Filing Number: 780944
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| Filing Accepted: 9/1/2024 |
| Last/Business Name
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PREFERRED STORAGE PLANTATION, LLC
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First Name |
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4551 W. SUNRISE BLVD. |
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PLANTATION,
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33313
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TSPENO@PRD-REALTY.COM |
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Insured |
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PREFERRED STORAGE PLANTATION, LLC |
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First Name |
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| Policy # * |
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IBP1008586 |
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Claim #* |
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5500494728 |
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Attorney is Applicable
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| Last Name* |
CHAVIN
First Name *
VALORIE
Initial
S
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12955 BISCAYNE BOULEVARD, SUITE 201 |
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NORTH MIAMI
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FL
33181
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VCHAVIN@CMSLAWGROUP.COM |
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 Authorized Insurer
 Unauthorized Insurer
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| Insurer Name |
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VANTAGE RISK SPECIALTY INSURANCE COMPANY
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,
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NAIC Company Code 16275 |
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| Name of individual responsible for violation (if any):*
LAURA BUCHER
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| Type of Insurance
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Commercial 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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Other
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Violation of Florida Administrative Code 69B-220.201
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Claim Denial
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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)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(3)(e) |
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Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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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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| 626.9541(1)(i)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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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.
Determined to deprive the Insured of just compensation for a significant fire loss, the Insurance Company engaged in a needlessly protracted and combative adjustment, requiring its Insured and the Insured’s representative to jump through hoops to comply with the Carrier’s beleaguering requests and multiple inspections. Throughout the adjustment, the Insurance Company’s adjuster made clear that the loss was approached with an eye towards underpayment and denial, immediately challenging the scope and value of the loss, refusing to consider the Insured’s expert’s opinions on damages and methods for repair, and making discourteous and unwarranted assumptions related to the Insured’s Public Adjuster’s workmanship (such as, “PAs have a tendency to fluff their estimates,” and “I assume you will still be disputing our findings . . . as I am used to working with PAs.”). While the Insured and its Public Adjuster fully cooperated with the Insurance Company’s investigation and adjustment of the loss, the Insurance Company – frustrated with the Insured’s refusal to accept the Carrier’s undervaluation of the claim – sought to intimidate, harass, and punish its Insured and its Public Adjuster with unnecessary demands for examinations under oath and property inspections outside the ordinary course of business. The Insurance Company’s elevation of its own interests over those of its Insured has left its Insured unable to properly repair its fire damaged property.
The Insured believes the following policy language may be at issue:
SECTION I – PROPERTY
A. Coverage
We will pay for direct physical loss of or damage to Covered Property at the premises described in the Declarations caused by or resulting from any Covered Cause of Loss.
1. Covered Property
Covered Property as described under Paragraph a. below, Business Personal Property as described under Paragraph b., below, or both, depending on whether a Limit of Insurance is shown in the Declarations for that type of property. Regardless of whether coverage is shown in the Declarations for Buildings, Business Personal Property, or both, there is no coverage for property described under Paragraph 2 Property Not Covered.
a. Buildings, meaning the buildings and structures at the premises described in the Declarations . . .
b. Business Personal Property located in or on the building at the described premises or in the open (or in a vehicle) within 100 feet of the described premises . . .
. . .
3. Covered Causes of Loss
Risks of direct physical loss unless the loss is:
a. Excluded in Paragraph B. Exclusions in Section I; or
b. Limited in Paragraph 4. Limitations in Section I.
. . .
5. Additional Coverages
a. Debris Removal
(1) Subject to Paragraphs (3) and (4), we will pay your expense to remove debris of Covered Property caused by or resulting from a Covered Cause of Loss that occurs during this policy period.
. . .
f. Business Income
(1) Business Income
(a) We will pay for the actual loss of Business Income you sustain due to the necessary suspension of your “operations” during the “period of restoration.” The suspension must be caused by direct physical loss of or damage to property at the described premises. The loss or damage must be caused by or result from a Covered Cause of Loss.
. . .
(b) We will only pay for loss of Business Income that you sustain during the “period of restoration” and that occurs within 12 consecutive months after the date of direct physical loss or damage. We will only pay for ordinary payroll expenses for 60 days following the date of direct physical loss or damage, unless a greater number of days is shown in the Declarations.
(c) Business Income means the:
(i) Net income that would have been earned or incurred if no physical loss or damage had occurred, but not including any Net Income that would likely have been earned as a result of an increase in the volume of business due to favorable business conditions caused by the impact of the Covered Cause of Loss on customers or on other businesses; and
(ii) Continuing normal operating expenses incurred, including payroll.
. . .
(5) Accrued Rental Charges
We will pay for the loss of accrued rental or lease charges for storage spaces rendered unrentable because of a covered loss.
. . .
g. Extra Expense
(1) We will pay necessary Extra Expense you incur during the “period of restoration” that you would not have incurred if there had been no direct physical loss or damage to property at the described premises. The loss or damage must be caused by or result from a Covered Cause of Loss.
. . .
o. Fire Extinguisher Systems Recharge Expense
(1) We will pay:
(a) The cost of recharging or replacing, whichever is less, your fire extinguishers and fire extinguishing systems . . . if they are discharged on or within 100 feet of the described premises.
. . .
p. Reasonable Emergency Measures
(1) We will pay up to $3,000 for the reasonable costs incurred by you for necessary measures taken solely to protect Covered Property from further damage when the damage or loss is caused by a Covered Cause of Loss.
(2)We will not pay more than the amount in (1) above, unless we provide you approval within 48 hours of your request to us to exceed the limit in (1) above. In such circumstance, we will pay only up to the additional amount for the measures we authorize.
If we fail to respond to you within 48 hours of your request to us and the damage or loss is caused by a Covered Cause of Loss, you may exceed the amount in (1) above only up to the cost incurred by you for the reasonable emergency measures necessary to protect the Covered Property from further damage.
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(4) A reasonable measure under this Additional Coverage, Reasonable Emergency Measures, may include a permanent repair when necessary to protect the Covered Property from further damage or to prevent the unwanted entry to the property. To the degree reasonably possible, the damaged property must be retained for us to inspect.
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E. Property Loss Conditions
. . .
3. Duties in the Event of Loss or Damage
In case of a loss to Covered Property, you must see that the following are done:
a. Give prompt notice to us or your insurance agent;
Except for reasonable emergency measures taken under Additional Coverages, Reasonable Emergency Measures, there is no coverage for repairs that begin before the earlier of:
(1) 72 hours after we are notified of the loss;
(2) The time of loss inspection by us;
(3) The time of other approval by us.
b. (1) To the degree reasonably possible, retain the damaged property; and
(2) Allow us to inspect, subject to 3.b.(1) above, all damaged property prior to its removal from the described premises.
c. Notify the policy if a law may have been broken, and provide the incident number and, if we request, a copy of the report.
d. Protect the property from further damage. The following must be performed:
(1) Take reasonable emergency measures that are necessary to protect the property from further damage, as provided under Additional Coverages, Reasonable Emergency Measures.
A reasonable emergency measure under 3.d.(1) above may include permanent repair when necessary to protect the covered property from further damage or to prevent the unwanted entry to the property. To the degree reasonably possible, the damaged property must be retained for us to inspect.
(2) keep an accurate record of repair expenses.
e. Cooperate with us in the investigation of a claim;
f. Resume all or part of your “operations” as quickly as possible.
. . .
h. As often as we reasonably require:
(1) Permit us to inspect the property proving the loss or damage and examine your books or records;
(2) Permit us to take samples of damaged and undamaged property for inspection, testing and analysis and permit us to make copies from your books and records;
You or any insured must:
(1) Submit to an examination under oath and recorded statements, while not in the presence of any other insured; and
(2) Sign the same.
. . .
(5) Anyone you hire in connection with the presentation of your claim and anyone insured under this policy other than 3.h.(3) or 3.h.(4) above must:
(a) Submit to examinations under oath and recorded statements, while not in the presence of any other insured and
(b) sign the same.
i. Send to us, within 60 days after our request, your signed, sworn proof of loss which sets forth, to the best of your knowledge and belief:
(1) The time and cause of loss;
(2) The interests of the insureds and all others in the property involved and all liens on the property;
(3) Other insurance which may cover the loss;
(4) Changes in title or occupancy of the property during the term of the policy;
(5) Specifications of damaged buildings and detailed repair estimates; and
(6) The inventory of damaged personal property described in 3.g above.
. . .
6. Loss Payment
In the event of loss or damage covered by this policy:
a. At our option, we will either:
(1) Pay the value of lost or damaged property;
(2) Pay the reasonable cost of repairing or replacing the lost or damaged property;
(3) Take all or any part of the property at an agreed or appraised value; or
(4) Repair, rebuild or replace any part or item of the property with material or property of like kind and quality subject to Paragraph d.(1)(e) below, or
b. If an identical replacement is not available we may, at our option substitute replacement of equal or greater features, functions or capabilities of the damaged property subject to Paragraph d.(1)(e) below.
. . .
g. Provided you have complied with all the terms of this Policy, we will pay for covered loss or damage upon the earliest of the following:
(1) Within 20 days after we receive the sworn proof of loss and reach written agreement with you or
(2) within 30 days after we receive the sworn proof of loss and:
(a) There is an entry of a final judgment; or
There is a filing with an appraisal award or a mediation settlement with us.
(3) Within 60 days of receiving notice of an initial, reopened or supplemental claim, unless we deny the claim during that time or factors beyond our control reasonably prevent such payment. If a portion of the claim is denied, then the 60-day time period for payment of claim relates to the portion of the claim that is not denied.
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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 Insured, Preferred Storage Plantation, LLC (the “Insured”) owns a storage facility insured by a businessowners policy issued by Vantage Risk Specialty Insurance Company (the “Insurance Company” or the “Carrier”). The Policy provides coverage for damages caused by fire. On April 30, 2024, a fire broke out in a storage unit within the Insured’s property, causing extensive smoke damage and activating the facility’s internal sprinkler system. When the fire department arrived to address the fire, water was utilized to extinguish the flames. The property was damaged not only by the fire and heavy smoke, but also by the substantial sprinkler and hose water used to dowse the fire. The Insured’s management company, Extra Space Storage, immediately retained a reputable mitigation company, ServPro, to address the fire and water remediation necessitated by the loss. ServPro assessed the damage and prepared a 24-Hour Report advising that the mitigation required will likely exceed three days of drying and may exceed $3,000.00 to complete. ServPro was instructed to begin mitigation in accordance with the Insured’s obligations to take reasonable steps to protect the property from further damage. The Insurance Company and its expert/consultant, Rimkus, were in direct contact with ServPro during the mitigation process and the Insurance Company never directed ServPro to limit the scope of the mitigation work being provided to the Insured or advised the Insured that the scope of ServPro’s mitigation would not be covered by the Insurance Company.
The magnitude of the loss compelled the Insured to retain professional assistance of a public adjuster to assist in submitting a claim to the Insurance Company. It contracted with Lesser and Company, Inc. to represent it through the adjustment of its Claim (the “Public Adjuster”). The Public Adjuster gave the Insurance Company notice of the loss and provided a copy of its Letter of Representation. From the outset, when the Insurance Company acknowledged receipt of the loss, it cautioned its Insured that “[t]here is a question whether coverage under this policy applies to this occurrence. The nature of this coverage question is as follows: scope and price of required repairs.” Without an inspection of the Property or even having received the Insured’s estimate for repairs, the Insurance Company confoundingly questioned the “scope and price” of repairs, indicating that it approached the loss with an eye toward underpayment.
To better appreciate the true scope and value of the damages to the insured property, the Insured retained All Phase Builders, Inc. (“All Phase”), to inspect the property and prepare an estimate of the real-world costs associated with restoring the property to its pre-loss condition. All Phase inspected the Property on May 3, 2024, and prepared a detailed line-item estimate of all permanent repairs necessary to restore the property, totaling $480,859.95. The All Phase estimate together with supporting photographs was provided to the Carrier for its consideration. The Carrier retained its own biased and outcome-oriented vendors to conduct multiple inspections of the property. Each time, the Insured welcomed the Carrier’s inspectors and remained willing and able to assist the Carrier in its investigation. After an inspection on May 3, 2024, the Carrier’s consultant, Compass Building Services, LLC, prepared an astonishingly low estimate alleging the entirety of the damage to the insured Property could be repaired for only $17,962.55, and addressing only minor repairs to drywall, insulation, doors and hardware, and cleaning the floors in the property’s storage area, single affected unit, breakroom, and breakroom closet. Based on the egregiously low Compass estimate, the Insurance Company issued correspondence to its Insured acknowledging coverage for the loss and issuing payment in the amount of $112,962.55. Of that amount, the Carrier advanced payment of $100,000.00 towards mitigation and allowed only $12,962.55 towards repairs after application of the policy’s deductible.
The Insured and Public Adjuster were baffled by the Carrier’s extreme undervaluation of the loss and refusal to acknowledge the scale of the damage to the property. They requested the Carrier reconsider its position, especially in light of the All Phase estimate that accurately reflects the total repairs necessary to restore the property following the loss. The Public Adjuster wrote to the Insurance Company explaining, “[a]fter reviewing Compass’ estimate of repairs, please be informed that we disagree with it and believe the scope of loss is completely off.” To comply with the Carrier’s requests for information related to the adjustment, the Insured submitted a Sworn Proof of Loss advising the Carrier that total damages were still undetermined, as it had yet to receive the total mitigation costs from ServPro and had not calculated the damages it suffered and continued to suffer as a result of its business interruption following the loss. The Insurance Company rejected the Proof of Loss because “the proof of loss submitted does not include the value of the damages being claimed,” despite that, pursuant to the terms of the policy, the Proof of Loss need only include information to the best of the Insured’s knowledge and belief. Still, the Insured endeavored to provide the Carrier with all information necessary to appreciate the true scope and value of the damages suffered to the best of its ability, given the available information at that time.
Acknowledging its initial Compass estimate failed to address the full scope of damages suffered by the Insured, the Insurance Company obtained a Smoke Damage Assessment and engaged Rimkus Consulting Group, Inc. to review the Assessment and photographs and prepare an estimate for additional smoke and soot mitigation. The Rimkus estimate totals $202,672.36. In addition, Compass prepared a supplemental estimate for repairs to the property totaling $87,794.54. On June 21, 2024, the Insurance Company issued a supplemental payment in the amount of $264,644.26 to compensate the Insured for damages to the property and necessary mitigation related to the loss. Despite the additional payment, the Carrier still fell far short of providing adequate monies to fully compensate its Insured for the loss. The Public Adjuster requested reconsideration, but the Carrier’s adjuster dismissed the concern, asserting that the Carrier will pay only “reasonable costs,” and alleging, “PAs have a tendency to fluff their estimates.” The Public Adjuster took umbrage with the Carrier’s adjuster’s accusation, as the Insured had continually done everything possible to demonstrate the true scope and value of the damages to the property and was relying on a licensed contractor’s estimate to establish the same. Nevertheless, the Insurance Company refused to acknowledge the Insured’s position and refused any additional payment.
In furtherance of its quest for just compensation for the loss, the Insured submitted a Sworn Proof of Loss “per the All Phase Builders Estimate for Permanent Repairs Only,” acknowledging that additional damages would be forthcoming based on the mitigation completed by ServPro and the interruption to the Insured’s business. The Public Adjuster endeavored to assist the Insurance Company in identifying and remedying the differences in scope and amount between the parties’ estimates by preparing a detailed comparison of the All Phase, Rimkus and Compass estimates. The Insurance Company’s adjuster dismissed the Public Adjuster’s attempts to reach an agreement and work together with its Insured and its representative to complete the adjustment of the Claim by stating, “there’s nothing to discuss at this point as we reject your estimate/disputes as written as being excessive.”
The Public Adjuster disputed the Carrier’s position that the All Phase estimate was “simply excessive,” and alerted the Insurance Company that the lion’s share of the remaining scope and amount dispute related to the proper method to repair the damage to the Insured’s flooring. While the Insurance Company maintained that the floor could be restored simply by cleaning, the Insured understood the floor could not be restored to its pre-loss condition by cleaning alone. In furtherance of its position, the Insured retained concrete restoration expert, Apsogi LLC, to determine the proper method to restore the flooring of the property following the fire, soot, and water loss. Apsogi inspected the loss and observed dark staining on the flooring that would not come off with chemical treatments or mechanical grinding. Because the stains penetrated the surface layer of the flooring, Apsogi confirmed to refurbish the floor to its original condition, the flooring must be “meticulously groun[d] down . . . to reveal the bare material beneath. Once the floor is stripped down, a high-traffic, non-slip sealer will be applied, ensuring enhanced durability and safety.” Aspogi prepared a bid to complete the floor restoration that totals $313,500.00. On or about August 12, 2024, the Public Adjuster submitted the expert report, bid and photographs to the Carrier, but the Carrier flatly rejected the method of repair proposed by Aspogi without obtaining a competing expert’s opinion. Disagreeing with the Carrier’s position, the Public Adjuster and Insured once again requested reconsideration. The request was again denied.
In retaliation for the Insured’s challenge of the Carrier’s undervaluation of the loss, the Insurance Company elevated the conflict and “lawyered up,” retaining an attorney to send a formal request for the examination under oath of “a representative who can provide binding testimony on behalf of the Insured as it relates to the above referenced loss, the amount of the loss, the claimed damage and the mitigation that was performed,” even though, based on the Insured’s Public Adjuster’s written communications and work product submitted, the Insurance Company was unquestionably on notice of the information that it was purportedly seeking through formal examination(s) under oath. The Insurance Company’s retention of counsel created an adversarial process, which forced the Insured, in turn, to retain counsel. The demand for an examination under oath serves no purpose but to intimidate, harass and punish the Insured, especially given that the Insured’s position on the claim had been made abundantly clear and was substantiated by multiple expert opinions and reports that had been provided to the Carrier. The Insured fully cooperated with the Insurance Company’s investigation, and the Carrier does not stand to glean any additional information from an examination under oath that it has not already been provided by the Insured and the Insured’s Public Adjuster.
On August 15, 2024, the Insurance Company’s representative responded to the Insured’s Public Adjuster’s submission of the Aspogi flooring report and the parties’ dispute relating to the proper method to repair the Insured’s flooring by again unnecessarily undermining the integrity of the Insured’s Public Adjuster and sarcastically stating that she “assume[s the Public Adjuster] . . . will still be disputing our findings on the concrete as I am used to working with PAs.” The Insurance Company’s adjuster advised that “if you are still disputing” the Insurance Company’s position on the proper method to restore the Insured’s flooring, that she would perform another re-inspection of the Property while she is “in Miami for trial the week of 9/2-9/6,” but insisted the inspection take place outside of normal business hours “at 6:30 PM on any of these nights (9/3, 9/4, 9/5).”
The Carrier further demanded the examination under oath of “the representative from ServPro who can testify as to the charges, amounts paid, claimed damage, mitigation, and all other questions that naturally flow from the loss and services performed.” Being that the Carrier was well aware of the mitigation completed by ServPro, maintained continuous communication with ServPro throughout the mitigation process, and failed to take any action to limit the mitigation efforts, the Carrier should not be permitted to avoid resolving the ServPro invoice to the detriment of its Insured.
On August 30, 2024, the Insured, though counsel, responded to the Insurance Company’s request for the Insured and its Public Adjuster’s examination under oath confirming that “[i]t is unclear why the EUOs of our client and its Public Adjuster are necessary, especially since the Insured’s position on the issues relating to the amount of the loss and the mitigation performed have been fleshed out at nauseum in written communications between the parties and over the phone.” Counsel advised that “it appears that this is nothing more than a simple scope and amount dispute.” “As such, [Counsel inquired into] whether there are alternative methods for the Insurance Company to obtain whatever outstanding information it is seeking through these EUOs in a less intrusive and more informal manner, assuming the Insurance Company actually needs additional information or clarification rather than the EUOs being requested to intimidate, harass, and punish the Insured and its Public Adjuster for disagreeing with the Insurance Company’s valuation of its Claim.” Counsel further requested documents and information from the Carrier so the parties “can have fruitful conversation and attempt to minimize or resolve any and all disputes that exist and/or remain between the parties.” The Insured awaits the Insurance Company’s response to its efforts to minimize and resolve the parties’ dispute, which, in reality, is limited to a scope and amount dispute that should be resolved in good faith negotiations during the adjustment of the loss.
Despite the Insured’s full and complete cooperation, the Insurance Company severely undervalued the claim and relied upon outcome-oriented adjusters and consultants who approached the loss with an eye towards denial and underpayment, especially as it relates to the proper method to refurbish the flooring. The Insurance Company ignored the Insured’s experts’ opinions on the proper methods and costs associated with restoring the Property and failed to obtain competing expert opinions before rendering its final determination. The damage caused to the insured property by the fire, smoke and water was obvious to any properly trained adjuster after one, let alone several inspections. Given the readily observable damage to the property and its obvious casual connection to the loss, the Insurance Company does not need any further post-loss compliance, especially a formal examination under oath, to determine the amounts necessary to restore the property to pre-loss condition. The scope and amount dispute should have been amicably resolved between the parties, but instead, the Insurance Company demanded unreasonable post-loss compliance to intentionally delay the resolution of the claim and punish its Insured for disagreeing with the Insurance Company’s deficient valuation of the significant loss.
The Insurance Company’s refusal to properly investigate, adjust, and fully compensate the Insured for its claim evidences the Insurance Company’s violation of section 626.9541(1)(i)(3)(a), Florida Statutes, which requires the Insurance Company to “adopt and implement standards for the proper investigation of claims. The Carrier’s misrepresentation of pertinent facts and insurance policy provisions relating to coverages at issue constitutes a violation of 626.9541(1)(i)(3)(b). The Insurance Company’s unreasonable failure to promptly and completely settle the claim establishes violations of sections 626.9541(1)(i)(4), 624.155(1)(b)(1), and 624.155(1)(b)(3). Further, the Insurance Company violated section 626.9541(1)(i)(2), Florida Statutes (“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;”).
The actions taken by the Insurance Company in the handling and adjustment of the claim giving rise to the violations addressed herein, including the established pattern of disregarding clear evidence of covered damages, discounting the Insured’s evidence of the true cost to make repairs and expert’s opinion on the proper method to effect repair of the floor, delaying adjustment and issuance of all monies due, misrepresenting coverages afforded under the Policy, requirements under the Policy for submitting proofs of loss, and obligations of its Insured, undermining the professionalism of the Insured’s representative, failing to retain qualified and competent adjusters and experts to fully and fairly adjust the claim, and unnecessary, retaliatory demands for examinations under oath occur with such frequency as to indicate a general business practice and these acts are willful, wanton, and in gross disregard for the rights of its Insured. Further, the combative, antagonistic, demeaning and unprofessional comments and conduct should be condoned by the Carrier. There is no place in the adjustment of a claim for the mistreatment of an insured or its representative(s), and this conduct should be condoned.
The Insurance Company’s actions amount to, but are not limited to:
A. “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;” (Fla. Stat. 624.155(1)(b)(1).
B. “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;” (Fla. Stat. sec. 624.155(1)(b)(3))
C. Claim Delay;
D. Claim Denial; and
E. Unfair Trade Practices
The Insurance Company’s actions further amount to unfair claim settlement practices:
1. 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; (Fla. Stat. 626.9541(1)(i)(2)).
2. Committing or performing with such frequency as to indicate a general business practice any of the following:
a. Failing to adopt and implement standards for the proper investigation of claims; (Fla. Stat. 626.9541(1)(i)(3)(a))
b. Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; (Fla. Stat. 626.9541(1)(i)(3)(b))
c. Failing to acknowledge and act promptly upon communications with respect to claims; (Fla. Stat. 626.9541(1)(i)(3)(c))
d. Denying claims without conducting reasonable investigations based upon available information; (Fla. Stat. 626.9541(1)(i)(3)(d))
e. Failing to promptly notify the insured of any additional information necessary for the processing of a claim; (Fla. Stat. 626.9541(1)(i)(3)(g))
f. Failing to clearly explain the nature of the requested information and the reasons why such information is necessary; (Fla. Stat. 626.9541(1)(i)(3)(h)).
3. Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 90 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by an act of God, prevented by the impossibility of performance, or due to actions by the insured or claimant that constitute fraud, lack of cooperation, or intentional misrepresentation regarding the claim for which benefits are owed. (Fla. Stat. 626.9541(1)(i)(4)).
In addition to the above statutory violations, the Insurance Company’s adjuster 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.
(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 Insurance Company breached this duty by failing to adhere to and comply with the above referenced obligations. To cure the defects outlined above, the Insurance Company must:
A. Tender all insurance proceeds due and owing to the Insured that would reasonably place the Property back into a pre-loss condition;
B. Timely communicate with the Insured’s representative(s) to complete the adjustment of the loss by participating in good faith negotiations to reach an agreement relating to the parties’ scope and amount dispute;
C. Immediately issue payment for statutory interest for any late payments;
D. Act fairly and honestly towards the Insured and with due regard for its interests;
E. Hire a fair, unbiased, and qualified adjuster(s) and expert(s) to properly assess the Insured’s damages;
F. Timely and substantively respond to the Insured’s representative(s)’s communications;
G. Issue a full and complete payment and provide a written explanation and detail of the payment issued;
H. Withdraw any and all unreasonable and unnecessary requests for post-loss policy compliance, including, but not limited to, the examinations under oath of the Insured and its Public Adjuster and/or limit the requests to less intrusive means;
I. Clearly explain the nature of the outstanding requested information, including what specifically the Insurance Company is seeking through the examination under oath of its Insureds and its Insured’s Public Adjuster, and the reasons why such information is necessary;
J. Timely adjust the claim with the Insured and avoid/limit any additional delay, costs, and prejudice that the Insurance Company’s conduct above has caused and continues to cause the Insured;
K. Participate in good faith claims adjustment to avoid the Insured incurring unnecessary costs of attorneys, appraisal, and/or litigation.
This Civil Remedy Notice is given to perfect the right to pursue the civil remedy authorized by this section.
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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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