Filing Number: 781319
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| Filing Accepted: 9/4/2024 |
| Last/Business Name
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6316 SAN JUAN LLC
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First Name |
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ALEX |
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| Street Address
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6316 SAN JUAN AVE |
| City, State Zip
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JACKSONVILLE,
FL
32210
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| Email Address
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WAKSMAN22@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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6316 SAN JUAN LLC |
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First Name |
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ALEX |
| Policy # * |
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CPS7861279 |
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Claim #* |
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02155834 |
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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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SCOTTSDALE 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 41297 |
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| Name of individual responsible for violation (if any):*
WHITNEY CURTHOYS
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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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Unfair Trade Practice
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Unsatisfactory Settlement Offer
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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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| 624.155(1)(b)(2) |
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Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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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)(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)(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)(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)(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.
ROOF EXCLUSION
SCHEDULE
Premises Address Description Of Building Or Structure
Page 4
1 1
This exclusion applies to all buildings or structures described in the
Schedule above. If the Schedule is left blank, then this exclusion
applies to all buildings or structures shown in the Declarations.
We will not pay for:
1. Any loss or damage to “roof coverings” including the layer of the roof that is used as the base for securing “roof
coverings”; or
2. Any loss or damage to covered property caused by or
resulting from rain, hail, melting snow or ice if the rain, hail,
melting snow or ice enter through “roof coverings” including
the layer of the roof that is used as the base for securing “roof
coverings.”
This exclusion applies regardless of whether any other cause
contributes concurrently or in sequence to cause damage to the “roof
coverings,” even if that other cause is a covered cause of loss. But if
fire or explosion occurs, we will pay for the loss or damage caused
by that fire or explosion.
For the purposes of this endorsement the following definition applies:
“Roof coverings” means the roof surface, shingles, tiles,
cladding, metal or synthetic sheeting, metal components or
similar materials covering the roof and includes all materials
used in securing the roof surface and all materials applied to
or under the roof surface for moisture protection, as well as
roof flashing.
“Roof coverings” includes any tarpaulins, canvas, plastic
sheeting, or any other material used a temporary roof covering
or substitute roof surface.
All other terms and conditions of this policy remain unchanged.
Appraisal
The appraisal provision is found in the Loss Conditions section of the policy:
B. Appraisal
If we and you disagree on the value of the property or the amount of loss, either may make written demand for an appraisal of the loss. In this event, each party will select a competent and impartial appraiser. The two appraisers will select an umpire. If they cannot agree, either may request that selection be made by a judge of a court having jurisdiction. The appraisers will state separately the value of the property and amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will:
a. Pay its chosen appraiser; and
b. Bear the other expenses of the appraisal and umpire equally.
If there is an appraisal, we will still retain our right to deny the claim.
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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.
**Civil Remedy Notice**
**To: Florida Department of Financial Services, as Receiver for Scottsdale Insurance Company**
**Address: 200 East Gaines Street, Tallahassee, FL 32399-0370**
**Date: September 4th, 2024**
From;
Alex Waksman
6316 San Juan Ave
Jacksonville, FL 32210
**RE: Civil Remedy Notice for Claim No. 02155834**
**Insured: 6316 San Juan, LLC & 101 NE 54st, LLC**
**Claimant: Alex Waksman**
**Location of Loss: 6316 San Juan Ave, Jacksonville, FL 32210**
**Date of Loss: December 12, 2023**
**Policy Number: CPS7861279**
Dear Florida Department of Financial Services, as Receiver for Scottsdale Insurance Company,
I, Alex Waksman, the insured, am filing this Civil Remedy Notice against Scottsdale Insurance Company regarding the handling of my insurance claim related to the vandalism and fire that occurred at my property, a shopping plaza in Jacksonville, Florida on December 12, 2023.
This incident and my insurance carriers conduct, has left me and my company, 6316 San Juan LLC, facing severe financial and emotional distress.
The claim arose from a tragic shootout that resulted in the death of one individual and several others injured. The perpetrators used AR-15s and 9mm guns, shooting at people and chasing them throughout the plaza. The bullets, which are scientifically proven to carry elements of heat, penetrated the beautiful brick exterior, the building walls, and the roofing system was shot up with bullets going through the roof. It is believed that some of the bullets were red-tipped, considering the amount of charring that was going on in the roof structure.
Scottsdale received the claim but failed to conduct a proper investigation. Instead, a junior adjuster named Joshua Coleman (colemanadjusting@gmail.com / 904-955-1657), provided a grossly inadequate estimate of approx $11,000 for the entire damage to the plaza. During the inspection Joshua admitted to both my property manager and My Public Adjuster that he had no experience with this type of claims. When my Public Adjuster, Aryeh Fraser, attempted to supplement the claim with a detailed estimate of over $900,000, the Carrier, through the current desk adjuster Whitney Curthoys (Office # 480-365-2365 / rademw1@nationwide.com), rejected the demand, refusing to comply with the policy regarding appraisal, refused to to pay out what I am owed and/or provide my full benefits under the subject policy, refused to provide payment based on her own experts she retained, and throw delays, “bate and switch” tactics and other bad faith mechanisms, refused to make me whole or allow me to repair my severely damaged property to date, more then 9 months later.
To recap: Date of loss 12/12/2023
Following the initial inspection with Joshua Colman the carrier on or around 1/23/2024, through its previous desk adjuster Marie Colon left my Public Adjuster a voicemail letting us know that upon review of the damages, they amount to $11,674 less depreciation and the $5,000 deductible = $6,674.81 for the total undisputed payment. She alleged that this was based on her filed adjusters estimate, however when my public adjuster reached out to Mr. Colman to inquire why he wrote up such a low and different amount then discussed at the meeting, he was told by Mr, Colman that the carrier had manipulated his estimate, and that the conclusions were not his at all.
This check for $6,674.81 was received by my PA office on or around 1/29/2024.
In response, I submitted an executed Proof of Loss and Demand for Appraisal on 1/31/2024, which was received by the carrier on 2/01/2024. On or around 2/05/2024, we received an email from the new and reassigned desk adjuster, Whitney Curthoys, acknowledging and confirming receipt of the Demand for Appraisal and our $972,004.90 estimate, stating that they are reviewing the documents and will notify us once their appraiser is appointed.
However, instead of proceeding with the appraisal process, the Carrier rejected the Demand for Appraisal and requested to reinspect the property with their experts.
I of course agreed and allowed access to my property whenever requested. The carriers representative inspected the property, brought Contractor’s, and multiple experts, and communicated with my Public Adjuster on multiple occasions confirming, that the brick exterior needed to be replaced and was irreparable. The carrier, clearly not liking what their own experts were telling them, reassigned the file to an engineer…
The carrier's engineer report (Envista forensics) was received on or around 5/02/2024. The report stated that there was no structural damages preset at the property. The engineer also stated that the bricks can be removed and independently repointed. There was no proposal or explanation on how the engineer concluded that a “repair” was possible.
Furthermore the engineer did not opin on the roofing system despite the fact that the roof damage was included in our demand and submission. On or around 5/23/2024, we received an email from desk adjuster Whitney Curthoys letting us know that a supplemental payment is being processed by the carrier based on the supplemental payment estimate received. This supplemental payment check in the amount of $20,336.07 was received by the PA office on or around 5/28/2024.
This email from the carriers desk adjuster also went on to state as follows:
“ We did also obtain a contractor estimate that EXCEEDS our estimate. Should you wish to see a copy for your review the contractor will conduct the necessary repairs for the estimated amount, should you be interested in seeking resolution of this matter based on the contractors estimate. We are NOT using the contractor estimate as an undisputed estimate as there are items we do not agree with at this time, but if you are seeking resolution of the claim, we can provide a copy of the estimate to you and see if an agreement can be reached .”
Clearly, the carrier received an unfavorable (to their cause, which at this point is pretty clearly, to pay as least as possible towards my damage” ) estimate from their own experts and contractors, and instead of simply accepting their recommendations and providing payment based on their opinions, the carrier manipulated their estimate, removed items that they arbitrarily “decided” I was unworthy of, all in an effort to hold leverage and gain unfair extortion power to, force me into a settlement if I wanted to receive my full benefits.
In total, we received two checks for this file: the initial payment of $6,674.81 received on or around 1/29/2024, and the supplemental payment of $20,336.07 received on or around 5/28/2024.
The damage estimate/s we have exceed $900,000!
In the email from the desk adjuster to my PA the Carrier has explicitly conditioned the full undisputed payment would only be provided if I agreed to a “ settlement” (sign a release), effectively holding me hostage and violating multiple Florida statutes.
Additionally, the Carrier is refusing to pay ANY amount for any damages that occurred to my roof, siting a roof exclusion from the policy.
On February 9, 2024, the carrier in response to the demand for appraisal and the submitted proof of loss completely rejected the claim for the roof damage or any structure “attached” to the roof, siting the above exclusion, arguing that it applies to this loss.
On or about 5/15/2024 my Public Adjuster pointed out in a detailed email response that this roof exclusion itself has exceptions in cases where a fire or an explosion occurred, which the carrier should easily find the case to be here, considering;
A. What powers the bullets to begin with is fire throw gunpowder and;
B. The damage to the wood framing being charring (burns to the wood from fire)
However the carrier refused to even consider his points. Pictures were provided showing and proving the damage to be from fire and char, and the again, the carrier stonewalled my claim.
Furthermore, my PA also pointed out that this exclusion speaks only to the roof and the immediate underlayment system.
The carrier unilaterally extended that exclusion towards the soffit, the framing of the building and the structure of the roof, all of which should not be part of that roof exclusion. To be clear, the bullet holes penetrated the soffit, the truss system, the runners, and the rafters, and the framing as well, before they penetrated the decking and the roofing shingles.
The carrier should’ve at least provided payment for the structural components, even if they chose to dispute that bullet holes and the bullet damage should be considered fire, all despite the policy provisions clearly stating that if fire affects the roof, there will be an exception to an exclusion resulting from the fire loss…
The Carrier is insisting in bad faith on ignoring this exception to their own exclusion. The Carrier is omitting ANY payment for these building components, despite them being impacted by the bullet holes, even to the extent that there is no exception to the exclusion due to the fire.
In addition to the above, the Carrier is also neglecting to pay for my lost rents.
I have provided multiple times all of my records pertaining to the financial requests, but the Carrier is holding me to a “corporate standard” with ongoing repeat requests for information that was already provided or is just excessive and accumulative effectively harassing and delaying payment to make me haul and allow me to move on from this loss.
The actions of Scottsdale Insurance Company have breached the following Florida Statutes:
1. **Florida Statute §624.155** - The Carrier's refusal to fully pay the legitimate claim, including the lost rents, and the coercive nature of requiring a release for payment constitutes a violation of this statute.
2. **Florida Statute §626.9541** - The Carrier's actions in manipulating estimates, providing partial payments, and demanding unnecessary documentation while conditioning full payment on a release are deceptive practices.
3. **Florida Statute §627.70131** - The delays, inadequate responses, and rejection of the appraisal request from Scottsdale Insurance violate the requirement to pay valid claims within a reasonable time frame.
In addition, per the departments request, I added what I know to be other statutory violations in the appropriate section.
I am requesting that the Florida Department of Financial Services, as Receiver for Scottsdale Insurance Company, provide notice to the carrier to immediate remedy this situation by paying me every last dollar I am owed based on my policy terms and conditions and reimburse me for any and all damages I am due and owed.
Please consider this notice as an opportunity to rectify the breaches and restore the trust that has been compromised by the handling of this claim, especially given the significant public attention this incident has received.
I direct all further communications regarding this matter to my Public Adjuster, Aryeh Fraser of Fraser Property & Adjusting Inc., who can be reached at ari@fraseradjusters.com or via phone number at 305-945-4030
Sincerely,
Alex Waksman
6316 San Juan Ave
Jacksonville, FL 32210
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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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