Shahriar Anoushfar v. Lexington Insurance Company

CourtCourt of Appeals for the Eleventh Circuit
DecidedOctober 18, 2021
Docket21-11244
StatusUnpublished

This text of Shahriar Anoushfar v. Lexington Insurance Company (Shahriar Anoushfar v. Lexington Insurance Company) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Shahriar Anoushfar v. Lexington Insurance Company, (11th Cir. 2021).

Opinion

USCA11 Case: 21-11244 Date Filed: 10/18/2021 Page: 1 of 20

[DO NOT PUBLISH] In the United States Court of Appeals For the Eleventh Circuit

____________________

No. 21-11244 Non-Argument Calendar ____________________

SHAHRIAR ANOUSHFAR, Plaintiff-Appellant, versus LEXINGTON INSURANCE COMPANY,

Defendant- Appellee.

Appeal from the United States District Court for the Middle District of Florida D.C. Docket No. 2:20-cv-00658-SPC-NPM ____________________ USCA11 Case: 21-11244 Date Filed: 10/18/2021 Page: 2 of 20

2 Opinion of the Court 21-11244

Before JORDAN, NEWSOM, and LAGOA, Circuit Judges. PER CURIAM: Shahriar Anoushfar appeals the district court’s order dis- missing his amended complaint under Federal Rule of Civil Pro- cedure 12(b)(6) for failing to state plausible claims for which relief could be granted. For the reasons stated below, we affirm. I. FACTUAL AND PROCEDURAL BACKGROUND Anoushfar owned a house in Punta Gorda, Florida (the “Property”) that he rented to a third party. Anoushfar purchased an insurance policy (the “Policy”) from Lexington Insurance Company to insure the Property for a one-year period, effective July 19, 2017. The Policy affords Anoushfar various coverages, including “Coverage A: Dwelling”—which covers the dwelling on the Property (and structures attached thereto), as well as material and supplies located on or next to the Property used to construct, alter, or repair the dwelling or other structures on the Property— with a stated limit of liability of $1,490,893.00. According to the amended complaint, on September 10, 2017, Hurricane Irma caused extensive windstorm damage to the Property, “including, without limitation, physical losses to the [Property’s] interior finish, roofing, exterior cladding, and win- dow systems/components” (the “Loss”). As a result, the Property became immediately uninhabitable, and Anoushfar’s tenant resid- USCA11 Case: 21-11244 Date Filed: 10/18/2021 Page: 3 of 20

21-11244 Opinion of the Court 3

ing in the Property vacated the premises due to the deplorable liv- ing conditions. Following Hurricane Irma, Anoushfar properly notified Lexington of the Loss, tendering the resulting insurance claim (the “Claim”) to Lexington. Lexington acknowledged receipt of the Claim and retained the services of a third-party adjusting company to inspect and estimate the cost to repair the covered damage to the Property related to the Claim. Following the third- party inspection, Lexington adjusted the Loss and estimated that Hurricane Irma had caused $5,452.00 in covered damage. On November 26, 2017, a claim representative for Lexington issued a letter to Anoushfar advising him that his Claim “ha[d] been closed without payment” as the document at the Property “did not ex- ceed the windstorm deductible.” During the timeframe leading up to Lexington’s initial ad- justment, Anoushfar retained a professional insurance consultant and engineering firm to prepare engineering and estimating as- sessments. These assessments estimated the replacement cost value (“RCV”) of the Loss to be $576,905.26. Anoushfar provided this RCV estimate, as well as his signed and notarized statement of proof of loss (the “POL package”) to Lexington for its evalua- tion and consideration. Lexington did not provide a timely re- sponse to the POL package; instead, its claim representative re- jected the POL package, stating that Lexington did not accept that amount of loss. USCA11 Case: 21-11244 Date Filed: 10/18/2021 Page: 4 of 20

4 Opinion of the Court 21-11244

Based on Lexington’s denial of payment, the parties’ “clear and unequivocal disagreement over the amount of the Loss,” and Lexington’s ongoing failure to further adjust the Claim upon re- ceiving the POL package, Anoushfar demanded binding appraisal proceedings in accordance with the Policy’s Appraisal clause. The Policy’s Appraisal clause provides, in relevant part: If you and we fail to agree on the amount of loss, ei- ther may demand an appraisal of the loss. In this event, each party will choose a competent and im- partial appraiser within 20 days after receiving a written request from the other. The two appraisers will choose an umpire. If they cannot agree upon an umpire within 15 days, you or we may request that the choice be made by a judge of a court of record in the state where the “residence premises” is located. The appraisers will separately set the amount of loss. If the appraisers submit a written report of an agreement to us, the amount agreed upon will be the amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will set the amount of loss. . . . Additionally, on May 4, 2018, Anoushfar filed a Civil Remedy No- tice of Insurer Violations (“CRN”). After receiving the CRN, Lex- ington agreed to appraisal. While the claim was pending and ap- praisal was ongoing, Anoushfar could no longer make mortgage payments on the Property and sold it in “as is” condition on Sep- tember 26, 2018, at a great financial loss. USCA11 Case: 21-11244 Date Filed: 10/18/2021 Page: 5 of 20

21-11244 Opinion of the Court 5

On October 16, 2018, the appraisal panel concluded its de- liberations and issued an appraisal award—signed by Anoushfar’s appraiser and the umpire—for the damage to the Property at $547,455.95 for its replacement cost and $504,173.54 for its actual cash value. In other words, the amount of the Loss was valued, at most, almost $30,000 less than the $576,905.26 that Anoushfar’s professional insurance consultant and engineering firm estimated the RCV of the Loss to be prior to the appraisal. Additionally, in the appraisal award form, three categories—“Ordinance & Law,” “Personal Property,” and “Loss of Use/ALE”—were labeled “TO BE DETERMINED.” Six days after the award was issued, Lexing- ton paid Anoushfar $420,614.94—the replacement cost minus de- preciation and the Policy’s deductible of $74,544.65. Following the issuance of the appraisal award, Anoushfar, believing that the appraisal award was more than half of the Property’s tax value, hired an engineer to opine on whether the Loss as to the Property was a “total loss” under the Policy. Anoushfar, however, did not raise the question of whether the damage to the Property constituted a “total loss” during the ap- praisal process. Anoushfar’s engineer determined that, under the facts and circumstances, the Property had suffered a “total loss.” Based on his reading of the Policy, Anoushfar requested Lexing- ton to pay the remaining balance of the Policy’s Coverage A for the total loss or, alternatively, to submit to appraisal on the ques- tion of whether the Loss was a “total loss.” Lexington, however, USCA11 Case: 21-11244 Date Filed: 10/18/2021 Page: 6 of 20

6 Opinion of the Court 21-11244

refused to pay any additional amount and also rejected his request for another appraisal on the total loss question. On July 10, 2020, Anoushfar filed a complaint against Lex- ington in Florida court. Lexington removed the action to federal district court on the basis of diversity. Subsequently, Anoushfar filed his amended (and the opera- tive) complaint on October 6, 2020. In his amended complaint, Anoushfar raised four claims. In Count I, Anoushfar sought spe- cific performance in the form of an order compelling Lexington to engage in appraisal proceedings on the total loss question.

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