Filing Number: 652135
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| Filing Accepted: 10/19/2022 |
| Last/Business Name
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| Street Address
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125 NIGHT OWL COURT |
| City, State Zip
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LONGWOOD,
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32779
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| Email Address
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COREMKTG@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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SERLUCO |
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First Name |
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JANET |
| Policy # * |
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UHV 3004245 08 |
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Claim #* |
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22FL00159007 |
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Attorney is Applicable
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| Last Name* |
MURRAY
First Name *
DAVID
Initial
C
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| Street Address* |
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109 N. BRUSH STREET, SUITE 350 |
| City, State Zip* |
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TAMPA
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FLORIDA
33602
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| Email Address * |
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SERVICE@MURRAYLAWGROUP.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):*
CLAIMS DEPARTMENT, SUPERVISORS, MANAGEMENT, AGENTS, AND ADJUSTERS, INCLUDING THE FOLLOWING REPRESENTATIVE & ADJUSTER(S): TAMMERA EDWARDS, RYAN KOMANETSKY, ALEXANDRA SORBO
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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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Non-renewal
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Claim Denial
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Claim Delay
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Other
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Violation of Code of Ethics
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Other
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Litigation Strategy and Behavior
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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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| 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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| 626.9541(1)(i)(3)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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| 626.9541(1)(i)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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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.
The Insured believes the language relevant to the violations includes the applicable coverages and limits from the Declaration Pages, the loss payment provision, the loss settlement provision, and any applicable endorsement related to the loss.
The Insured refers to the specific policy language set forth in United’s April 5, 2022 letter:
SECTION I – PERILS INSURED AGAINST
A. Coverage A – Dwelling And Coverage B – Other Structures
1. We insure against direct physical loss to property described in Coverages A and B.
2. We do not insure, however, for loss:
a. Excluded under Section I – Exclusions;
. . .
(6) Any of the following:
(a) Wear and tear, marring, deterioration;
(b) Mechanical breakdown, latent defect, inherent vice or any quality in property that causes
it to damage or destroy itself;
. . .
Paragraph 2.c.(6)(c) is replaced by the following:
(c) Smog, rust or other corrosion;
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(f) Settling, shrinking, bulging or expansion, including resultant cracking, of bulkheads, pavements, patios, footings, foundations, walls, floors, roofs or ceilings;
. . .
SECTION 1 – PERILS INSURED AGAINST (UPC 191 02 18 – Special Provisions)
A. Coverage A – Dwelling And Coverage B– Other Structures
In Form HO 00 03:
Item A.1. is deleted and replaced by the following:
1. We insure against sudden and accidental direct physical loss to property described in Coverage A and B.
. . .
SECTION 1 - EXCLUSIONS
. .
B. We do not insure for loss to property described in Coverages A and B caused by any of the following. However, any ensuing loss to property described in Coverages A and B not precluded by any other provision in this policy is covered.
1. Weather conditions. However, this exclusion only applies if weather conditions contribute in any
way with a cause or event excluded in A. above to produce the loss.
. . .
3. Faulty, inadequate or defective:
. . .
b. Design, specifications, workmanship, repair, construction, renovation, remodeling, grading, compaction;
c. Materials used in repair, construction, renovation or remodeling; or
d. Maintenance;
of part or all of any property whether on or off the "residence premises".
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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 addition of the above statutory provisions alleged to have been violated, see also the following statutes and rules:
624.155(1)(a)1 Any person may bring a civil action against an insurer when such person is damaged: (a) by violation of any of the following provisions by the insurer: (1) Section 626.9541(1)(i), (o), or (x)
69B-220.201(3)(b) An adjuster shall treat all claimants equally.
69B-220.201(3)(b)(1) An adjuster shall not provide favored treatment to any claimant.
69B-220.201(3)(b)(2) An adjuster shall adjust all claims strictly in accordance with the Insurance contract.
69B-220.201(3)(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
69B-220.201(3)(d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.
69B-220.201(3)(f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim.
69B-220.201(3)(k) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise.
626.877 Every adjuster shall adjust or investigate every claim, damage, or loss made or occurring under an insurance contract, in accordance with the terms and conditions of the contract and of the applicable laws of this state.
626.878 An adjuster shall subscribe to the code of ethics specified in the rules of the department. The rules shall implement the provisions of this part and specify the terms and conditions of contracts, including a right to cancel, and require practices necessary to ensure fair dealing, prohibit conflicts of interest, and ensure preservation of the rights of the claimant to participate in the adjustment of claims.
626.9744(1) When a loss requires repair or replacement of an item or part, any physical damage incurred in making such repair or replacement which is covered and not otherwise excluded by the policy shall be included in the loss to the extent of any applicable limits. The insured may not be required to pay for betterment required by ordinance or code except for the applicable deductible, unless specifically excluded or limited by the policy.
626.9744(2) When a loss requires replacement of items and the replaced items do not match in quality, color, or size, the insurer shall make reasonable repairs or replacement of items in adjoining areas. In determining the extent of the repairs or replacement of items in adjoining areas, the insurer may consider the cost of repairing or replacing the undamaged portions of the property, the degree of uniformity that can be achieved without such cost, the remaining useful life of the undamaged portion, and other relevant factors.
627.70131(5)(a) Within 90 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer which reasonably prevent such payment. Any payment of an initial or supplemental claim or portion of such claim made 90 days after the insurer receives notice of the claim, or made more than 15 days after there are no longer factors beyond the control of the insurer which reasonably prevented such payment, whichever is later, bears interest at the rate set forth in F.S. § 55.03. Interest begins to accrue from the date the insurer receives notice of the claim. The provisions of this subsection may not be waived, voided, or nullified by the terms of the insurance policy. If there is a right to prejudgment interest, the insured shall select whether to receive prejudgment interest or interest under this subsection. Interest is payable when the claim or portion of the claim is paid. Failure to comply with this subsection constitutes a violation of this code. However, failure to comply with this subsection does not form the sole basis for a private cause of action.
627.7152(9)(b) (“Assignment Agreements”) An insurer must respond in writing to the notice [of intent to litigate] within 10 business days after receiving the notice specified in paragraph (a) by making a presuit settlement offer or requiring the assignee to participate in appraisal or other method of alternative dispute resolution under the policy. An insurer must have a procedure for the prompt investigation, review, and evaluation of the dispute stated in the notice and must investigate each claim contained in the notice in accordance with the Florida Insurance Code.
FACTS AND CIRCUMSTANCES GIVING RISE TO THE VIOLATION
The property located at 125 Night Owl Court, Longwood FL 32779 (“the Insured Property”) was damaged by a covered loss on or about March 16, 2022. The storm crossed over the Insured Property and caused damages to the Insured’s home and the surrounding neighborhood homes. The Insured, Janet Serluco (“Insured”) , provided notice of the loss to his property insurer, United Property & Casualty Insurance Company (“United”).
United (through Matthew Suggs of FKS Insurance Claims) inspected the Insured Property on March 28, 2022. By letter dated April 5, 2022, United (through Adjuster Tammera Edwards) partially denied the Insured’s claim stating that:
“The inspecting adjuster found damage to a gutters and downspout. A repair estimate has been completed for repairs.
The inspecting adjuster also observed prior repairs, cracked tiles, broken tiles that is unrelated storm damage. Also, installation issues throughout the roof, which has been excluded from the estimate. The adjuster also observed conditions of deterioration causing failure to the underlayment to the back slope, deterioration to the valley flashing to the front slope which reflects mechanical breakdown.
At this time, these damages appear to be more closely related to age, wear & tear, weathering & exposure, installation, and/or mechanical means. Additionally, the adjuster observed ensuing water damage to the dining room, living room, kitchen, bedroom, and master bathroom with no apparent storm created opening.
Based upon the facts revealed during our investigation, we are unable to provide coverage as the damage(s) are specifically excluded by your policy. Your policy states there have to be a storm created opening for the ensuing water damage to be covered. The specific policy language is captioned further down for your reference.”
The Insured retained public adjusting firm, ELM Public Adjusting Services, to assist with her claim. By e-mail dated, May 31, 2022, the Insured (through her public adjuster) provided an executed Letter of Representation.
On June 7, 2022, Adjuster Ryan Komanetsky sent a letter acknowledging ELM Public Adjusting Services Letter of Representation. Additionally, the same day, Adjuster Ryan Komanetsky sent a Request for Information letter, including United’s request for a Proof of Loss and estimates or invoices for repairs as a result of the loss.
On June 15, 2022, the Insured (through her public adjuster) provided United with her Sworn Proof of Loss along an estimate and photographs in support of damages totaling $131,538.11.
By letter dated June 16, 2022, United (through Claims Adjuster Ryan Komanetsky) advised that “unable to accept it with regard to scope and substance as we are not in agreement with the scope or pricing of the damage.” United also cannot agree to the amounts claimed therein “with regard to scope and substance as we are not in agreement with the scope or pricing of the damages.”
By letter dated July 25, 2022, United (through Claims Adjuster Alexandra Sorbo) advised that it would be standing on its original partial denial letter. In the letter, Ms. Sorbo states the following:
“Based upon the facts revealed during our investigation, the observed damages to the tile roof system are due to wear and tear, installation deficiencies, and foot traffic. The interior damages were not the result of storm-created damages, nor was there a storm created opening found to the roofing system. At this time we are standing on our prior coverage determination and we are respectfully denying your supplement request as we are unable to provide any further coverage at this time because the damages are specifically excluded by the policy.” This letter followed the re-inspection performed by third party engineering firm SDII Global, but their report was not disclosed to the Insured or her representatives.
Despite having been provided a copy of the Insured’s estimate of damages, and the facts that the loss and damages are covered under the insurance policy, United has not taken any further action to adjust the claim and has continued to fail to pay all monies owed to the Insured. United conducted deficient inspections and has improperly failed and/or refused to pay all amounts owed for the Insured’s loss.
United has failed and/or refused to admit full coverage and has not issued any monies for the Insured’s loss. United relied on a deficient inspection and investigation as the basis of its undervaluation and partial denial, and it has improperly failed and/or refused to pay any amounts owed for the Insured’s loss. The Insured has complied with each and every demand and request of United as required under the Policy, and fully cooperated with United in its investigation.
United has failed to create and implement adequate guidelines for proper claims investigation, claims evaluation, claims handling, and for training and supervision of employees and independent contractors handling its claims resulting in statutory violations as set forth above. United has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s claim for damages. The Insured Property was damaged by a covered loss. United has undervalued the claim, ignored obvious signs of damage, and has improperly denied coverage for interior damage.
The concept of insurance is that it is the insurer's granting of timely and prompt indemnity or security against a contingent loss. Fla. Stat. § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment is made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. United has failed to comply with its duty to indemnify the Insured.
United refuses to pay insurance proceeds owed to the Insured as required by the policy and law. Refusal and/or failure to settle the Insured’s claim when under all the circumstances it could have and should have done so had it acted fairly and honestly towards the Insured is wrong.
The actions taken by United in the handling and adjustment of the Insured’s claim were willful, wanton, and in disregard for the rights of its Insured and occur with such a frequency as to indicate a general business practice, and further, are in violation of Florida Statutes § 624.155 and § 626.9541.
Based on the foregoing actions and omissions, United has engaged in wrongful conduct. That wrongful conduct includes, but is not limited to, the following:
1. Improper claim delay.
2. Improper claim denial and portion of the claim & damages
3. Undervaluing the Insured’s damages.
4. Underpaying the Insured’s damages.
5. Not conducting a full and fair investigation of the Insured’s claim.
6. Looking for ways to deny recovery to the Insured.
7. Looking for ways to delay recovery to the Insured.
8. Not adjusting the claim and not evaluating the loss properly, promptly, and fairly so as to provide full and prompt indemnity to its Insured.
9. Failing to implement proper standards for the adjustment and investigation of insurance claims.
10. Not training, supervising, or managing adjusters and independent contractors properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholders’ interests by attempting to deny or minimize payments owed.
11. Establishing severity control initiatives and otherwise establishing a culture of not fully and promptly paying claims following losses.
12. Making misrepresentations to the Insured about the cause of damages at the Insured Property.
13. Making misrepresentations to the Insured about the scope of damages at the Insured Property.
14. Ignoring and/or failing to give full consideration to claim documentation from the Insured showing the full extent and scope of damages.
Therefore, to cure the defects outlined in this Civil Remedy Notice, United must:
• Admit coverage and tender all insurance monies owed to the Insured for the loss to the Insured Property.
• Tender insurance proceeds to the Insured in an amount totaling at least $25,000 to assist the Insured to being making repairs to the Insured property.
A copy of this form has been submitted to the FDFS and has been printed out and mailed to the following parties providing them notice of the filing of the Civil Remedy Notice:
United Property & Casualty Insurance Company, via Certified Mail, R.R.R.
Claims Department, United Property & Casualty Ins. Co., via regular US Mail.
Alexandra Sorbo, United Property & Casualty Ins. Co., via email.
Ms. Janet Serluco, via email.
Mr. Eric Miller, Public Adjuster, via email.
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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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