Filing Number: 649835
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| Filing Accepted: 10/3/2022 |
| Last/Business Name
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BUTLER
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First Name |
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STEPHEN |
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| Street Address
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21483 PEACHLAND BLVD |
| City, State Zip
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PORT CHARLOTTE,
FL
33954
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| Email Address
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FLBBUTLER10@YAHOO.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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BUTLER |
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First Name |
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STEPHEN |
| Policy # * |
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UHV 2486525 10 |
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Claim #* |
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22FL00169734 |
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Attorney is Applicable
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| Last Name* |
INNOCENT
First Name *
KIMBERLY
Initial
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| Street Address* |
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1580 SAWGRASS CORPORATE PARKWAY, SUITE 130 |
| City, State Zip* |
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SUNRISE
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FL
33323
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| Email Address * |
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KIMBERLY@INNOCENTLAWFIRM.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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UNITED PROPERTY & CASUALTY 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 10969 |
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| Name of individual responsible for violation (if any):*
AARON STRANGE
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Unsatisfactory Settlement Offer
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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)(2) |
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A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
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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)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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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 I - PROPERTY COVERAGES
In Form HO 00 03:
Coverage A - Dwelling
Item 1.a. is replaced by the following:
The dwelling on the “residence premises” used mainly as your private residence shown on the Declarations, including attached structures, other than fences, and attached wall-to-wall carpeting if damage to the dwelling is caused by a covered loss.
Form UPC 191 02 18, SPECIAL PROVISIONS - FLORIDA, SECTION I - PERILS INSURED AGAINST, par. A. 1.a, pg. 2 of 17.
SECTION I - PERILS INSURED AGAINST
Coverage A - Dwelling And Coverage B- Other Structures
In Form HO 00 03:
Item A.1. is deleted and replaced by the following:
We insure against sudden and accidental direct physical loss to property described in Coverage A and B.
2. We do not insure, however, for loss:
c. Caused by:
(6) Any of the following:
(a) Wear and tear, marring, deterioration;
Under 2.b. and c. above, any ensuing loss to property described in Coverages A and B not precluded by any other provision in this policy is covered.
Form UPC 191 02 18, SPECIAL PROVISIONS - FLORIDA, SECTION I - PERILS INSURED AGAINST, par. A. 1., pg. 6 of 17.; Form HO 00 03 05 11, SPECIAL PROVISIONS - FLORIDA, SECTION I - PERILS INSURED AGAINST, par. A.2.,A.2.c.(6)(a), and closing paragraphs of paragraph 2 , pg. 9 of 24.
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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.
In Florida, the work of adjusting insurance claims engages the public trust. United Property & Casualty Insurance Company (“INSURER”) has breached the public’s trust by its adjustment of Stephen Butler’s (“Insured”) claim of loss. INSURER’S principal address is 800 2nd Avenue South, SAINT PETERSBURG, FL 33701. INSURER has failed to create and implement adequate guidelines for the proper investigation and evaluation of claims, claims handling, and for training and supervision of employees resulting in statutory violations as set forth above. INSURER has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the INSURED’S insurance claim for damages. INSURER has failed to promptly settle the Insured's insurance claim when the obligation to settle the insurance claim had become reasonably clear. To date, notwithstanding the Insured's pleas otherwise, INSURER has continued to refuse to acknowledge its obligation to conduct a proper investigation, and to tender the full amount of insurance monies due and owing its Insured under the policy.
This claim involves the Insured's property located at 21483 Peachland Blvd, Port Charlotte, FL 33954, which sustained significant damage from a plumbing failure on or around July 11, 2022. Specifically, a plumbing failure occurred due to a pressurized water line under the shower. INSURER acknowledged the claim and assigned a field adjuster to inspect the loss.
In correspondence dated September 27, 2022, INSURER’s Adjuster, Aaron Strange incorrectly determined that although “the sudden rupture of the line was understood to be the cause of the observed damages, this is supported from the water usage records provided to our office. The deterioration of the water line leading up to it’s [sic] eventual failure is understood to be from wear and tear over time. Your policy provides coverage for the ensuing water damage; however, it excludes coverage for wear, tar [sic], and/or deterioration.”
The Policy is an All-Risk Policy, which covers sudden and accidental direct physical loss to property described in Coverage A and B. Further, the Property provides coverage for ensuing losses. INSURER has acknowledged that “the sudden rupture of the line” was the cause of the loss. Yet, it improperly asserts that coverage is excluded due to wear and tear even though the policy specifically states that the loss must be caused by “wear and tear” for that exclusion to apply.
To date, it has been ninety five (95) days since the claim was reported and INSURER has failed to fully indemnify its Insured for this loss. The Insured, of course, is very disappointed with INSURER’s poor investigation and nonpayment of the claim. The Insured has retained a public adjuster, Adam Donatelle of Donatelle Claim Advisors, who has prepared an estimate of the Insured's damages, which totals $22,954.75. Therefore, demand is hereby made as follows: Estimate $22,954.75 Less Deductible $2,500 LESS PRIOR PAYMENT $6,579.74 TOTAL $13,875.01.
The concept of insurance is that the insurer will investigate and grant timely and prompt indemnity or security against a contingent loss. Florida Statute §624.02 defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies. Inherent in that definition is the fact that payment must be made timely and promptly so that the Insured may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. INSURER has breached this duty.
The Insured were and still are, forced to expend out of pocket monies to submit their insurance claim, e.g., retaining a public adjuster, an attorney, and other experts to force INSURER to honor its obligations under the insurance policy and to pay all the insurance proceeds due and owing to them.
INSURER has refused and/or failed to tender all the insurance proceeds due and owing to the Insured. INSURER’s refusal and/or failure to settle the insurance claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards the Insured is wrongful conduct. Furthermore, the Insured contend that INSURER’s adjusters and/or representatives financially benefit from such wrongful conduct. Therefore, to cure the defects outlined in this Civil Remedy Notice, INSURER must tender to the Insured $13,875.01 as set forth above, plus interest. This notice is given in order to perfect the right to pursue the civil remedy authorized by Fla. Stat. §624.155.
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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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