Filing Number: 657015
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| Filing Accepted: 11/14/2022 |
| Last/Business Name
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BAY AREA PUBLIC ADJUSTER
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First Name |
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WILLIAM SABIN |
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| Street Address
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PO BOX 55369 |
| City, State Zip
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ST. PETERSBURG,
FL
33732
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| Email Address
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SABIN@BAYAREAPA.COM |
| Complainant Type:
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Third Party |
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| Last/Business Name* |
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NELSON |
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First Name |
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NYDIA |
| Policy # * |
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FE-0000913183-00 |
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Claim #* |
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HO0522415734 |
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Attorney is Applicable
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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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MONARCH NATIONAL 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 15715 |
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| Name of individual responsible for violation (if any):*
ANY AND ALL ADJUSTERS, SUPERVISORS, MANAGEMENT, ATTORNEYS AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY MONARCH NATIONAL INSURANCE COMPANY INVOLVED WITH THE HANDLING OF THIS CLAIM INCLUDING TAWANA HAYMER, HOMEOWNER’S PROPERTY CLAIMS ADJUSTER.
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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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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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| 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)(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 I - PROPERTY COVERAGES
A. Coverage A - Dwelling
1. We cover:
a. The dwelling on the "residence premises"
shown in the Declarations, including structures
attached to the dwelling, and
SECTION I - PERILS INSUREDAGAINST
A. Coverage A - Dwelling And Coverage B -
Other Structures
1. We insure against risk of direct physical loss to
property described in Coverages A and B.
Loss Payment
We will adjust all losses with you. We will pay you
unless some other person is named in the policy
or is legally entitled to receive payment. Loss will
be payable 60 days after we receive your proof of
loss
In addition, it is believed that the following policy provisions are applicable:
Duties in event of loss policy provision
All terms, conditions and sections of the insurance policy, including, but not limited to:
Section 1 of the insurance policy
Property coverages
Section 1 - perils insured against
Coverage A- dwelling
We insure against risk of direct physical loss to property described in coverages A and B.
FLORIDA ADMINISTRATIVE CODE SECTIONS VIOLATED
In addition to the statutory violations referenced above, the Insured states that Monarch National Insurance Company violated the following Florida Administrative Code Sections:
69B-220.201(3)(a) Adjuster shall disclose all financial interests and any direct or indirect aspect of an adjusted transaction.
69B-220.201(3)(b) An adjuster shall treat all claims equally. An adjuster shall not provide favored treatment to any claimant. Adjuster shall adjust all claims strictly in accordance with the insurance contract.
69B-220.201(3)(c) An adjuster shall never approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
69B-220.201(3)(e) An adjuster shall handle every adjustment and settlement with honesty, integrity, and allow fair adjustment or settlement to all parties without any remuneration to himself except to that which he is legally entitled.
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 thereof.
69B-220.201(3)(m) An adjuster shall not knowingly fail to advise a claimant of their rights in accordance with the terms and conditions of the contract and applicable laws of the state of Florida.
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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. Monarch National Insurance Company has breached the public’s trust by its adjustment of Nelson, Nydia’s (“Insured”) claim of loss.
Monarch National Insurance Company underpaid the customer based on the estimate provided to Monarch National Insurance Company by the insured’s public adjuster. Monarch National Insurance Company has opened coverage but falls below the insured’s deductible. Monarch National Insurance Company has tendered $0.00. Our estimate for repairs to place the insured back to pre-loss condition totals $30,897.44 after deductible. Monarch National Insurance Company has placed their insured in a vulnerable financial position to force a lesser settlement.
Monarch National Insurance Company 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 in paragraph No. 5. Monarch National Insurance Company has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim for damages.
Notwithstanding the Insured’s timely notification to Monarch National Insurance Company of the insurance claim, Monarch National Insurance Company has failed or refused to settle the Insured’s claim in a timely manner and/or adjust the loss with the Insured.
Monarch National Insurance Company has failed to promptly settle its Insured’s insurance claim when the obligation to settle the insurance claim had become reasonably clear. To date, notwithstanding the Insured’s pleas otherwise, Monarch National Insurance Company has continued to refuse to acknowledge its obligation to conduct a proper investigation, and to tender the insurance monies due and owing its Insured under the policy.
This claim involves the Insured’s property located at 10851 Kirkwall Port Drive Wimauma, FL 33598 which suffered a sudden loss caused by hurricane on or about 9/28/2022. The Insured made application for insurance benefits under the Policy No. FE-0000913183-00, under Claim No. HO0522415734. Monarch National Insurance Company partially accepted coverage for the loss, however, has failed to pay the full amount of benefits due to the Insured.
The insureds utilized the services of a licensed public adjuster who inspected the insureds’ property and
determined that the loss was a covered loss and had caused $30,897.44 in damages after the deductible. The insureds’ public adjuster prepared an estimate for the insureds using XACTIMATE software that incorporated standard industry pricing and accurately reflects the repairs necessary to return the insureds’ property to its pro-loss condition.
The Insured was, and still is, forced to expend out of pocket monies to submit the insurance claim, e.g., retaining legal counsel and other experts to force Monarch National Insurance Company to honor its obligations under the insurance policy and to pay all the insurance proceeds due and owing to the Insured.
Monarch National Insurance Company adjusted the loss and tendered insurance benefits of $0.00 and has refused and/or failed to tender additional insurance proceeds due and owing to the Insured. Monarch National Insurance Company’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 its Insured is wrongful conduct. Furthermore, the Insured contends that Monarch National Insurance Company’s adjusters and/or representatives financially benefit from such wrongful conduct.
Therefore, to cure the defects outlined in this Civil Remedy Notice, Monarch National Insurance Company must:
(1) Create and implement adequate guidelines for the proper investigation and evaluation of claims and for the training and supervision of employees, which will avoid future statutory violations as set forth above in paragraph No. 5, and prevent this from occurring in the future;
(2) Monarch National Insurance Company must create and implement adequate guidelines for the proper investigation and evaluation of these type of claims and for the training and supervision of employees with regard to these claims to ensure that the claims handling procedure with regard to these types of losses are adequate to prevent other insureds from being treated unfairly and wrongfully;
(3) Monarch National Insurance Company must tender to the Insured, $30,897.44, plus interest, fees and costs; and
(4) Monarch National Insurance Company must act fairly and honestly towards its Insured and with due regard for the Insured’s interests in attempting to settle its Insured’s claim.
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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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