Filing Number: 664480
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| Filing Accepted: 12/27/2022 |
| Last/Business Name
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BRAZAO DE BARROS
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First Name |
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SAMUEL |
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| Street Address
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14650 TULLAMORE LOOP |
| City, State Zip
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WINTER GARDEN,
FL
34787
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| Email Address
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BARROSGENERALSERVICES@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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BRAZAO DE BARROS |
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First Name |
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SAMUEL |
| Policy # * |
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EDH4022687-06 |
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Claim #* |
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EDI954581 |
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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
,
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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EDISON 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 12482 |
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| Name of individual responsible for violation (if any):*
TUWANNA MING, RYAN PHILLIPS, PAULA FINSTROM, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, EDISON 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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Claim Denial
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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 Claimant
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Other
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not adjusting claims and evaluating loss properly
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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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Other
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looking for ways to delay full recovery to the Claimant
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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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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.
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.
Edison Insurance Company (the “Insurer”) has committed the following in handling the Claimant’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) looking for ways to deny benefit payments and otherwise “stone wall” claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) looking for ways to delay benefit payments; and 7) conducting inadequate investigations.
The Claimant timely submitted a claim to the Insurer for wind damage sustained to the above-referenced insured property from Hurricane Ian on September 27, 2022, including the ensuing damage therefrom. The Insurer responded with a letter dated November 18, 2022, stating that the amount of covered damage did not exceed the policy deductible. The Insurer also advised some of the damage stemmed from flood, which is not covered by the policy. Ultimately, the Insurer stated that the repair cost amounted to $509.52 which fell below the Claimant’s $7,132.23.00 deductible. Given the scope and nature of the damage, the Claimant retained a public adjuster who produced an estimate on October 30, 2022, detailing $101,981.23 in covered damage due to the Claimant.
The Insurer misrepresented the loss and erroneously denied coverage for the Claimant’s damage. The Insurer claims the property damage was caused by flood, but the damage was caused by wind-driven rain through the Claimant’s windows as a direct result of Hurricane Ian. Although the Insurer and Claimant are in dispute about how the property was damaged, the Insurer knows or should know that when independent perils coverage and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured 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 initial investigation by the Insurer’s field adjuster was inadequate. 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 Claimant’s property, including significant damage to the flooring, ceiling, and walls throughout the home. The Insurer’s estimate of the Claimant property’s loss simply would not restore the property to its pre-loss condition which is Insurer’s duty under its own contract of insurance. The Insurer has violated its duties by issuing a coverage determination that misrepresents the true scope of damages to the insured’s property and the true replacement cost of the damages. This is an underhanded attempt to place the financial interest of the Insurer over those of the Claimant, to delay the Claimant’s claim, and to delay the Claimant’s ability to restore the property to its pre-loss condition.
Additionally, Insurer shifted the burden and cost of investigating and insuring the loss onto the Claimant. The Insurer upon the Claimant’s loss had the duty to provide the full benefits under?the policy. These benefits include providing the Claimant with a proper investigation of the loss in addition to the funds necessary to return the property to its pre-loss condition.??However, during the course of its investigation, the insurer’s adjuster did not use a moisture meter, despite the presence of interior water damage. A moisture meter can be purchased online from Amazon for around $40 before tax. The Insurer could purchase a moisture meter and assess thousands of properties with one meter. Instead, the Insurer would rather place its financial interests over those of the Claimant 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 Claimant’s property. The Insurer and its adjuster have colluded to misrepresent the true scope of damages to the insured property and the true replacement costs of the damages.
The Insured suffered extensive interior water damage. Despite the presence of such extensive damage, the Insurer refused to conduct a mold inspection which has put the Claimant’s health at risk. Thankfully, upon inspecting the property, the Claimant’s public adjuster discovered that mold was of concern. However, it is not the job of the Claimant to inform the Insurer of visible water damage so a mold inspection can be conducted. To the contrary, it is the job of the Insurer to employ competent adjusters to know that when water damage is visible a mold inspection must be conducted.
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 which have frustrated and delayed resolution of 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 Claimant’s ability to begin restoring the home to its pre-loss condition.
The insurer’s actions amount to but are not limited to the following:
1. Not treating the policyholder with good faith claims conduct
2. Looking for ways to reduce recovery to the Claimant
3. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Claimant
4. Conducting inadequate investigations
Therefore, to cure the defects outlined in this civil remedy notice, the insurer must:
(1) Admit full coverage for the Claimant’s loss.
(2) Tender full benefits owed to Claimant 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 Email:
Edison Insurance Company
903 NW 65th St., Suite 200
Boca Raton, FL 33487
Csclaims@edisoninsurance.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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