Filing Number: 658637
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| Filing Accepted: 11/28/2022 |
| Last/Business Name
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HARTMAN
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First Name |
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PATRICIA |
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| Street Address
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4531/4533 SKYLINE BLVD |
| City, State Zip
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CAPE CORAL,
FL
33914
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| Email Address
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NYJETSPAT@AOL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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HARTMAN |
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First Name |
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PATRICIA |
| Policy # * |
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HCPC-DP3-387651-9 |
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Claim #* |
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922305 |
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Attorney is Applicable
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| Last Name* |
KRAPF
First Name *
GRANT
Initial
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| Street Address* |
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2790 SUNSET POINT ROAD |
| City, State Zip* |
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CLEARWATER
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FLORIDA
33759
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| Email Address * |
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GRANT@KRAPFLEGAL.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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HOMEOWNERS CHOICE PROPERTY & CASUALTY INSURANCE COMPANY, INC.
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| Insurer Name* |
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| Street Address* |
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NAIC Company Code 12944 |
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| Name of individual responsible for violation (if any):*
DAVID WELLS, PLACIDA CARABALLO, ANY OTHER INDIVIDUAL FROM, OR AGENT OF, HOMEOWNER’S CHOICE PROPERTY & CASUALTY INSURANCE COMPANY WHO WAS INVOLVED IN THE CLAIM.
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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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Unfair Trade Practice
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Claim Delay
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Other
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Not treating the policyholder with good faith claims conduct
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Other
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Looking for ways to deny full recovery to the Claimants
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Other
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Looking for ways to delay full recovery to the Claimants
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Other
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Not training, supervising, or managing adjusters properly so that prompt and full payments are made,
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Other
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Failing to provide the Claimants with the full benefits awarded to him under the contract of insuran
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Other
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Failing to implement proper standards for the adjustment and investigation of claims
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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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
627.444 (2)(a) Notwithstanding any other law, an insurer shall provide to an insured within 15 calendar days after an individual or entity designated by the insurer receives the insured’s written request, either: A loss run statement.
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Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language.
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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.
Homeowner’s Choice Property & Casualty Insurance Company (the “Insurer”) has committed the following in handling the Claimants’ 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) conducting inadequate investigations; and 6) making material misrepresentations of the coverages afforded under the insurance policy.
The Claimant timely submitted a claim on or about June 20, 2022, to the Insurer for wind damage sustained to the above-referenced insured property on or about March 12, 2022, including any ensuing damage therefrom. Due to the scope and nature of the damage, the Claimant retained a public adjuster who, in a report dated July 31, 2022, revealed covered damages of $30,127.06 to the dwelling. In a letter dated August 17, 2022, the Insurer misrepresented the loss by asserting that only $13,220.52 was due to its Claimant for the substantial damage, after accounting for the deductible and recoverable depreciation. Within the same letter, the Insurer cites that “there was no wind or hail damage to the roof. The roof has leaked due to wear, tear, and deterioration which are all specifically excluded under the policy.” Interestingly, the Insurer enclosed the estimate it was replying on which oddly accounts for a roof replacement of 25 roofing squares. This is to say, the provisions cited within the coverage letter and the estimated enclosed are contradictory.
Nevertheless, the Insurer and its hired guns arrived at these conclusions because they failed to conduct a thorough and adequate investigation or intentionally ignored the damages observed thereby failing to make truthful and unbiased reports of the facts after conducting the investigation. As a result, the Insurer misrepresented the loss and underpaid the claim. The Insurer’s estimate of the Claimant property’s loss simply would not restore the property to its pre-loss condition which is the Insurer’s duty under its own contract of insurance. Despite the contradictory assertions, the damage was caused by a windstorm. The Insurer here places its financial interest over the health and safety of the Claimant by underpaying the claim. The foregoing is an underhanded attempt to place the financial interests of the Insurer over those of the Insured and to delay and frustrate the Claimant’s ability to have the claim adjusted promptly to begin restoring the property to its pre-loss condition.
To the extent that the Insurer is alleging that the damage was caused by non-covered perils in the policy, Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016) applies. The Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. The concurring cause doctrine states that coverage may exist where an Claimant risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697.
The Insurer’s adjuster knew or should have known that over 25 percent of the Claimant’s roof was damaged as a result of a covered peril, and presumably did. The Insurer also knows that the Claimant needs a new roof in order to comply with the Florida Building Code, because more than 25 percent of the Claimant’s roof is damaged and matching roofing tile cannot be purchased. The Insurer did not allocate enough coverage to pay for a full re-roof despite knowing it is obligated to do so. According to Florida Statute s. 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 s. 626.9744 requires that the Insurer make reasonable repairs or replacement that match the quality, color or size of the items that needs repair. This has further delayed the Claimant from being able to restore the property to its pre-loss condition and is an underhanded attempt to place the financial interest of the Insurer over Claimant.
Although there was interior water damage, the adjuster did not use a water meter or inspect for mold. A water meter can be purchased online from Amazon for around $44 before tax. The Insurer could purchase a water meter and assess thousands of properties with one meter. The Insurer’s adjuster should have a full tool belt to thoroughly investigate claims. Instead, the Insurer’s adjuster has no need for a tool belt because they don’t have the necessary tools to fill it. It is clear the Insurer would rather place its financial interests over those of the Insured by failing to provide the adjuster with the necessary tools to correctly inspect the loss. As a result of the inadequate investigation and surrounding circumstances, it is apparent that the Insurer significantly underestimated the scope of the loss to the Insureds property.
Not surprisingly, the Insurer continued to delay and frustrate the Claimant’s ability to have this claim adjusted promptly by failing to timely provide the Claimant with the policy after it was requested on June 28, 2022. The policy was not received within 30 days of the first written request. Each Insurer which does or may provide liability insurance coverage to pay all or a portion of any claim which might be made shall provide, within 30 days of the written requires of the claimant, a statement, under oath, of a corporate officer or the insurer’s claims manager or superintendent, a copy of the policy. Fla. Stat. 627.4137(1)(e). Insurers have a duty to settle claims in good faith when, under all the circumstances, they could and should have done so, had they acted fairly and honestly toward its insureds and with due regard for their interests. This is to say, this Insurer has failed and/or refused to promptly acknowledge the Claimant’s communication in an attempt to frustrate and delay the resolution of this claim.
Furthermore, the Insurer and its agents failed to comply with Fla. Stat. § 627.444 in not providing Claimant and her representatives with a loss run statement. On June 28, 2022, the Insurer was provided a Letter of Representation, but has not yet provided a loss run statement. Upon an Insurer receiving a written request for a loss run statement, the Insurer is required, within fifteen (15) calendar days, to provide either a loss run statement or information on how to obtain a loss run statement at no charge through a consumer reporting agency. There has been no response within the fifteen (15) calendar days of Claimant’s written request and the Insurer has not provided information on how to obtain a loss run statement at no charge through a consumer reporting agency. This Insurer has breached its duty to settle claims in good faith when, under all the circumstances, it could and should have done so. The Insurer and its agents have not acted fairly and honestly toward Claimant and her representatives. Lastly, the Insurer has failed or refused to promptly acknowledge the Claimant’s communications in an attempt to frustrate and delay the resolution of Claimant’s claim.
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 the Insurer has breached this duty. The Insurer has conducted poor and inadequate investigations and has significantly underestimated the replacement costs of Claimant’s property to further frustrate and delay the Claimant’s claim. The Insurer is placing its financial interests over those of the Claimant and the Claimant’s safety. The foregoing has only delayed the Claimants’ ability to begin restoring the insured property to its pre-loss condition.
The Insurer’s actions amount to but are not limited to the following:
1. Claim delay
2. Not treating the policyholder with good faith claims conduct
3. Looking for ways to reduce recovery to the Claimants
4. Looking for ways to deny recovery to the Claimants
5. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Claimant
6. 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
7. Placing the financial interest of the Insurer over that of the Claimant
8. Conducting inadequate investigations
9. Making material misrepresentations of the coverages afforded under the insurance policy.
10. Failing to provide a loss run statement
Therefore, to cure the defects outlined in this Civil Remedy Notice, the Insurer must:
(1) Admit full coverage for the Claimants’ loss.
(2) Tender full benefits owed to the Claimants 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 Electronic Mail:
Homeowner’s Choice Property & Casualty Insurance Company
P.O. Box 22967
Tampa, FL 33622
claims@hcpci.com
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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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