Filing Number: 633644
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| Filing Accepted: 6/22/2022 |
| Last/Business Name
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| Street Address
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15 CASTLEKNOCK DRIVE |
| City, State Zip
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ASHEVILLE,
NO
28803
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| Email Address
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OB1KANOLI@YAHOO.COM |
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Insured |
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| Last/Business Name* |
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BYRD |
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First Name |
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O'BRIAN |
| Policy # * |
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4105-13-89-96/09245 |
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Claim #* |
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032999302 0101 071 |
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Attorney is Applicable
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| Last Name* |
IYAMPILLAI
First Name *
PATRICK
Initial
A
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| Street Address* |
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2803 FRUITVILLE ROAD, STE. 240 |
| City, State Zip* |
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SARASOTA
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FL
34237
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| Email Address * |
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PATRICKI@HALELAW.COM |
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| Insurer Type
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 Authorized Insurer
 Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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GOVERNMENT EMPLOYEES INSURANCE COMPANY
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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 22063 |
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| Name of individual responsible for violation (if any):*
PATRICK ARUN IYAMPILLAI
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| Type of Insurance
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Auto
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| Reason for Notice
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Claim Delay
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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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.
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| 624.155(1)(b)(3) |
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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.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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| 626.9541(1)(i)(3)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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| 626.9541(1)(i)(3)(i) |
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Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Section IV – Uninsured Motorists Coverage
Insured means you, your relatives, and any other person while occupying an insured auto.
Uninsured auto is an auto for which the total of all bodily injury liability insurance available in the event of an accident is less than the damages sustained in an accident by an insured.
We will pay damages for bodily injury, sustained by an insured, caused by accident which the insured is legally entitled to recover from the owner or operator of an uninsured auto arising out of the ownership, maintenance or use of that auto.
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Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
O’Brian Byrd
1754 Rustling Dr.
Fleming Island, FL 32003
ob1kanoli@yahoo.com
Insured: Tahnee Byrd
O’Brian Byrd
Policy #: 4105-13-89-96/09245
Claim #: 032999302 0101 071
Authorized Insurer: GOVERNMENT EMPLOYEES INSURANCE COMPANY
P.O. Box 9091
Macon, GA 31208-9091
Attn: Florida Claims
Adjuster: Anthony Wilcox
Reasons for Notice: Claim Delay
Unsatisfactory Settlement Offer
Statutory Provisions: 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.
Policy Language:
Under Section I, we will pay damages which an insured becomes legally obligated to pay because of:
1. Bodily injury, sustained by a person, and
2. Damage to or destruction of property,
arising out of the ownership, maintenance or use of the owned auto or a non-owned auto
We will defend any suit for damages payable under the terms of this policy. We may investigate and settle any claim or suit. We have not duty to investigate or defend any claims which are not covered under the terms of this policy. Our duty to defend ends when the limits of liability for bodily injury liability have been exhausted by payments of judgements or settlements.
Narrative:
On February 12, 2021, Claimant was involved in a motor vehicle collision, where he suffered serious bodily injuries. The Tortfeasor who caused the crash had bodily injury (BI) coverage, however they are insufficient in fully compensating claimants’ injuries with their insurance carrier, GOVERNMENT EMPLOYEES INSURANCE COMPANY, at $100,000. Therefore, Claimant submitted an underinsured motorist (UM) claim through his insurance company, also GOVERNMENT EMPLOYEES INSURANCE COMPANY, principal address: P.O. Box 9091, Macon, GA 31208-9091. Pursuant to policy #4105-13-89-96 Underinsured Motorist section, GOVERNMENT EMPLOYEES INSURANCE COMPANY agrees to pay for an insured person (Claimant) when physically injured by an underinsured motor vehicle. The Tortfeasor has insufficient bodily injury coverage. Therefore, Claimant is continuing to present an underinsured motorist claim pursuant to policy #4105-13-89-96 and Florida Law.
Despite having knowledge of the severity of Claimant’s permanent injuries and the Tortfeasor having insufficient bodily injury coverage, GOVERNMENT EMPLOYEES INSURANCE COMPANY has failed to propose any settlement offer(s) to resolve the claim. GOVERNMENT EMPLOYEES INSURANCE COMPANY has UM policy limits totaling $30,000, and only the tendering of those policy limits would remedy this civil remedy notice.
As a result of injuries sustained in the crash, Claimant presented to Baptist Clay Emergency Center for physical complaints from the crash. After a thorough physical examination and review of Claimant’s chest X-Ray imaging, Dr. Carlos Guevarra, MD, prescribed Flexeril, provided educational materials, and recommended he follow up with his primary care provider if his symptoms did not improve. Claimant then presented to Dr. June Gentile, D.C. for C-Spine imaging. During his EMC determination, Dr. June Gentile found that Claimant’s symptoms previously noted by the referring physician are consistent with and represent an “emergency medical condition” as defined under the Florida Motor Vehicle No Fault Law. Dr. Gentile subsequently conducted a C-Spine LAT MRI on Claimant, yielding the following results: disk degeneration with anterior endplate osteophytes at C4/C5, C5/C6, and C6/C7. No spondylolisthesis is seen. Hypolordosis is seen. There is no evidence of fracture through C7. The spinous processes are intact. A normal odonto-axial alignment is seen.
Claimant further presented to Physician Partners of America for a subsequent Physical exam. Dr. Andrea Trescot noted the following: He his having daily headaches that radiate from his neck into the back of his head (left worse than right). He is forgetting things; he reported that last week he forgot his social security number. Dr. Trescot’s assessment notes signs of cervicalgia, s/p flexion/extension injury, shoulder pain, intermittent memory loss, possible transient ischemia, and possible post-traumatic vertebral artery compromise. This assessment is concordant with those of the aforementioned providers and facilities. For treatment, Claimant was prescribed Tramadol and ordered a cervical MRI/MRA of the brain due to his sudden onset memory loss. An MRI of the shoulder, US injection of the AC Join, and PT for the shoulder was also advised.
Claimant then presented to All Gentle Chiropractic and was treated by Dr. June Gentle, D.C.. Dr. Gentle noted Claimant’s weakness in his left shoulder and his decreased sensation in his L5-S. Dr. Gentle also noted Claimant’s increase in neck pain and recommended Claimant follow up with his primary care physician or another doctor.
Claimant then presented to Akumin MRI Orange Park for an MRA of the head and MRI of the C-Spine. Dr. Ronald Landau’s findings and impressions are the following: MRA of the head: The vertebral arteries are demonstrated and can be seen to normally join to form the basilar artery. There is hypoplasia of the right vertebral artery. There is a dominant left vertebral artery. The anterior and posterior communicating arteries are unremarkable in appearance. There is no evidence of aneurysm formation, vascular malformation, or vascular occlusion. Hypoplastic right vertebral artery and dominant left vertebral artery. No evidence of aneurysm formation, vascular malformation, or vascular occlusion. MRI of C-Spine: There is reversal of the normal cervical lordosis suggestive of underlying muscular spasm. There is congenial narrowing of the spinal canal on the basis of short pedicles. Disk bulging at C3-4. Disk bulging and superimposed midline posterior disk herniation and associated radial tear at C4-5. Disk bulge and superimposed midline posterior disk herniation at C5-6. Disk bulge and superimposed midline posterior disk herniation and associated radial tear at C6-7. Disk bulge and superimposed right paracentral posterior disk herniation and associated radial tear at C7-T1. Cord compression at C4-5. Neural encroachment. Claimant similarly presented to A1 Imaging of Orange Park for an additional C-Spine examination, wherein Dr. Vincenzo Giuliano’s impressions were concordant with Dr. Landau’s findings.
Claimant additionally presented to Surgery Consultants of Sarasota for further recommendations and treatment strategies. After reviewing the radiology and examining Claimant’s condition, Dr. Tan Duy, DO had the following recommendations: “I have reviewed the findings and options of treatment with the patient. I have recommended conservative treatment to include physical therapy. Based on the present clinical history, diagnostic studies, musculoskeletal neurological examination, I believe the patient’s symptoms do not appear to warrant surgical intervention. However, it is within reasonable medical certainty the patient’s symptoms more than likely will increase in the future and the patient likely will require cervical fusion and cervical spine radiofrequency ablation, which could incur extensive medical costs. The patient is to avoid high impact activity and overhead lifting. The MRI findings indicate the patient has suffered a permanent cervical injury as a direct result of the motor vehicle accident that occurred on 2/12/21. The patient is to follow up after pain management, if not improved.”
To date, Claimant has accumulated over $29,012.10 in medical bills for treatment of his injuries from the subject motor vehicle accident. The injuries sustained by Claimant are permanent and ongoing. He is anticipated to continue incurring medical bills for reasonable future medical treatment including physical therapy.
Despite having knowledge of the above, including their contractual duties pursuant to policy # 4105-13-89-96, GOVERNMENT EMPLOYEES INSURANCE COMPANY has inexplicably failed to propose a reasonable and satisfactory settlement offer. Thus, GOVERNMENT EMPLOYEES INSURANCE COMPANY is failing to handle this matter in good faith. This failure to make a reasonable offer is causing undue delay, which prejudices Claimant and jeopardizes his medical and general well-being. GOVERNMENT EMPLOYEES INSURANCE COMPANY, through their claims adjusters has failed to properly, correctly, and accurately handle this claim in good faith, in violation of Florida Statutes 624.155, thereby necessitating the filing of this Civil Remedy Notice. The only remedy to this Civil Remedy Notice, within the cure period, would be a tendering of the subject UM policy limits.
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The submitter hereby states that this notice is given in order to perfect the rights of the
person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.
Before submitting a Notice using this system, please verify that all text has been entered
correctly and completely. Once the Notice has been submitted, the text cannot be changed
or deleted.
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DFS-10-363
Rev. 10/14/2008
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