Filing Number: 685763
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| Filing Accepted: 3/29/2023 |
| Last/Business Name
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NORMAN WALLEN AND KAREN WALLEN
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First Name |
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| Street Address
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1832 SW 38TH LANE |
| City, State Zip
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CAPE CORAL,
FL
33914-55
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| Email Address
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WITHHELD |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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NORMAN WALLEN AND KAREN WALLEN |
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First Name |
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| Policy # * |
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09-6820236663-03 |
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Claim #* |
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401520 |
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Attorney is Applicable
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| Last Name* |
DE SOUZA
First Name *
JACKSON
Initial
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| Street Address* |
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501 E. LAS OLAS BLVD, SUITE 200 |
| City, State Zip* |
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FORT LAUDERDALE
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FL
33301
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| Email Address * |
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JACKSON@KWGLEGAL.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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FIRST COMMUNITY 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 13990 |
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| Name of individual responsible for violation (if any):*
UNKNOWN
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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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Unfair Trade Practice
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Unsatisfactory Settlement Offer
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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)(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)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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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.
Loss settlement provision
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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.
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 its interests. The carrier has done everything possible to delay the claim and refuses to provide any sort of status of the claim. Furthermore, the carrier is required to properly investigate and adjust claims and cannot place that burden upon the insured. 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 insureds’ claim. Subsequently, the insureds submitted a loss package in the amount of $18,687.03 needed to restore the property back to its pre-loss condition to the carrier. The carrier initially has made insufficient payment totaling $8,514.36. This payment was based off the carrier’s own unilaterally determined deficient valuation of the damages to the property. The insureds have complied with all the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. More than one hundred and seventy-nine (179) days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of the full loss and has not taken any meaningful ensuing action since issuing payment base don its own unilaterally determined valuation.
It is clear that the carrier is not treating the insureds with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insureds; failing to implement proper standards for the adjustment and investigation of claims and placing the company’s interests before the insureds’ interests; not training, supervising or managing adjusters properly so that prompt and full payments are made; refusing to pay the full amount owed to the insureds despite the fact that the damages are covered under the policy; looking for ways to delay full recovery or any recovery to the insureds; and refusing to provide coverage for the insureds’ loss in a timely manner. The Carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(d), and Fla. Stat. §627.70152(4) making a carrier’s response to a 10-day letter with a pre-suit settlement offer, request for mediation, or demand for appraisal mandatory.
Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1) Pay the complete covered loss in the amount of $18,687.03 less the applicable policy deductible and any prior payment(s); 2) Pay the insureds’ attorneys’ fees and costs as they have been forced to retain counsel; and 3) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been printed out and mailed.
Please do not hesitate to contact the undersigned or Rylee Lopez at (754) 231-8107 if you have any questions or concerns.
Sincerely,
Jackson de Souza, Esq.
Jackson de Souza
Attorney at Law
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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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