Filing Number: 654847
|
| Filing Accepted: 11/1/2022 |
| Last/Business Name
*
|
|
|
MCWEENEY
|
|
First Name |
|
CHARLES |
|
| Street Address
*
|
|
4421 SW 25TH CT |
| City, State Zip
*
|
|
CAPE CORAL,
FL
33914
|
| Email Address
*
|
|
LILYBRANDON@AOL.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
MCWEENEY |
|
First Name |
|
CHARLES |
| Policy # * |
|
FLP386737 |
|
Claim #* |
|
1108232221013 |
|
Attorney is Applicable
|
| Last Name* |
EDWARDS
First Name *
JOHN
Initial
|
| Street Address* |
|
925 SOUTH FEDERAL HIGHWAY |
| City, State Zip* |
|
BOCA RATON
,
FLORIDA
33432
|
| Email Address * |
|
JEDWARDS@KPATTORNEY.COM |
|
|
| Insurer Type
*
|
|
 Authorized Insurer
 Unauthorized Insurer
|
|
|
| Insurer Name |
|
|
| Insurer Name* |
|
ASI PREFERRED INSURANCE CORP.
|
| Insurer Name* |
|
|
| Street Address* |
|
|
| City, State Zip* |
|
,
|
|
NAIC Company Code 13142 |
|
|
| Name of individual responsible for violation (if any):*
CHRISTY SAMPLE
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
|
Claim Denial
|
|
|
Claim Delay
|
|
|
Unsatisfactory Settlement Offer
|
|
|
Unfair Trade Practice
|
|
|
*
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)(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)(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.
Loss settlement provision of the policy and Coverage A of the Policy.
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
The carrier has not attempted in good faith to settle the insureds’ claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insureds and with due regard for their interests. The carrier has done everything possible to delay the claim and refuses to pay the complete covered loss amount due under the policy. Furthermore, the carrier is required to properly investigate and adjust claims and cannot place that burden upon the insureds. This was made clear by the appellate court and the Florida Supreme Court in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005)(“The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insureds…”).
The carrier was immediately put-on notice of the insured’s Hurricane Ian claim. The carrier initially attempted to low-ball the claim. The insured subsequently submitted a detailed loss package with extensive supporting documentation in the amount of $86,000.00 which is needed to restore the property back to its pre-loss condition to the carrier. The carrier is aware of the entire loss package for the claim submitted by the insured and has still failed to take any meaningful ensuing action. Furthermore, since the commencement of the claim the carrier has failed to timely communicate with the insured. The carrier’s failure to respond to the insured’s communications within a timely matter is a direct violation of Florida Statute 627.70131. The carrier’s conduct makes it clear that they are attempting to intentionally downplay the extent of the damage and undervalue the damages in its estimate for the sole benefit of maximizing the company’s profits, thereby placing shareholder’s interests ahead of its insureds’ interests. It is obvious that the carrier is not attempting to pay for the clearly covered damages owed under the policy and is attempting to delay the claim. This intentional delay with the claim has led to direct prejudice of the insured. To date the carrier has refused to pay the fully covered amount owed under the policy or even to attempt to treat the claim with good-faith.
It is clear that the carrier is not treating the insureds with good faith claims conduct; failing to pay a claim clearly owed and acknowledged in writing; not adjusting the claim and evaluating
the loss properly, promptly and fairly to provide full and prompt indemnity to the insured; failing
to implement proper standards for the adjustment and investigation of claims; not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the insured’s interests; refusing to pay the full amount owed to the insured despite the fact that the damages are covered under the policy; looking for ways to delay full recovery or any recovery to the insured; and refusing to provide coverage for the insured’s loss in a timely manner.
The carrier’s actions are in violation of the Loss Settlement provision of the policy, by failing to tender all sums of money due and owing under the policy, as well as the following Florida Statutes:
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)(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)(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 notify the insured of any additional information necessary for the processing of a claim.
This notice is provided in order to perfect a right to pursue the civil remedy authorized by Florida Statute §624.155. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must:
1) Pay all amounts due and owing to the insured in the amount of $86,000.00 minus any prior payments and minus the applicable deductible for indemnity benefits; and
2) Review and acknowledge receipt of communication made by the insured in regards to the subject claim;
3) Pay the insured’s attorney’s fees and costs as the carrier’s actions have forced them to retain the undersigned;
4) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made.
Please do not hesitate to contact the undersigned or Michelle Clayton at 561-892-9963 if you have any questions or concerns.
Sincerely,
John D. Edwards
Attorney at Law
|
|
|
*
|
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
|