Filing Number: 696774
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| Filing Accepted: 5/25/2023 |
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LANPHER
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First Name |
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ROBERT |
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| Street Address
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1 SKIDMORE RD |
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WINTER HAVEN,
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33884
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| Email Address
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BLANPHER1@GMAIL.COM |
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Insured |
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| Last/Business Name* |
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LANPHER |
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First Name |
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ROBERT |
| Policy # * |
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7709HR001427 |
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Claim #* |
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835163-GN |
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Attorney is Applicable
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| Last Name* |
ANGELONE
First Name *
ANTHONY
Initial
R
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| Street Address* |
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777 S HARBOUR ISLAND BLVD, SUITE 950 |
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TAMPA
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FLORIDA
33602
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| Email Address * |
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AANGELONE@MERLINLAWGROUP.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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NATIONWIDE PROPERTY AND CASUALTY INSURANCE COMPANY
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| Insurer Name* |
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NAIC Company Code 37877 |
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| Name of individual responsible for violation (if any):*
NATIONWIDE PROPERTY & CASUALTY INSURANCE COMPANY; SCOTT AYERS; JAMES R. MANN, JR.
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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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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)(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)(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.
NATIONWIDE PROPERTY & CASUALTY INSURANCE COMPANY HAS NOT PROVIDED A COMPLETE AND/OR CERTIFIED COPY OF THE POLICY, DESPITE THE REQUESTS BY THE INSUREDS AND THEIR PUBLIC ADJUSTER. THE POLICY PROVISIONS LISTED BELOW ARE BASED ON THE DECLARATION PAGES AND LETTERS SENT BY NATIONWIDE TO THE INSUREDS, INCLUDING A LETTER DATED NOVEMBER 17, 2022. BECAUSE NATIONWIDE HAS FAILED TO PROVIDE THE INSUREDS WITH A COMPLETE AND/OR CERTIFIED COPY OF THE POLICY, THE INSUREDS ARE UNABLE TO LIST ALL APPLICABLE POLICY LANGUAGE RELEVANT TO THE VIOLATIONS DESCRIBED HEREIN.
HOMEOWNERS DECLARATIONS
POLICY NUMBER: 7709HR001427
INSURED:
Robert Lanpher and Amy Lanpher
POLICY PERIOD: 01/24/2022 – 01/24/2023
LOCATION OF PROPERTY:
1 SKIDMORE RD, WINTER HAVEN, FL 33884
POLICY COVERAGES:
A. DWELLING $1,557,400
B. OTHER STRUCTURES $33,328
C. PERSONAL PROPERTY $778,700
D. LOSS OF USE $155,740
CALENDAR-YEAR HURRICANE DEDUCTIBLE: $31,148
BUILDING ORDINANCE OR LAW COVERAGE: 25% OF DWELLING
HOMEOWNERS 3 – SPECIAL 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.
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;
SECTION I – PERILS INSURED AGAINST
A. Coverage A – Dwelling and Coverage B – Other Structures
1. We insure against direct physical loss to property described in Coverages A and B.
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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. NATIONWIDE PROPERTY & CASUALTY INSURANCE COMPANY (“NATIONWIDE”) has breached this duty by its adjustment of its Insureds' claim of loss.
NATIONWIDE 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 the Insureds and with due regard for their interests. NATIONWIDE has done everything possible to delay the claim and refuses to pay the complete covered loss amount due under the Policy. Furthermore, NATIONWIDE is required to properly investigate and adjust claims and cannot place that burden upon the Insureds. 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…”).
NATIONWIDE has failed to create and implement adequate guidelines for proper investigation and evaluation of claims and for training and supervision of employees resulting in statutory violations set forth above. NATIONWIDE has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insureds’ insurance claim for damages based on all information available and has instead ignored relevant and obvious information that evidences that additional payment is required under the policy.
Notwithstanding the timely notification of the insurance claim, NATIONWIDE has delayed and/or refused tendering to the Insureds all insurance proceeds due and owing under the insurance policy in a timely manner.
To date, notwithstanding the Insureds’ pleas otherwise, NATIONWIDE has continued to refuse to acknowledge its obligation to tender all monies due and owing the Insureds, or assist them in the mitigation of their damages.
In consideration of the premium paid to it by Robert and Amy Lanpher (the “Insureds”), NATIONWIDE issued a Homeowners Insurance Policy, POLICY NO.: 7709HR001427 (“the Policy”). The Policy provides coverage on a replacement cost basis with a limit of liability in the amount of $1,557,400 for Coverage A Dwelling, $33,328 for Coverage B Other Structures, and $778,700 for Personal Property, subject to a $31,148 hurricane deductible. The Policy also affords Building Ordinance or Law coverage in the amount of 25% of Coverage A, which equates to $389,350.
On or about September 28, 2022, while the Policy was in full force and effect, the Insureds suffered a hurricane loss at the property located at 1 Skidmore Rd, Winter Garden, FL 33884 (“the Property”). Damages resulting from a hurricane are undisputedly covered under the Policy.
On or about October 7, 2022, the Insureds timely notified NATIONWIDE of the damages and opened a claim pursuant to the terms and conditions of the Policy; claim number 835163-GN. James R. Mann, Jr. (Florida License Number E132083), was assigned by NATIONWIDE as the Claims Adjuster for the Insureds’ claim.
In response to the claim for benefits, NATIONWIDE sent an adjuster and representative to investigate and adjust the loss. On or about October 19, 2022, NATIONWIDE’s Field Adjuster, Scott Ayers, inspected the Property on NATIONWIDE’s behalf.
Following his inspection, Scott Ayers created an initial estimate of damages in the amount of $16,074.15 as replacement cost value, $15,003.80 actual cash value (“NATIONWIDE’s First Estimate”).
NATIONWIDE’s First Estimate contains a “Date Completed” of October 20, 2022. Importantly, NATIONWIDE’s First Estimate was created through the estimating program Xactimate. Xactimate uses .ESX software. When Xactimate’s .ESX software is converted to Portable Document Format (“PDF”), the conversion date is automatically added to the bottom-right of pages 2 through the last page of the estimate. NATIONWIDE’s First Estimate has a conversion date of October 20, 2022, which means NATIONWIDE’s First Estimate Completed on October 20, 2023, by Scott Ayers was the same estimate provided to the Insureds on or about November 17, 2022.
Notably, NATIONWIDE’s First Estimate does not account for general contractor overhead and profit, despite the numerous trades involved to restore the Property to its pre-loss condition. Notwithstanding the egregiously low valuation of the damages, NATIONWIDE’s First Estimate accounts for a roofer, painter, fence repairman, and a demolition crew. Based on the numerous trades involved according to NATIONWIDE’s First Estimate, it is reasonably likely the Insureds’ would require the services of a general contractor to facilitate the repairs. Florida law requires an insurer to pay the Insureds general contractor overhead and profit on an actual cash value basis where it is reasonably likely that the Insureds would require the services of a general contractor. NATIONWIDE has failed to do so in an attempt to low-ball the Insureds’ claim and look for any basis to deny payment, finding the damages below the Insureds’ $31,148 hurricane deductible under the Policy.
Moreover, NATIONWIDE’s First Estimate omitted, inter alia, any amounts for the roof of the Dwelling and the roof of the dock.
On or about October 27, 2022, NATIONWIDE retained an outcome-oriented engineering firm, Donan Engineering, to inspect the Property on NATIONWIDE’s behalf. No reports from Donan Engineering have ever been provided to the Insureds, despite their requests. It is contended that NATIONWIDE retained Donan Engineering only to support its already-made coverage decision; the estimate was completed and converted to PDF prior to Donan Engineering’s inspection.
On or about November 17, 2022, NATIONWIDE sent two letters to the Insureds. One of the letters authored by James R. Mann, Jr stated “In follow up to our Inspection on October 20, 2022, we’ve determined the damage to your Property being claimed is $16074.15 (sic). Your policy carries a $31148.00 (sic) deductible. Because the amount of your loss is less than your deductible, we are unable to make payment on your Homeowners claim.” This letter did not contain any reservations of rights, policy exclusions relied upon by NATIONWIDE, or any substantive basis for making the determination that the significant damages were valued only at $16,074.15.
The second letter sent by NATIONWIDE on or about November 17, 2022, states “We’ve completed our investigation and have determined a portion of your Homeowners claim is covered under your policy. Your policy covers ADD DETAILS ABOUT WHAT IS COVERED.” (emphasis added). The letter lists several policy provisions, then goes on to state “Our review showed that the property did have damage from the storm and we are attaching our estimate outlining the covered repairs. There was some cracking of stucco at the support beams and exterior wall areas that are not related to the storm and excluded per the policy language. The damage to the dock is excluded due to exclusions for flood and surface water. There was no damage found to the roof of the home. Please note that the metal fence damage was paid for in a prior claim from 4/2021 (Claim number 784761-GL).”
The roof of the Insureds’ home is Oriental Style Tyle, manufactured by Tsuraya Company Ltd. in Aichi-Pre, Japan and distributed by Maruhachi Ceramics of America. The Notice of Acceptance for the Oriental Style Tyle expired December 2017. Because the Notice of Acceptance has expired, the roof cannot be repaired with the same Oriental Style Tile per the Florida Building Code.
The Insureds purchased the Property approximately 5 years prior to the damage caused by Hurricane Ian on or about September 28, 2022. Each year since the purchase of the Property, the Insureds contracted with Springer-Peterson Roofing & Sheet Metal, Inc. (“Springer-Peterson”) to inspect and maintain their roof.
Prior to Hurricane Ian, the roof of the Property was in good, well-maintained condition. Following Hurricane Ian, significant damages were observed to the roof. NATIONWIDE is aware of the damages directly caused by Hurricane Ian to the roof of the Property and has made a decision to deny coverage for same. The Insureds contend the reason is because the roof cannot be repaired due to the tile being unique, discontinued, and without a valid Notice of Acceptance as required by the Florida Building Code. Therefore, if NATIONWIDE stated the roof was damaged by Hurricane Ian, NATIONWIDE would have to pay for the full replacement of the roof.
Because of the unique nature of the roof of the Property, Springer-Peterson is one of few roofing companies qualified to maintain and install the Oriental Style Tile. In fact, it is believed Springer-Peterson was the roofing company that originally installed the roof of the Property. Springer-Peterson provided to the Insureds an estimate of the cost to replace the roof in the amount of $339,985.00. This estimate was provided to NATIONWIDE whom, to date, continues to deny coverage for the roof of the Property.
Thus, it is contended that NATIONWIDE has denied coverage under the Policy for the roof of the Property either in hopes the Insureds would not pursue litigation, or in anticipation that litigation could result in a settlement below the cost to restore the Property to its pre-loss condition as is due and owing under the Policy. NATIONWIDE’s decision to deny coverage appears to be a general business practice of implementing a cost-benefit analysis when determining to pay a claim clearly owed or pay claims once they have been litigated, as opposed to settling claims when the obligation to do so would be clear to a carrier acting in good faith and with due regard for the interests of its insureds.
Regarding the fence for which NATIONWIDE claims was previously paid in a prior claim, NATIONWIDE paid for a repair to a portion of the fence damaged by a tornado incident. NATIONWIDE was provided with photographs showing where the metal fence was damaged in the prior claim versus where the metal fence was damaged in the Insureds’ Hurricane Ian claim. The damaged areas are not the same. NATIONWIDE’s First Estimate did not account for the metal fence, and its decision to deny coverage for the metal fence damaged by Hurricane Ian was another attempt by NATIONWIDE to undervalue the Insureds’ claim and assert the total damaged fell below the Policy’s hurricane deductible. Notwithstanding, the metal fence was included in the second estimate from NATIONWIDE for the Insureds’ claim.
Regarding the dock, NATIONWIDE denied coverage for any portion of the dock, not just the portion damaged by surface waters, which is not covered under the Policy. The roof of the dock was damaged by Hurricane Ian’s winds, yet NATIONWIDE wrongfully asserted the entirety of the dock was excluded from coverage.
Following receipt of NATIONWIDE’s First Estimate, the Insureds, through there public adjuster, sent NATIONWIDE a preliminary estimate totaling $105,675.70 for replacement cost value, $100,223.00 actual cash value. This preliminary estimate did not include the roof of the Dwelling, as it was still being investigated by the Insureds at the time.
On or about January 4, 2023, the Insureds provided NATIONWIDE with their Preliminary and Subject to Addendum Sworn Statement and Proof of Loss (“Sworn Proof of Loss”).
Prior to January 16, 2023, the Insureds contacted Interactive Engineering, Inc. to perform an inspection and prepare a report on their behalf. On or about January 16, 2023, Interactive Engineering, Inc. performed the inspection.
On or about January 20, 2023, NATIONWIDE sent “Jimmy” to investigate the loss. The Insureds are unaware of “Jimmy’s” role, the company he is employed by, or his full name.
On or about January 20, 2023, NATIONWIDE increased its estimate to $20,206.69, which still does not include, inter alia, overhead and profit, the roof, and dock, and still fell below the Policy’s hurricane deductible.
On or about February 16, 2023, the Insureds received from the engineer they hired from Interactive Engineering, Inc. an engineer report detailing the damages to the Property, and the cause and origin of same. This engineer report was provided to NATIONWIDE and thereafter ignored by NATIONWIDE. Importantly, among the copious findings in the report, the Insureds’ engineer determined the roof throughout the Property sustained direct physical damages as a result of the winds from Hurricane Ian.
On or about March 16, 2023, and following receipt of the Insureds’ Engineer Report, NATIONWIDE sent Donan Engineering to perform a second inspection. On or about March 29, 2023, NATIONWIDE sent Haag Engineering to perform an inspection, supposedly, of the roof of the Property.
Once again, NATIONWIDE retained outcome-oriented engineers to provide an opinion that the damages were not covered by the Policy. Donan Engineering, as well as Haag Engineering, were retained by NATIONWIDE to inspect the Property during the investigation of the Insureds’ claim. According to the final Coverage Decision Letter sent by NATIONWIDE and dated May 11, 2023, Donan “re-confirmed their previous findings and also inspected [the Insureds’] windows. Donan found that the windows of your home were not damaged by Hurricane Ian.” Moreover, Haag was supposedly retained to inspect the roof of the Property and, according to NATIONWIDE’s Letter, Haag “confirmed that the tile roof oof [the Insureds] home was not damaged by Hurricane Ian.” However, NATIONWIDE did not provide either Donan nor Haag’s report to the Insureds, despite the Insureds’ requests.
Importantly, in both occasions that NATIONWIDE retained engineers to inspect the Property during the investigation of this claim, NATIONWIDE had already completed and converted to PDF its Estimates. Clearly, NATIONWIDE’s engineers did not add to or subtract from the amount NATIONWIDE determined the value of the Insureds claim to be.
NATIONWIDE has a duty to the Insureds of honesty, fairness, and transparency. By ignoring the Insureds’ engineer report and refusing to provide any of the reports it obtained during the investigation, NATIONWIDE has breached this duty.
Nevertheless, NATIONWIDE’s actions, inactions, and opaque investigation of the Insureds’ claim furthers the contention that NATIONWIDE has improperly conducted a cost-benefit analysis in determining whether to settle the Insureds’ claim now, as a reasonable carrier acting in good faith and with due regards for its insureds’ interest would have in these circumstances, or awaiting for litigation in hopes to settle on less favorable terms than contemplated by the Policy.
Furthermore, and while there are additional damages for which NATIONWIDE failed to include in either of its Estimates, NATIONWIDE failed to include any amounts for the Office of the Property. NATIONWIDE was provided photographs from the Insureds, adjusters, and engineers of the damages, yet failed to account for any damages to the Office. Most notably, the Office is in NATIONWIDE’s January 20, 2023, estimate, yet there are no line items for the section, no statement in any of the letters as to why NATIONWIDE refused to account for the Office, and no statement that in any of the estimates that there was no damage to the office. It appears NATIONWIDE forgot to estimate for the office, which is yet another example of how NATIONWIDE has failed to implement the proper standards for the investigation and adjustment of the Insureds’ claim. The alternative is that NATIONWIDE purposefully omitted any amounts for the Office, despite having the section included in its Estimate, because NATIONWIDE looked for any basis to deny payment to the Insureds for their claim. Either reason for NATIONWIDE’s failure to include amounts for the Office is evidence that NATIONWIDE has failed to properly invest the Insureds’ claim and act in the best interests of the Insureds.
NATIONWIDE’s refusal to consider the findings of the Insureds’ engineer is in violation of the Policy and Florida law requiring that NATIONWIDE adjust claims WITH the Insureds. However, despite their requests, the Insureds were not provided a complete and/or certified copy of the Policy from NATIONWIDE.
Since the beginning of the claim, NATIONWIDE has engaged in a pattern of delay and denial that has harmed the Insureds. NATIONWIDE has not settled the claim when it could and should have done so had it acted fairly and honestly and has failed to take into account the information and evidence that clearly shows/ed additional payment is owed.
It is clear NATIONWIDE is not on the Insureds’ side.
NATIONWIDE violated section 624.155(1)(b)(1), Fla. Sat., when it failed to attempt in good faith to settle the 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 their interests. Specifically, had NATIONWIDE acted fairly and honestly toward the Insureds and with due regard for their interests NATIONWIDE would have promptly tendered payment for the roof replacement and other Hurricane Ian damages upon receipt of the documentation submitted by the Insureds. Further, had NATIONWIDE acted fairly and honestly toward the Insureds and with due regard for their interests, NATIONWIDE would not have retained outcome-oriented engineers to provide an opinion that significant amounts of the damages were excluded from coverage under the Policy, and would have provided the reports from Donan Engineering and Haag Engineering to the Insureds.
NATIONWIDE violated sections 626.9541(1)(i)(2) and 626.9541(1)(i)(3)(b), Fla. Stat., when it made material misrepresentations to the Insureds that the damages to the roof of the Property was not damaged by Hurricane Ian, that the windows weren’t damaged by Hurricane Ian, that the dock was completely excluded from coverage under the Policy despite the damage to the roof of the dock caused by wind, and, inter alia, that no payment was due and owing for the damages to the Office of the Property. These material misrepresentation were made for the purpose and with the intent of settling the claim on less favorable terms than those provided in and contemplated by the Policy.
NATIONWIDE violated section 626.9541(1)(i)(3)(a), Fla. Stat., when it failed to adopt and implement standards for the proper investigation of claims. This is evidenced by the fact that NATIONWIDE ignored information and evidence in support of roof replacement. Moreover, this is evident in the fact that no line items are included in the estimate for the Office, yet a section of NATIONWIDE’s January 20, 2023, Estimate is entitled “Office.” NATIONWIDE should have standards for the proper investigation of claims which includes promptly inspecting the damages and communicating with the insured(s) and retaining competent impartial and unbiased representatives for the investigation of damages and reviewing those opinions for accuracy before issuing coverage decisions. Because NATIONWIDE’s Estimates were Completed and converted from Xactimate prior to the inspections by its engineers, the engineers were only sent by NATIONWIDE to further its position that the Insureds’ claim falls below the hurricane deductible under the Policy.
The actions and violations noted above were either done intentionally or as the result of NATIONWIDE’s failure to adopt and implement the proper standards for the investigation and adjustment of claims.
Overall, NATIONWIDE’s investigation and handling of the claim was inadequate and contrary to its obligations under the insurance policy and Florida law.
The Insureds have done everything legally requested by NATIONWIDE to date. To cure the violations set forth in this Civil Remedy Notice, NATIONWIDE must now agree to acknowledge its duties and obligations under the law in adjusting the Insureds’ claim and tender rightfully owed insurance benefits to return the Insureds to their pre-loss condition.
The concept of insurance is that insurance is the insurer’s granting of timely and prompt indemnity or security against a contingent loss. Florida law defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that the policyholder may mitigate his/her damages and to put him/her back into the position they were in prior to loss as quickly as possible. NATIONWIDE breached this duty.
The Insureds were and still are forced to expend out of pocket monies to submit the insurance claim, e.g., retaining experts, and legal counsel, to force NATIONWIDE to honor its obligations under the insurance policy and to pay all the insurance proceeds due and owing the Insureds.
NATIONWIDE has refused and/or failed to tender all insurance proceeds to the Insureds upon demand. NATIONWIDE’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 the Insureds is wrongful conduct. the Insureds contend that NATIONWIDE has financially benefited from its improper withholding of due and owing insurance proceeds by profiting from the “float”. Furthermore, the Insureds contend that NATIONWIDE and/or its representatives financially benefit by such unfair trade practices as a part of their general business practices. the Insureds contend that NATIONWIDE pressures its agents and/or representatives, through financial incentives, to look for reasons to underpay or deny claims instead of fulfilling their obligations to do the opposite as a general business practice.
This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statute, including any and all bad faith/extra contractual, should NATIONWIDE fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. the Insureds also intend to seek punitive damages against NATIONWIDE as it appears that NATIONWIDE’s violations occur with such frequency as to evidence a general business practice and the violations were willful, wanton and malicious and were in reckless disregard for the rights of its insureds.
While no specific “cure amount” is required for this Civil Remedy Notice to be valid, the policyholders will consider the allegations contained herein “cured” if NATIONWIDE:
(1) Immediately tenders $419,129.60, with no requirement for the policyholders to sign a release. NATIONWIDE has been provided with documents to support this amount, including the Insureds’ Estimate provided in support of the Preliminary and Subject to Addendum Sworn Statement and Proof of Loss, the window estimate, and the roof estimate.
While the Insureds are requesting that this be done to “cure” this Civil Remedy Notice, they are willing to consider, and may accept, any reasonable counteroffer. Therefore, if NATIONWIDE disagrees with the requests, the Insureds request that NATIONWIDE make a counteroffer before the end of the “cure period” and provide supporting documentation for any such offer so that they may understand any discrepancies that could exist regarding the estimates.
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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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