Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 651248

Filing Accepted: 10/13/2022

Print Filing

Complainant

Last/Business Name *

SMETANA

First Name

WILLIAM

Street Address *

2822 NW 41ST PL.

City, State Zip *

CAPE CORAL, FL 33993

Email Address *

BILLSMETANA@OUTLOOK.COM

Complainant Type: *

Insured

Last/Business Name*		SMETANA		First Name		WILLIAM
Policy # *		UHF 4424483 01		Claim #*		22FL00166781

Attorney

Attorney is Applicable

Last Name*	KRAPF First Name * GRANT Initial W.
Street Address*		2790 SUNSET POINT ROAD
City, State Zip*		CLEARWATER , FLORIDA 33759
Email Address *		GRANT@KRAPFLEGAL.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		UNITED PROPERTY & CASUALTY INSURANCE COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 10969

Name of individual responsible for violation (if any):* CAITLYN SHARP, GENERALLY THE CLAIMS DEPARTMENT OF THE INSURER AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, FAMILY SECURITY INSURANCE COMPANY WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Denial
	Other : Not treating the policyholder with good faith claims conduct
	Other : Looking for ways to deny full recovery to the Insured
	Other : Looking for ways to delay full recovery to the Insured
	Other : Looking for ways to reduce recovery to the Insured
	Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made,
	Other : Failing to provide the Insured with the full benefits under the contract of insurance in a timely fa
	Other : Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt in
	Other : Placing the financial interest of the Insurer over that of the Insured
	Other : Conducting inadequate investigations

* 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)(2)		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.
	626.9541(1)(i)(3)(a)		Failing to adopt and implement standards for the proper investigation of claims.
	626.9541(1)(i)(3)(b)		Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
	626.9541(1)(i)(3)(c)		Failing to acknowledge and act promptly upon communications with respect to claims.
	626.9541(1)(i)(3)(d)		Denying claims without conducting reasonable investigations based upon available information.

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language.

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Family Security Insurance Company (“Insurer”) has committed the following in handling the Insured’s claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the Policy Holder and Claimant; 3) not adjusting the claims promptly and fairly; 4) not attempting in good faith to settle claims; 5) looking for ways to delay benefit payments; 6) conducting inadequate investigations; 7) denying a claim which it knew or should have known the policy and Florida law provided coverage for; and 8) failing to render a claims determination within ninety (90) days. Claimant timely submitted a claim to Insurer on June 15, 2022, for wind damage sustained to the above-referenced insured property on March 13, 2022, including the ensuing damage therefrom. Insurer sent a field adjuster to inspect the property on July 13, 2022. Then, in a letter dated October 3, 2022, Claimant was informed by Insurer that there was no wind damage to the roof, but rather that the roofing system revealed signs of “blistering, thermal cracking, zippering, and loose/unsealed shingles, attributable to mechanical damage, faulty installation and/or materials and wear, tear, and/or deterioration over time.” However, Insurer failed to hire an engineer or roofing expert to determine the cause of loss. This misrepresentation of the damages at the insured property resulted in the wrongful denial letter that Claimant received. Given the scope and nature of the damage, Claimant retained a roofing contractor who produced an estimate dated September 8, 2022, detailing $25,741.20 in covered damage to the dwelling. Despite the claim being reported on June 15, 2022, Insurer took little to no action until the following month on July 7, 2022, when it conducted a recorded statement. Then, about a week later, it sent its field adjuster to inspect the property on July 13, 2022. During the inspection, the field adjuster inspected the property for a mere thirty (30) minutes, spending fifteen (15) of those minutes on the roof. In such a short period of time, Insurer did not properly investigate the loss or determine when or how the Claimant’s roof damage occurred. As such, Insurer has ignored covered damage and has failed to pay Claimant for the loss so that the property may be restored to its pre-loss condition. This is an underhanded attempt to place the financial interests of Insurer over those of Claimant and to delay and frustrate Claimant’s ability to have the claim adjusted promptly to begin restoring the property. Insurer upon receiving notice of Claimant’s loss had the duty to provide the full benefits under the policy. This includes providing the Claimant with a proper investigation and the funds necessary to return the insured property to its pre-loss condition. Despite the obvious covered wind damage under the policy, Insurer here placed its financial interest over the health and safety of Claimant by denying the claim Claimant needs a new roof to comply with the Florida Building Code, because more than 25% of Claimant’s roof is damaged. Insurer is refusing to pay for a full roof replacement despite knowing its obligation to do so. Florida Building Code section 611.1.1 states that not more than 25% of the total roof area or roof section of any existing building or structure shall be repaired, replaced, or recovered in any 12-month period unless the entire roofing system or roof section conforms to requirements of this code. Insurer knows, or should have known, that over 25% of Claimant’s roof is damaged due to wind and that it is responsible for replacing the roof. However, Insurer and its adjusters are misrepresenting the damage to avoid coverage, thereby prioritizing Insurer’s financial interests over Claimant’s interest and safety. Further, according to Florida Statute § 627.7011(1)(b), Insurers have a duty to cover all costs necessary to meet applicable laws and ordinances regulating the repair of any property and Florida Statute § 626.9744 requires that Insurer make reasonable repairs or replacement that match the quality, color or size of the items that needs repair. Additionally, Insurer further delayed and frustrated Claimant's ability to have the claim adjusted promptly and begin restoring the home by waiting more than ninety (90) days after receiving notice of the Insured’s claim to issue a payment. Insurer delayed by failing to timely make a claims determination after receiving the claim pursuant to Florida Statute § 627.70131. Under this statute, Insurer had ninety (90) days from the reported date of loss to make a claims determination. Claimant reported the loss on June 15, 2022, and, as such, a claims decision was due ninety (90) days from that date or on September 13, 2022. Insurer failed to do anything - within 90-days from the date of receiving the claim - to further the claim towards a resolution. It was not until October 3, 2022 that Insurer provided Claimant with a claims determination. Accordingly, Insurer’s business practice delayed and frustrated Claimant’s ability to have the claim adjusted promptly to begin restoring the property to its pre-loss condition. In short, Insurer is not acting with due regard for the Claimant’s interests or safety. In Florida the work of adjusting insurance claims engages the public trust. Insurers have a duty to treat all Claimants equally and Insurer has breached this duty. Insurer has conducted poor and inadequate investigations and has wrongfully denied the replacement costs of Claimant’s property to further frustrate and delay the claim. Insurer is placing its financial interests over those of the Claimant and the Claimant’s safety in an attempt to retain funds which Insurer knows should go to the Claimant to restore the home to its pre-loss condition. The foregoing has only delayed the Claimant’s ability to begin restoring the insured property to its pre-loss condition. Therefore, Insurer’s actions amount to but are not limited to the following: 1. Claim denial 2. Claim delay 3. Unfair trade practice 4. Not treating the policyholder with good faith claims conduct 5. Looking for ways to deny full recovery to the Insured 6. Looking for ways to delay full recovery to the Insured 7. Looking for ways to reduce recovery to the Insured 8. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholder’s interests 9. Failing to provide the Insured with the full benefits awarded to him under the contract of insurance in a timely fashion 10. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 11. Placing the financial interest of Insurer over that of the Insured 12. Conducting inadequate investigations Therefore, to cure the defects outlined in this Civil Remedy Notice, Insurer must: (1) Admit full coverage for the Insureds’ loss. (2) Tender full benefits owed to the Insureds under the insurance contract. (3) Pay all attorney’s fees, costs, and interest. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. Via E-mail: Family Security Insurance Company claims@upcinsurance.com

Comments

User Id		Date Added		Comment
dcaraker@upcinsurance.com		11-10-2022		All parties to this dispute have amicably resolved their differences and settled the underlying claim. Thus, all purported violations alleged in the subject CRN have been cured.
grant@krapflegal.com		11-10-2022		The details herein have been amicably resolved between the parties; therefore, we withdraw this Civil Remedy Notice.

Acknowledgement
*	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.

DFS-10-363
Rev. 10/14/2008