Filing Number:     282490

Filing Accepted:  3/26/2015

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Complainant

Last/Business Name *   WHIDDEN   First Name   ASHLEY Street Address * 3106 RIO GRANDE TRAIL City, State Zip * KISSIMMEE, FL 34741 Email Address * Complainant Type: * Third Party

Insured

Last/Business Name*   WHOLESALE CLUB   First Name   BJ'S Policy # * 11GPP4961004 Claim #* 11GPP4961004

Attorney

Attorney is Applicable Last Name* ROMERO First Name * MARIO Initial Street Address* 198 BROADWAY AVENUE City, State Zip* KISSIMMEE , FLORIDA 34741 Email Address * MORTEGA@FORTHEPEOPLE.COM

Violation

Insurer Type *   Authorized Insurer Unauthorized Insurer   Insurer Name Insurer Name*   ARCH INSURANCE COMPANY Insurer Name* Street Address* City, State Zip* , NAIC Company Code 11150   Name of individual responsible for violation (if any):* MICHELLE BOMBARD Type of Insurance * Commercial Property & Casualty

Reason for Notice * Claim Delay * Statutory provision(s) which the insurer allegedly violated.   624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests. 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims. 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims. * Specific policy language that is relevant to the violation. Enter all words or phrases (one at a time) that should be used to filter. Third party claimant and we have not been provided a copy of the complete policy that they carrier has access to.   * Facts and circumstances giving rise to the violation. Enter all words or phrases (one at a time) that should be used to filter. Ms. Whidden suffered severe injuries as a result of a fall at BJ's wholesale club on 9/18/2013. Her injuries consists of a comminuted fracture involving the L3 spinous process. A demand was submitted to their risk management department on August 11, 2014. On November 10, 2014, additional records were submitted for their review. Again, on December 8, 2014 we submitted a final set of medical record for their review and requesting a follow up to begin negotiations on this claim. We have no response to our emails, faxes and phone calls and our numerous attempts of communication have remained unanswered. BJ's wholesale Club/Arch Insurance company have failed to respond and we have provided more than a reasonable amount of time to do so. As a result, this has caused an unnecessary claim delay, even with their knowledge of the extent of the injury and the medical treatment rendered and treatment that will be sought in the future which shows that they are engaging in tactics designed to delay the matter without regard to the complainants interests.

Comments

User Id   Date Added   Comment gary@shendellpollock.com 04-28-2015 Filing Number: 282490 Arch Insurance Company’s Response to Civil Remedy Notice This is Arch Insurance Company’s (“Arch”) response to Civil Remedy Notice 282490 (the “CRN”) filed by Mario Romero, Esq. on behalf of Ashley Whidden (“Claimant”). After reviewing the CRN, Arch conducted a thorough review of BJ’s Wholesale Club’s (“Insured”) claim analysis and supporting materials, including the Claimant’s medical records that is the subject of the CRN. At this juncture, Arch maintains its position that it is not obligated to resolve the subject claim, as Arch’s insurance policy only provides for indemnification above the amount scheduled on the Self-Insured Retention Endorsement. Arch denies that it has violated the statute(s) as alleged in the CRN. At all times, Arch acted in good faith, fairly and honestly toward its insured, with due regard for the insured’s interests. Moreover, the CRN fails to adequately describe any alleged violations and also fails to provide sufficient information to allow Arch to correct the alleged violations. Arch requests that the Claimant provide any and all information which would support any position that the Claimant’s damages are above the self-insured retention, particularly in light of the current settlement demand well within the self-insured retention. A detailed analysis of Arch’s decision has been delivered to the Claimant’s counsel and a copy will be sent to the Department if requested.