Miller v. AARP Services, Inc.

District Court, Virgin Islands·Decided May 5, 2023·No. 1:19-cv-00049·Unknown

Opinion

DISTRICT COURT OF THE VIRGIN ISLANDS

DIVISION OF ST. CROIX ║ RUTH MILLER and GALEN SWINGEN, ║ ║ Plaintiffs, ║ 1:19-cv-00049-MEM-EAH ║ v. ║ ║ AARP SERVICES, INC., AARP, INC., ║ GRUPO COOPERATIVO SEGUROS ║ MULTIPLES, COOPERATIVA DE ║ SEGUROS MULTIPLES OF PUERTO ║ RICO, SEDGWICK CLAIMS ║ MANAGEMENT SERVICES, INC., ║ VERICLAIM, INC., RUSSELL RAGSDALE, ║ and OVERSEAS INSURANCE ║ AGENCY, INC., ║ ║ Defendants. ║ ________________________________________________ ║

TO: Pamela L. Colon, Esq. For Plaintiffs Karen Ellis Carr, Esq. Eric Roman, Esq. Mattie Bowden, Esq. Andrew C. Simpson, Esq. For AARP, Inc. and AARP Services, Inc. Ann Cecile O’Neill, Esq. Eugenio W.A. Geigel-Simounet, Esq. For GCSM and CSMPR Richard H. Hunter, Esq. Joshua D. Lerner, Esq. Peter Tepley, Esq. Victor G. Sanabria, Esq. For Vericlaim, Sedgwick, and Ragsdale

MEMORANDUM OPINION THIS MATTER 1:19-cv-00049-MEM-EAH Memorandum Opinion Page 2 GRANT

For the reasons that follow the Court will the motion and enter the AARP Defendants’ proposed protective ordBeAr CwKitGhR thOeU CNoDu rt’s modification. I. Plaintiffs’ Allegations1 The Complaint in this case was originally filed in Superior Court in August 2019. Dkt. No. 1-1. Plaintiffs Ruth Miller and Galen Swingen alleged that Miller applied for a homeowner’s inIsdurance policy in October 2014 for a home they were about to purchase on St. Thomas. . ¶ 15. Based on the advertising and branding of the insurance policy, Plaintiffs believed that the insurance was provided through the AARP Defendants; in fact, the insurance was through Real Legacy Assurance (“Real Legacy”), a wholly owned subsidiary of Cooperativa de Seguros Multiples of Puerto RicIod (“CSMPR”), and member

company of Grupo Cooperativo Seguros Multiples (“GCSM”). . ¶¶ 5, 6, 16-20. Plaintiffs jointly purchased the policy, which beIcdame effective on November 25, 2014; they renewed the policy in 2015 and 2016. . ¶¶ 32-33. The policy included coverage for windstorm losses in the following amounts: $450,000 for a dwelling; $15,000 fIodr an outbuilding; and $30,000 for contents; Plaintiffs timely paid their policy premiums. . ¶¶ 47-48. OnI Sdeptember 6, 2017, Hurricane Irma caused catastrophic damage to Plaintiffs’ property. . ¶¶ 62-63. Plaintiffs hired tIwdo public adjusters to adjust their losses, the first

firm estimated damages of $487,000. . ¶¶ 64-65. After the second adjuster contacted 2 Real Legacy, it hired Sedgwick Claims Management Services, Inc. (“Sedgwick”) and its 1:19-cv-00049-MEM-EAH Memorandum Opinion Page 3 Id

3 subsidiary, Vericlaim, Inc. (“Vericlaim”) to adjust the claim. . ¶¶ 8, 9, 67. Sedgwick and Vericlaim sent their employee, Russell RagsdaIdle, to adjust Plaintiffs’ claim, but he did not inspect the property until October 2017. . ¶¶ 68-69. In January 2018, Ragsdale completed his estimate of $309,000, which was inadequate becauIdse it used unit pricing below the industry standard unit pricing for the Virgin Islands. . ¶¶ 70-71. Plaintiffs agreed generally with the scope of the work, but disputed the unit pricing; the AdjustIedr Defendants had used substantially higher unit pricing for other Hurricane Irma losses. . ¶¶ 72-73. In January 2018, Plaintiffs demanded payment of the undisputed amount of actual cash value (“ACV”) of damages—$309,000—from Real Legacy; it paid Plaintiffs $222,243.53 (the undisputeIdd ACV of the dwelling and content losses less certain holdbacks and a deductible). . ¶¶ 75-77. The Adjuster Defendants agreed with Plaintiffs that the disputed amount of damages in excess of $309,000 would be resolved by submitting the scope of work to a Virgin Islands contractor for a dwelling damages determination based on actual unit costs in the Virgin Islands—this determIidnation would be binding on all parties as to the amount of Plaintiffs’ dwelling damages. . ¶ 78. Thus, Plaintiffs hired a contractor to prepare the evaluation, and, in late March 2018, IPdlaintiffs submitted the estimation of charges of $460,743.93 to the Adjuster Defendants. . ¶¶ 79- 82. For months, theI Addjuster Defendants failed to respond to Plaintiffs’ submissions and payment demands. . ¶ 83. In July 2018, Plaintiffs made a formal demand to the Adjuster Defendants for payment of the holdback amount from the initial payment of the ACV, but 1:19-cv-00049-MEM-EAH Memorandum Opinion Page 4 Id

the Adjuster Defendants again failed to respond for months. . ¶¶ 85-86. In September 2018, the Adjuster Defendants claimed that they had not completed their review of the contractor’s damages determination and refused to recommenIdd additional payment until Plaintiffs produced progress photos and proof of funds spent. . ¶¶ 95-99. Because Real Legacy had suffered $110,000,000 in losses and was under- reinsured by $70,000,000, in September 2018, the Office of the Commissioner of Insurance of Puerto RIdico placed Real Legacy under regulatory supervision through a Rehabilitation Order. . ¶¶ 100-102. At the time of the Rehabilitation IOdrder, Plaintiffs’ claim was one of eighty-two unpaid pending claims in the Territory. . ¶ 103-04. On November 30, 2018, Plaintiffs again submitted proofs of loss to the Adjuster Defendants for the undisputed recoverable depreciation that had been withheld inId January 2018 and for the balance of the actual cost of repairs owed under the policy. . ¶¶ 106, 108. By November 2018, the Adjuster Defendants still had not submitted the damIadges determination for payment to the AARP Defendants, GCSM, CSMPR, and Overseas. . ¶ 107. On the same day that Plaintiff submitted the proofs of loss to the Adjuster Defendants, Plaintiffs submitted the proofs of loss, the original damages determination from the contractor,I dand the factual history of the claim directly to Real Legacy and demanded payment. . ¶ 109. In December 2018, the Adjuster Defendants required more receipts and a possible reinspection by a local adjuster befIodre they would submit the

proofs of loss to Real Legacy and/or issue further payments. . ¶ 110. In January 2019, the Court of First InIsdtance of San Juan ordered Real Legacy to 1:19-cv-00049-MEM-EAH Memorandum Opinion Page 5

112-13. When added to the initial undisputed damages, the final agreed total of Plaintiffs’ damages was $460,073.02, a mere $670.93 less than the damage determination reIadched by the licensed contractor and submitted to the Defendants ten months earlier. . ¶¶ 113-14. But by the time the Adjuster Defendants submitted their report and recommendation, Real Legacy was in liquidation, and Plaintiffs are still owed $151,073.02 in additional undisputed dwelling damages, the $64,927.43 holdback on dweIlIl.i ng daPmroacgeeds,u arnadl Hthies t$o3r,y4 15.20 holdback on contents damages. Plaintiffs brought claims of breach of contract, breach of the duty of good faith and fair dealing, bad faith, breach of fiduciary duty, fraud in the inducement, unfair trade practice, misrepresentation, and negligence against the AARP Defendants, GCSM, CSMPR,

and Overseas. Dkt. No. 1-1. Plaintiffs brought claims of breach of contraIdct and tortious interference with contractual relations against the Adjuster Defendants. . The AARP Defendants removed the case to this Court in October 2019. Dkt. No. 1. 4 All Defendants filed motions to dismiss. Dkt. Nos. 21, 23, 29. In March 2021, Judge 5 Malachy E. Mannion ruled on the motions to dismiss and entered an order which: (1) granted the AARP Defendants’ motion with respect to the unfair trade practice claim and denied it as to all other counts; (2) granted the Adjuster Defendants’ motion; and (3) granted GCSM and CSMPR’s motion as to the unfair trade practice claim and denied it as to all other counts. Dkt. Nos. 87, 88. After the ruling on the motions to dismiss, the remaining Defendants answered. Dkt. Nos. 90, 94. Thus, in June 2021, the Court entered 1:19-cv-00049-MEM-EAH Memorandum Opinion Page 6

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