Filing Number: 685077
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| Filing Accepted: 3/27/2023 |
| Last/Business Name
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GLOBALPRO RECOVERY INC.
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First Name |
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| Street Address
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3139 SW 27TH AVE |
| City, State Zip
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MIAMI,
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33133
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| Email Address
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FBELTRAN@GLOBALPRO.COM |
| Complainant Type:
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Third Party |
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| Last/Business Name* |
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HORBACZEWSKI |
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First Name |
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HENRY |
| Policy # * |
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NF033FL0119140 |
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Claim #* |
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EV2022028946 |
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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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NATIONAL FIRE & MARINE 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 20079 |
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| Name of individual responsible for violation (if any):*
ERIC BLAZER, TISZARA PRUNTY
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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 Denial
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Claim Delay
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Unfair Trade Practice
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Other
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Misrepresentations
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Other
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Breach of Contract
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Other
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Violation of Florida Statues
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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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| 624.155(1)(b)(3) |
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Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
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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)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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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)(f) |
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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.
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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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
UNIT-OWNERS COVERAGE A – SPECIAL COVERAGE
Section I – Perils Insured Against
Perils Insured Against
1. We insure against direct physical loss to property described in Coverage
Wind-Driven Rain Endorsement
The following Peril is added for Coverage A and C: Wind-driven Rain
This peril includes loss caused by rain, snow or sleet that is driven by wind. This peril includes loss to personal property or the building interior caused by water when direct force of wind causes water to enter the building without causing an opening in the exterior.
Windstorm or Hail Coverage
The following is added to Section I – Perils Insured Against: Windstorm
This peril includes loss caused by windstorm, hail, snow or sleet. This peril does not include loss to personal property or the building interior caused by water, sand or dust unless the direct force of wind or hail damages the building causing an opening in the roof or wall and the water, sand or dust enters through the opening.
HOMEOWNERS 6 – UNIT-OWNERS FORM
Agreement
We will provide the insurance described in this policy in return for the premium and compliance with all applicable provisions of this policy period
Section 1 – Property Coverages
A. Coverage A – Dwelling
1.We cover:
a.The alterations, appliances, fixtures and improvements which are part of the building
contained within the “residence premises”;
b.Items of real property which pertain exclusively to the “residence premises”
B. Coverage C – Personal Property
1. Covered Property
We cover personal property owned or used by an “insured” while it is anywhere in the world.
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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.
On or about September 28, 2022, the Insured, Henry Horbaczewski (the “Insured”), suffered a covered property damage loss when Hurricane Ian struck Florida and severely damaged the Insured’s Property located at 3215 West Gulf Drive, Unit B101, Sanibel, FL 33957 (the “Property”). Shortly thereafter, and after the Insured had reported the claim to the carrier on or about September 30, 2022, the Insured retained the services of GlobalPro Recovery, Inc. (“GlobalPro”), a public adjusting firm, to represent the Insured’s interests in pursuing an insurance claim, and to perform public adjusting services on behalf of the Insured. On or about November 7, 2022, GlobalPro proceeded to submit its Letter of Representation and signed contract with the Insured to National Fire & Marine Insurance Company (the “Insurer”) under Policy Number NF033FL0119140, et al., and under assigned claim number EV2022028946. The Insurer acknowledged receipt of the foregoing on November 7, 2022. This Civil Remedy Notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statute Section 624.155.
The Insurer improperly denied this claim not once, but twice; the second time after a reinspection at the Property at which time the Insurer’s adjuster and GlobalPro discussed at least some covered wind damages and discussed GlobalPro submitting an estimate to the adjuster that the carrier could “work with”. Moreover, the Insured’s immediately adjacent neighbor received policy limits for wind-related damages to his unit, and the Insurer here was advised of same. The Insured’s unit, while being on the first floor, is elevated and not on ground level. There were wind-related and caused damages, and interior water intrusion, which are covered under the policy and which should have been acknowledged as covered and paid by the Insurer. However, the Insurer improperly and in bad faith denied this claim, prompting the filing of this Civil Remedy Notice.
The field adjuster, Eric Blazer, inspected the Property on October 28, 2022. On November 17, 2022, GlobalPro was advised that the field report from the field adjuster was still pending. By November 29, 2022 (a month after the field inspection), there was still no update on the claim and so GlobalPro had to follow up with carrier again for a status on the claim. The same day the carrier advised they were still pending receipt of the field report.
On December 22, 2022, the assigned adjuster, Tiszara Prunty, advised that we should have received a denial letter (by that date, we had not received any denial letter) and went on to state the following: “The field adjuster did not find any damage caused by wind. The damage to the dwelling and personal property was caused by flood, and there is no coverage for flood on this policy.” The field adjuster and the desk examiner/adjuster clearly failed to recognize that there was also wind-related and caused damages and resulting water intrusion which caused damages to the Property, and which are therefore covered under the policy here. The next day, December 23, 2022, Ms. Prunty emailed the denial letter dated December 19, 2022.
Thereafter, and because the Insurer improperly denied coverage for the claim and damage to the Property caused by Hurricane Ian, GlobalPro continued its efforts to communicate with both the field adjuster and desk examiner/adjuster, in an effort to further discuss the claim and the improper denial. The desk adjuster/examiner, Ms. Prunty, advised that since the field adjuster was the one who inspected the Property and submitted the report of findings, that GlobalPro would need to communicate with him (Mr. Blazer) in order to get coverage properly acknowledged and a claim payment issued. Despite repeated attempts to communicate with the field adjuster, Mr. Eric Blazer, based on the desk examiner’s representations, GlobalPro was unbale to reach the field adjuster after weeks of calls, voice messages, and follow up emails. On January 31, 2023, GlobalPro reached out to the desk examiner again and sent the following email communication:
Good morning Tiszara,
I hope all is well! Per our prior discussions regarding this matter, my office has been trying
to reach the field adjuster (Eric Blazer) to discuss the improper denial, and we have been
attempting to contact him for the last 2-3 weeks but have not heard back. We have made serval
phone calls, left voice messages, and sent emails – no response or call back. I need to speak
with you ASAP. Please return my call at your earliest convenience.
The foregoing clearly evidences the Insurer’s failure to adopt and implement standards for the proper investigation of claims in violation of Florida Statute Section 626.9541(1)(i)(3)(a), Further, the foregoing shows the Insurer’s failure to acknowledge and act promptly upon communications with respect to claims in violation of Florida Statute Section 626.9541(1)(i)(3)(c). At that time, the desk examiner advised she would assign another field adjuster since the prior adjuster had likely left the area, and GlobalPro agreed that would be best so that this claim could be reevaluated, the Property reinspected, and the claim properly acknowledged as covered and a claim payment issued.
GlobalPro then proceeded to explain to the desk examiner that “This Property is elevated, the bottom/ground floor is parking, and the “first floor” where the Insured Property is located is elevated above the parking. You can see from the photos that the unit is not on the ground/bottom floor. Also, the Insured’s neighbor who lives in Unit 102, got full policy limits on his wind claim for Hurricane Ian damages.” The desk examiner responded that she would request a reinspection, per prior discussions with GlobalPro.
By February 6, 2022, there had been no updates on the reinspection. After GlobalPro followed up, the desk examiner advised that the same adjuster (Mr. Eric Blazer) would do the reinspection, despite the fact the desk examiner made representations that a new, different field adjuster would be assigned to do the reinspection and reevaluate the claim. Upon learning this, GlobalPro responded to the desk examiner as follows: “I just called you. Please call me back ASAP. That is the individual who originally was assigned, and who has been MIA for weeks and nonresponsive to communication attempts. You said someone new would be assigned to reinspect, and as such we want someone new assigned to reinspect and handle this matter appropriately. Please return my call.” The foregoing clearly evidences the Insurer’s misrepresentations regarding the claim in violation of Florida Statute Sections 626.9541(1)(i)(2) and 626.9541(1)(i)(3)(b). Of course, conveniently later the same day, the original field adjuster, Mr. Blazer, called GlobalPro’s offices. Thus clearly, Mr. Blazer had been purposely non-responsive to communication attempts by GlobalPro, until GlobalPro addressed his unresponsiveness and failure to communicate with the carrier directly. The foregoing clearly shows the Insurer’s failure to adopt and implement standards for the proper investigation of claims in violation of Florida Statute Section 626.9541(1)(i)(3)(a), as well as the Insurer’s failure to acknowledge and act promptly upon communications with respect to claims in violation of Florida Statute Section 626.9541(1)(i)(3)(c). When GlobalPro insisted that a new field adjuster be assigned, per the representations made by the desk examiner and because the original field adjuster had been unresponsive, the desk adjuster replied “I cannot request for a different adjuster unless there was proof the adjuster was in fact being non-responsive.” Interestingly, GlobalPro had submitted proof to the Insurer that the field adjuster had not been responsive, including emails showing our attempts to communicate with him and follow up.
Notwithstanding, on February 7, 2023, a reinspection of the Property was performed with the original field adjuster, Mr. Blazer, and a representative from GlobalPro. During this reinspection, Mr. Blazer advised and indicated to GlobalPro that the estimate previously submitted, for over $500,000.00 (from a contractor), was too high and that he needed an estimate he could work with. At this reinspection, it was discussed that this Property is elevated (not on ground level), and that while there may have been some damage to the Property from flood, there was also damage to the Property from wind as well. Further, it was explained to Mr. Blazer that the Property Owner’s immediately adjacent neighbor obtained policy limits from his wind carrier for property damages to the neighboring unit caused by wind-related forces and damages from Hurricane Ian. Upon completion of the reinspection, the field adjuster asked the representative from GlobalPro to prepare and submit an estimate that he could work with, for less money, and indicated that coverage would be afforded for wind related damages to the Property. On or about March 6, 2023, GlobalPro did just that and submitted an estimate to the carrier for $236,841.21. However, on March 16, 2023, instead of acknowledging at least some coverage for damage to covered Property, the carrier denied the claim in whole (again).
The foregoing summary of the Insurer’s handling of the matter shows that GlobalPro had to follow up with the Insurer numerous times to obtain updates and the field adjuster was unresponsive and failed to properly communicate with GlobalPro. Notwithstanding the fact that the Insured complied with all the Insurer’s requests and provided documentation as requested, the Insurer still took the improper and bad faith position to deny the claim. As such, the foregoing shows the Insurer’s failure to acknowledge and act promptly upon communications with respect to claims in violation of Florida Statute Section 626.9541(1)(i)(3)(c) as well as the Insurer’s failure to adopt and implement standards for the proper investigation of claims in violation of Florida Statute Section 626.9541(1)(i)(3)(a). Also though, this evidences the Insurer’s violation of Florida Statute Section 626.9541(1)(i)(3)(d) by denying claims without conducting reasonable investigations based upon available information.
Clearly, based on the foregoing, the communications between the Insured and Insurer, and the course this clam has taken, the Insurer has unreasonably and in bad faith handled the adjustment and investigation of this claim, has improperly and in bad faith denied this claim, and in addition has violated several Florida laws in the adjustment and handling of the claim. The Insurer failed to adopt and implement standards for the proper investigation of claims in violation of Florida Statute Section 626.9541(1)(i)(3)(a). Moreover, the Insurer has failed to acknowledge and act promptly upon communications with respect to claims in violation of Florida Statute Section 626.9541(1)(i)(3)(c) and has failed to provide a reasonable explanation in writing to the Insured of the basis in the policy, in relation to the facts or applicable law, for denial of the claim in violation of Florida Statute Section 626.9541(1)(i)(3)(f). The Insurer’s unreasonable handling of this claim and violations of Florida laws has been detrimental to the Insured and has caused the unnecessary and unreasonable delay and denial of this claim. Moreover, the Insurer made misrepresentations to the Insured in the course of the adjustment, handling and investigation of this claim in violation of Florida Statute Sections 626.9541(1)(i)(2) and 626.9541(1)(i)(3)(b). From the facts, correspondence noted above and between the Insurer and GlobalPro, and course this claim has taken, it is obvious that the Insurer is not attempting in good faith to settle this claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward the Insured and with due regard for the Insured’s interests, in violation of Florida Statute Section 624.155(1)(b)(1). The Insurer has failed to promptly settle or otherwise resolve this claim when the obligation to settle this claim has become reasonably clear in violation of Florida law.
In addition to the above statutory violations, the Insurer’s adjuster(s) violated the following ethical requirements of Florida Administrative Code 69B-220.201:
(3) Code of Ethics . . . An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance. The following are standards of conduct that define ethical behavior, and shall constitute a code of ethics that shall be binding on all adjusters:
(b) An adjuster shall treat all claimants equally.
2. An adjuster shall adjust all claims strictly in accordance with the insurance contract. DFS-10-363 Rev. 11/2007
(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
(d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.
(e) An adjuster shall handle every adjustment and settlement with honesty and integrity, and allow a fair adjustment or settlement to all parties without any remuneration to himself except that to which he is legally entitled.
(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.
(o) 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.
In Florida, the work of adjusting insurance claims engages the public trust. During the adjustment of the Insured’s claim, the Insurer breached this duty by failing to adhere to and comply with the above referenced obligations and Florida statutes. To cure the defects outlined above, the Insurer must:
A. Immediately acknowledge coverage for the loss and damages being claimed;
B. Immediately and in good faith communicate with GlobalPro in an attempt to settle and resolve
the claim;
C. Act fairly and honestly towards the Insured and with due regard for the Insured’s interests;
D. Tender all insurance proceeds due and owing to the Insured under the Insured’s insurance
policy with the Insurer that would reasonably place the Insured back to a pre-loss
condition; and
E. Create and implement adequate guidelines for the proper investigation and evaluation of
damages, resulting damages, and loss claims, and for the training and supervision of
employees with regard to these claims to ensure that the Insurer’s handling procedures are
adequate to stop the claimants from being treated unfairly
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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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