Shahriar Anoushfar v. Lexington Insurance Company

Court of Appeals for the Eleventh Circuit·Decided October 18, 2021·No. 21-11244·Unpublished

Opinion

[DO NOT PUBLISH]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

2 Opinion of the Court 21-11244

Before JORDAN, NEWSOM, and LAGOA, Circuit Judges. PER CURIAM:

Shahriar Anoushfar appeals the district court’s order dismissing his amended complaint under Federal Rule of Civil Procedure 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 window systems/components” (the “Loss”). As a result, the Property became immediately uninhabitable, and Anoushfar’s tenant resid-

21-11244 Opinion of the Court 3

ing in the Property vacated the premises due to the deplorable living 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 exceed the windstorm deductible.”

During the timeframe leading up to Lexington’s initial adjustment , Anoushfar retained a professional insurance consultant and engineering firm to prepare engineering and estimating assessments . 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 evaluation and consideration. Lexington did not provide a timely response to the POL package; instead, its claim representative rejected the POL package, stating that Lexington did not accept that amount of loss.

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 receiving 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, either may demand an appraisal of the loss. In this event, each party will choose a competent and impartial 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 Notice of Insurer Violations (“CRN”). After receiving the CRN, Lexington agreed to appraisal. While the claim was pending and appraisal was ongoing, Anoushfar could no longer make mortgage payments on the Property and sold it in “as is” condition on September 26, 2018, at a great financial loss.

21-11244 Opinion of the Court 5

On October 16, 2018, the appraisal panel concluded its deliberations 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, Lexington paid Anoushfar $420,614.94—the replacement cost minus depreciation 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 appraisal 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 Lexington to pay the remaining balance of the Policy’s Coverage A for the total loss or, alternatively, to submit to appraisal on the question of whether the Loss was a “total loss.” Lexington, however, 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 Lexington in Florida court. Lexington removed the action to federal district court on the basis of diversity.

Subsequently, Anoushfar filed his amended (and the operative ) complaint on October 6, 2020. In his amended complaint, Anoushfar raised four claims. In Count I, Anoushfar sought specific performance in the form of an order compelling Lexington to engage in appraisal proceedings on the total loss question. In Count II, he sought a declaratory judgment as to the parties’ rights, duties, and responsibilities under the Policy with respect to the Loss and the question of whether it constituted a total loss under the Policy, as there was “an ongoing and justiciable dispute ” between him and Lexington “with respect to the type/extent of coverages, coverage benefits, and/or contractual remedies due to [him] under the Policy’s terms and provisions in light of the particular facts and circumstances of the Loss” and the question of whether there was a total loss. In Count III, he claimed that Lexington breached its contract with him by failing to agree to an appraisal panel’s consideration of the total loss question or by failing to pay him the Policy’s limits after his engineer determined that the Loss constituted a total loss under the Policy. And, in Count IV, Anoushfar alleged that Lexington’s post-Loss, pre-appraisal conduct constituted bad faith in violation of Florida law.

21-11244 Opinion of the Court 7

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