Filing Number:     303879

Filing Accepted:  1/18/2016

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Complainant

Last/Business Name *   CHAU   First Name   AGNES Street Address * 716 EAST COLONIAL DRIVE City, State Zip * ORLANDO, FL 32803 Email Address * Complainant Type: * Insured

Insured

Last/Business Name*   CHAU   First Name   AGNES Policy # * 972791459A Claim #* 594S75114

Attorney

Attorney is Applicable Last Name* RUDD First Name * RYAN Initial Street Address* 1018 EAST ROBINSON STREET City, State Zip* ORLANDO , FLORIDA 32801 Email Address * RRUDD3@PAYAS-LAW.COM

Violation

Insurer Type *   Authorized Insurer Unauthorized Insurer   Insurer Name Insurer Name*   STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY Insurer Name* Street Address* City, State Zip* , NAIC Company Code 25178   Name of individual responsible for violation (if any):* JAY JACKSON Type of Insurance * Auto

Reason for Notice * Claim Denial Claim Delay Unsatisfactory Settlement Offer Unfair Trade Practice Other : Failure to tender policy * 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. 624.155(1)(b)(3) Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage. 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of 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. WE WILL PAY DAMAGES FOR BODILY INJURY AN INSURED IS LEGALLY ENTITLED TO COLLECT FROM THE OWNER OR DRIVER OF AN UNINSURED MOTOR VEHICLE. THE BODILY INJURY MUST BE SUSTAINED BY AN INSURED AND MUST BE CAUSED BY ACCIDENT ARISING OUT OF THE OPERATION, MAINTENANCE OR USE OF AN UNINSURED MOTOR VEHICLE. THE BODILY INJURY MUST BE A SERIOUS INJURY AS DESCRIBED IN SECTION 627.737(2)OF THE FLORIDA MOTOR VEHICLE NO-FAULT LAW BEFORE WE WILL PAY DAMAGES CONSISTING OF PAIN, SUFFERING, MENTAL ANGUISH, OR INCONVENIENCE.   * Facts and circumstances giving rise to the violation. Enter all words or phrases (one at a time) that should be used to filter. THIS IS A CASE OF CLEAR LIABILITY WITH SIGNIFICANT PROPERTY DAMAGE. THE UNDERINSURED REAR ENDED MRS. CHAU CAUSED OVER $11,000.00 IN DAMAGE TO HER VEHICLE. MRS. CHAU PRESENTED TO FLORIDA HOSPITAL WITH NECK AND BACK PAIN AND FOLLOWED UP WITH DR. LARKIN FOR CHIROPRACTIC CARE ALONG WITH PHYSICAL THERAPY. SHE HAD MRI'S OF THE LUMBAR AND CERVICAL SPINE PERFORMED WHICH SHOWED THREE HERNIATIONS IN THE CERVICAL SPINE AND ONE HERNITION IN THE LUMBAR SPINE. THE HERNIATIONS IN THE CERVICAL SPINE ARE EITHER TOUCHING OR ABUTTING THE SPINAL CORD. MRS. CHAU HAS UNDERGONE ESI'S AND HAS BEEN RECOMMENDED FOR A TWO LEVEL LUMBAR FUSION. THE SURGERY IS ESTIMATED TO COST IN EXCESS OF $80,000.00. MRS. CHAU'S CURRENT MEDICAL EXPENSES EXCEED $35,000.00. THE UNDERINSURED CARRIER HAS BEEN PROVIDED ALL DOCUMENTS REQUESTED TO DATE AND WERE PROVIDED WITH A THIRTY DAY TIMES SENSITIVE DEMAND FOR THE POLICY LIMITS ($300,000.00) WHICH EXPIRED ON DECEMBER 28, 2015.THE UNDERINSURED OFFERED $5,000.00 ON January 4, 2016 TO RESOLVE THIS CLAIM. AS A RESULT OF THIS CRASH AND MRS. CHAU'S INJURIES SHE HAS SUSTAINED A FIFTEEN PERCENT IMPAIRMENT RATING. MRS. CHAU NEEDS THIS MONEY IN ORDER TO MOVE FORWARD RECOMMENDED TREATMENT/SURGERY. THE UNDERINSURED CARRIER NEEDS TO TENDER ITS POLICY LIMITS IN ORDER TO RESOLVE THIS CLAIM.

Comments

User Id   Date Added   Comment florida.civilremedy@statefarm.com 03-23-2016 Other edh11@dbksmn.com 03-16-2016 50502/TKK Ryan P. Rudd, Esq. 1018 E. Robinson St. Orlando, FL 32801 Re: Response to Statutory Civil Remedies Notice Dated February 29, 2016 Fla.Dept. Fin. Serv. Filing No: 303879 State Farm Claim No.: 59-4S75-114 Insured: Agnes Chau Claimant: Agnes Chau (UM) Date of Loss: July 29, 2014 Style of Case: Agnes Chau v Ali Fazlulahi, Enterprise Leasing, Company of Orlando, LLC & State Farm Mutual Automobile Insurance Company, Orange County Circuit Court Case No.: 15-CA-8301 Judge Keith White Our File No.: 50502 Dear Mr. Rudd: This letter shall serve as a response to the above referenced Civil Remedies Notice (“CRN”): 1. DENIAL OF ANY VIOLATION: State Farm categorically denies that it violated any of the provisions referenced in the Notice. 2. BASIS FOR STATE FARM’S DENIAL OF CLAIM: Ms. Chau claims the reason for her claim is due to: Claim Denial, Claim Delay, Unsatisfactory Settlement Offer, Unfair Trade Practice and Failure to tender policy. She has also referenced various subsections of Section 624.155, Florida Statutes, that he contends State Farm has violated. Ms. Chau’s assertions are incorrect for several reasons: (A) Ms. Chau has received $100,000 from the tortfeasor as well as $10,000 of PIP benefits and other PIP adjustments. (B) Given the nature of Ms. Chau’s injuries and her pre existing condition, she has been fully and adequately compensated and no UM insurance proceeds are due. In spite of there being no UIM proceeds being due, State Farm has offered to resolve Ms. Chau’s UIM claim against State Farm for $5,000. 3. State Farm also notes the following: (A) State Farm has diligently investigated the underlying claim by reviewing all documents provide by you on behalf of Ms. Chau and by requesting additional documentation that may help evaluate the claim. (B) State Farm has responded to all inquiries by you on behalf of Ms. Chau as it relates to the underlying claim. (C) The information that State Farm currently possesses does not warrant a tender of any portion of Ms. Chau’s UM/UIM coverage, although State Farm has offered to resolve the claim for $5,000. (D) State Farm will continue to investigate the underlying claim. Should you have any questions, please contact us. Very truly yours, Kevin Knight