Filing Number:     387302

Filing Accepted:  4/26/2018

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Complainant

Last/Business Name *   ARMSTRONG   First Name   CHERYL Street Address * 36 PEEPTOAD RD City, State Zip * WARWICK, RH 02888 Email Address * Complainant Type: * Third Party

Insured

Last/Business Name*   NBC UNIVERSAL THEME PARKS   First Name   Policy # * Claim #* P 505-421203-01

Attorney

Attorney is Applicable Last Name* SHELOSKE First Name * JEFFREY Initial M Street Address* 123 FIRST STREET N. City, State Zip* WINTER HAVEN , FLORIDA 33881 Email Address * JEFF@BROOKSLAWGROUP.COM

Violation

Insurer Type *   Authorized Insurer Unauthorized Insurer   Insurer Name Insurer Name*   CHUBB INDEMNITY INSURANCE COMPANY Insurer Name* Street Address* City, State Zip* , NAIC Company Code 12777   Name of individual responsible for violation (if any):* GREGORY THOMAS Type of Insurance * Commercial Property & Casualty

Reason for Notice * Claim Denial Unsatisfactory Settlement Offer Unfair Trade Practice 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. 626.9541(1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement. 626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim. * Specific policy language that is relevant to the violation. Enter all words or phrases (one at a time) that should be used to filter. N/A   * Facts and circumstances giving rise to the violation. Enter all words or phrases (one at a time) that should be used to filter. (1) FAILURE TO PAY CLAIM; (2) FAILURE TO PROMPTLY INVESTIGATE CLAIM; (3) FAILURE TO PROPERLY INVESTIGATE CLAIM; (4) FAILURE TO ACT IN DUE DILIGENCE AND GOOD FAITH TO RESOLVE CLAIM; (5) PLACING FINANCIAL INTEREST OF INSURER BEFORE THAT OF POLICY HOLDERS AND CLAIMANTS; (6) FAILURE TO PROPERLY TRAIN AND EVALUATE ADJUSTERS; (7) LOOKING FOR WAYS TO DENY COVERAGE, PAY LESS, DELAY PAYMENT AND OTHERWISE "LOW BALL" OR "STONEWALL" CLAIM

Comments

User Id   Date Added   Comment sonya.okolosi@chubb.com 05-01-2018 April 30, 2018 Florida Department of Financial Services RE: Civil Remedy File Number: 387302 Claimant: Cheryl Armstrong Date of Loss: 01/22/2018 Insurer: ACE American Insurance Company (Chubb) Third Party Administrator: Helmsman Management Services, Inc. Claim Number: P 505-421203-01 To whom it may concern: This will confirm our receipt of Civil Remedy notice number 387302, filed on 04/26/2018. Please allow this letter to serve as our business reply. This issue involves a general liability claim filed by Mrs. Cheryl Armstrong against NBCUniversal. Helmsman Management Services, a division of Liberty Mutual, is the third party administrator for Comcast NBCUniversal (NBCUniversal) regarding their General Liability claims. NBCUniversal has a contract of insurance with Chubb and a service contract for claims management with Helmsman Management Services. The facts of the above-mentioned loss are as follows. On 01/22/2018 at approximately 0830 hours, Mrs. Armstrong alleges that she slipped and fell on the Dr. Suess – Lost Continent Bridge at the NBCUniversal Studios Theme Park in Orlando, FL, alleging injury to her right knee. It was reported that after the incident occurred that Mrs. Armstrong was assisted to her feet by her family and she continued to walk across the bridge into the Lost Continent area of the park. Mrs. Armstrong then stopped and sat on the benches in front of Poseidon’s Treasure. At that time the NBCU Health Services team responded to the scene, Mrs. Armstrong declined assistance and was proceeded back into the park. On January, 30th 2018 a letter of representation from attorney Jeff Sheloske of the Brooks Law Group, PA was received and a claim file was created and assigned to Technical Claims Specialist Gregory Thomas. An investigation was started immediately after receipt of the letter of representation. An acknowledgement letter was issued to the Brooks Law Group on 02/01/2018. On 03/15/2018, a voicemail was left for the Brooks Law Group, PA requested a statement from Mrs. Armstrong, and further a letter was issued 03/15/2018 requesting same. In this same letter, it was explained that our investigation revealed no defects with the bridge in question and explaining the NBCU did not breach duties owed to Mrs. Armstrong. The next correspondence received from the Brooks Law Group was a demand package, dated 03/28/2018, requesting settlement and providing limited medical documentation. An acknowledgement letter of the demand package was issued back to the Brooks Law Group on 04/04/2018. The letter also advises of Helmsman Manager Services denial of liability based upon our investigation, however it also states that “any additional evidence” provided by Brooks Law Group would be reviewed and considered regarding our liability findings. A separate denial letter was issued on the same date 04/04/2018. Our denial was based on the fact that there was not enough evidence presented to support that NBCUniversal breached any duty to Mrs. Armstrong. Below you will find a rebuttal to each of the five violations attorney Jeff Sheloske stated in his complaint: 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. Helmsman Management Services, Inc. (to be referred to as Helmsman) is a third party administrator on behalf of NBCUniversal. Helmsman does not make it a practice to make offers and/or settlements on behalf of NBCUniversal when Helmsman does not feel that NBCUniversal is at fault for the alleged loss. 626.9541(1)(i)(3)(a) – Failing to adopt and implement standards for the proper investigation of claims. Mr. Thomas requested a statement from Brooks Law Group of their client Mrs. Cheryl Armstrong as outlined above. Further, Mr. Thomas requested all relevant medical notes and bills which Brooks Law Group did not provide. Based upon our investigation and Brooks Law Group’s refusal of our request for a statement this claim was subsequently denied. 626.9541(1)(i)(3)(c) – Failing to acknowledge and act promptly upon communications with respect to claims. Notice of the claim was received via letter of representation from Brooks Law Group and report from NBCUniversal on 01/30/2018, an acknowledgement letter was issued to Brooks Law Group on 02/01/2018. A demand package including limited medical documentation was received 04/03/2018, acknowledged in our notes on 04/04/2018 and a subsequent acknowledgement letter of the demand package was issued to Brook Law Group on 04/04/2018. This letter also advised our liability position and denial of this claim. 626.9541(1)(i)(3)(f) – Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromised settlement. This statute does not apply in this situation. Mrs. Cheryl Armstrong is not an insured under the Chubb. Mrs. Cheryl Armstrong filed a third party liability claim against NBCUniveral in this situation. 626.9541(1)(i)(3)(g) – Failing to promptly notify the insured of any additional information necessary for the processing of a claim. Again, as stated above, this statute does not apply in this situation. Mrs. Cheryl Armstrong is not an insured under the Chubb. Mrs. Cheryl Armstrong filed a third party liability claim against NBCUniversal in this situation. Please advise if I can be of further assistance. Sincerely, Jonathon Folds, MBA Team Manager Helmsman Management Services