including but not limited to attorneys’ fees which are recoverable pursuant to Welf. & Inst. 6 Code, § 15657.5(a). 7 FIFTH CAUSE OF ACTION 8 (Negligent Misrepresentation Against Defendants Romel Carlo Santiago and DOES 11-20) 9 49. Plaintiffs incorporate by reference paragraphs 1 through 48, inclusive, as though set 10 forth in full herein. 11 50. Santiago was the adjuster assigned to the Claim in 2022. In this role, he made verbal 12 representations regarding the Loss, the Policy, and Plaintiffs’ entitlement to payment of benefits under 13 the Policy. These representations conveyed information in a commercial setting for a business 14 purpose. 15 51. On or about July 7, 2022, Santiago verbally represented to Plaintiffs that the security 16 deposit issued by State Farm for temporary housing was paid out of their personal property claim and 17 therefore, Plaintiffs should keep any refund on the deposit. Based on this representation, Plaintiffs did 18 not take further action to return the refunded portion of the security deposit to State Farm. However, 19 this representation was later determined to be false when State Farm requested Plaintiffs return the 20 refunded portion of the security deposit. 21 52. In light of State Farm’s subsequent request, Plaintiffs are informed and believe and 22 thereon allege that Santiago made the representation regarding the security deposit without any 23 reasonable belief in its truth. 24 53. Plaintiffs justifiably and reasonably relied on Santiago’s representation by foregoing 25 further action regarding the deposit and using the money to pay for repairs which State Farm owed but 26 failed to pay. Plaintiffs suffered harm from their detrimental reliance on Santiago’s representations. 27 The exact amount of Plaintiffs’ damages will be proven at time of trial. 28 /// 9 PLAINTIFFS’ COMPLAINT FOR DAMAGES AND DEMAND FOR JURY TRIAL 1 PRAYER FOR DAMAGES 2 WHEREFORE, Plaintiffs pray for damages and other judicial relief: 3 1. For special damages according to proof; 4 2. For general damages according to proof, including emotional distress and mental 5 suffering; 6 3. For contract benefits under the Policy; 7 4. On the second and fourth causes of action only, for attorneys’ fees according to proof; 8 5. On the second and fourth causes of action only, for an award of punitive and/or 9 exemplary damages pursuant to Civil Code section 3294 in an amount to punish Defendant and DOES 10 1 through 10, and each of them, and deter them from engaging in similar conduct in the future; 11 6. On the third cause of action only, for injunctive relief; 12 7. On the fourth cause of action only, for treble damages; 13 8. For pre-judgment interest as permitted by law; 14 9. For Plaintiffs’ costs and expenses of suit; and 15 10. For such other and further relief as the Court deems just and proper. 16 ABIR COHEN TREYZON SALO, LLP 17 18 Dated: July 3, 2024 By:____________________________________ 19 Sara A. McClain, Esq. Attorneys for Plaintiffs DOUGLAS NORD and 20 FRANCES NORD 21 22 DEMAND FOR JURY TRIAL 23 Plaintiffs request a jury trial on all causes of action alleged. 24 ABIR COHEN TREYZON SALO, LLP 25 26 Dated: July 3, 2024 By:____________________________________ Sara A. McClain, Esq. 27 Attorneys for Plaintiffs DOUGLAS NORD and 28 FRANCES NORD 10 PLAINTIFFS’ COMPLAINT FOR DAMAGES AND DEMAND FOR JURY TRIAL