Civil Remedy Notice of Insurer Violations
Login

Filing Number:     782319
Filing Accepted:  9/11/2024
         Print Filing
Complainant
Last/Business Name *  
LE JARDIN HOUSE CONDOMINIUM ASSOCIATION, INC   First Name  
Street Address * 1135 KANE CONCOURSE 6TH FLOOR
City, State Zip * MIAMI, FL 33154
Email Address * MATT@THELANDAULAWGROUP.COM
Complainant Type: * Insured
Insured
Last/Business Name*   LE JARDIN HOUSE CONDOMINIUM ASSOCIATION, INC   First Name  
Policy # * WKFCC­05109­00 Claim #* 4209717
Attorney
Attorney is Applicable
Last Name* LANDAU First Name * MATTHEW Initial
Street Address* 1300 N FEDERAL HWY., STE 205
City, State Zip* BOCA RATON , FLORIDA 33434
Email Address * MATT@THELANDAULAWGROUP.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   LEXINGTON INSURANCE COMPANY
NAIC Company Code 19437
 
Name of individual responsible for violation (if any):* EDUARDO SUAREZ
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unfair Trade Practice
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) 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.
624.155(1)(b)(3) 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.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(f) 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.
626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Lexington’ claim settlement procedures resulting in delays, denials and undue hardship to the Insured/Complainant, more specifically Insurance Company’s misapplication and misinterpretation of policy terms and conditions found in (but not limited to) the Policy “Definitions”, the section of Conditions and the section of Additional Coverages, as well as the terms of the Special Provisions and Endorsements. 698-220.201(3)(b) An Adjuster shall treat all claimants equally 69B-220.201 (3)(b)2 An adjuster shall adjust all claims strictly in accordance with the insurance contract 69B-220.201 (3)(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured 69B-220.201 (3)(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 69B-220.201 (3)(m) An adjuster shall not knowingly fail to advise a claimant of the claimant’s rights in accordance with the terms and conditions of the contract and of the applicable laws of this state. And adjuster shall exercise care not to engage in the unlicensed practice of law as prescribed by the Florida Bar. 698-220(3)(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 or the matter as you understand at the time.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On or about November 15 2023, while the policy was in full force and effect, the subject property located at 1135 Kane Concourse 6th Floor Miami, FL 33154 sustained a covered loss to the property as a result of a substantial weather event which caused extensive damage to the property when a wind created opening allowed water to pour into the ventilation shaft of the building and damaging the elevator. The Insured promptly filed a claim with Lexington for damages occurring to the building and invoices reflecting damage in the amount of $27,157.73. In the course of submitting the claim Complainant provided detailed information regarding this loss. Complainant granted Lexington Insurance Company the opportunity to fully inspect the property and investigate this loss thoroughly. Lexington Insurance Company, by and through their claim’s examiner Eduardo Suarez, failed to acknowledge this damage and have failed to indemnify the Insured for their loss. Lexington Insurance Company has failed to respond timely to the insured’s multiple requests for claim determination and has failed to apply the correct policy coverage, implying that this loss is excluded under equipment breakdown coverage when it is actually a covered property damage claim resulting from a wind event. They have been presented with clear evidence of substantial damage. However, Lexington Insurance Company clearly has no intention of honoring its full obligations under the policy and the law. This claim remains improperly and insufficiently adjusted. To date, Lexington Insurance Company has improperly denied the claim. They have conducted an inadequate evaluation of this claim and failed to respond in a timely manner to this claim. It is clear Lexington Insurance Company has no intention of adjusting this claim in a timely or fair manner. It is also apparent that Lexington Insurance Company and its adjuster have failed to properly document the file and have not placed a priority on this claim. It is believed this is not conduct that is unique to this particular claim but is rather a product of a systematic approach as to how Lexington Insurance Company Claims handles claims as a general business policy. Lexington Insurance Company knows that it would be in the Insureds’ interests and their obligation under the insurance policy to promptly adjust and issue unencumbered payment for the substantial damages in order avoid additional damages to the premises and the Insured. Despite the fact that the home continues to contain substantial Lexington Insurance Company has refused and/or failed to tender all insurance proceeds to the Insured as required by the policy and law. Lexington Insurance Company has breached its statutory and contractual responsibilities by its refusal and/or failure to settle the Insured’s claim when under all the circumstances it could have and should have done so had it acted fairly and honestly towards the Insured. Lexington Insurance Company has unlawfully, immorally, unfairly, deceptively and/or in bad faith pursuant to the above-stated legal authorities that govern the insurance policy (“Policy”), adopted and implemented a general business practice of misconstruing the Policy for their own financial gain. More specifically, and Lexington Insurance Company has a fiduciary duty to duly and promptly investigate, adjust, pay and/or settle claims in strict accordance with the Policy and Florida law, they have willfully, wantonly, contumaciously and/or recklessly disregarded the rights of the Insureds as further outlined below. Upon information and belief, Lexington Insurance Company performs the subject actions as a business practice, including delaying the claim and issuing "low ball" payments in an attempt to dissuade its insureds from pursuing the claim to the detriment of its insureds to increase financial profits. It is clear that Lexington Insurance Company is not treating the Insured with good faith claims conduct; failing to pay the full value of a claim clearly owed; failing to recognize the proper scope of the loss and pay the proper value of the policy. Specifically, they have refused to make payments with respect to the dwelling, contents, law and ordinance changes as applicable; have not adjusted the claim nor evaluated the loss properly, promptly and fairly to provide full and prompt indemnity to the Insured; failed to implement proper standards for the adjustment and investigation of claims; failed to utilize and/or apply, reliable principals and methods as it relates to extending full coverage for a claim once sufficient facts and/or data gathered in relation to same, including failing to utilize proper rebuilding cost in its damage assessment and failed to provide adequately for alternative living expenses; failed to make a timely, written coverage determination; not trained, supervised or managed adjusters properly so that prompt and full payments are made, but rather have placed the company’s interests before the Insured’s interests; refused to pay the full amount owed to the Insured despite the fact that the damages are covered under the policy; looked for ways to delay full recovery; and low-balled the Insured. The Insured has suffered consequential damages as a result of the stated misconduct herein, including but not limited to inability to use funds owed to rebuild their property. The adjusters acting on behalf of Lexington Insurance Company have acted in contravention of one or more standards of conduct that constitute the code of ethics that is binding on all adjusters, as more fully set forth in Florida Administrative Code Section 69B-220.201 Ethical Requirements for All Adjusters (company employee, independent, and public). Pursuant to subsections 2(a) and (b) thereof, a violation of any provision of this rule shall constitute grounds for administrative action against the licensee and a breach of any provision of this rule constitutes an unfair claims settlement practice. Therefore, to cure the defects outlined in this Civil Remedy Notice, Lexington Insurance Company must (1) Stipulate and fully confess and tender all insurance proceeds due and owing to the Insured that would reasonably place the Insured back into a pre-loss condition; (2) Issue payment to the Complainant per an amount that corresponds with its own highest usual and customary reimbursement rates for vendors in the community providing the services in question; (3) Pay statutory interest on the amount of unpaid contract damages from the date of the loss to the present time pursuant to F.S. §627.70131 as well as all other applicable statutes, (3) Pay Insured’s reasonable attorney’s fees and costs incurred in relation to litigation arising from conduct referenced herein ; (4) Tender additional payment to the insured for all consequential damages resulting from Lexington Insurance Company bad faith actions as determined by Florida law; (5) stipulate and fully confess that the Complainant is entitled to judgment in its favor as it relates to, and detailed in the Petition for Declaratory Relief that is currently pending and; (6) Stipulate and confess that the Policy Cap under the Policy runs in conflict with Coverage A of the subject policy and therefore, has been improperly and/or inconsistently considered in relation to the Complainant’s service charges as a matter of course; (7) If there is a disagreement as to the reimbursement rate of the service charges, and to avoid a cost prohibitive appraisal process to resolve same, that Prepared submit to mediation in accordance with the Policy. All of the foregoing must be done timely to avoid/limit any additional delays, costs, and prejudice that Lexington Insurance Company conduct has caused and continues to cause the Insured. Complainant reserves all rights and remedies at law or in equity and nothing stated herein is intended to waive any such rights or remedies. Nor is this list intended to imply that no other actions were taken by Lexington Insurance Company that could be deemed a violation of law and failing to list them here shall not preclude the Insured from raising it at a later time. Lexington Insurance Company or their agent should contact counsel for the Insured to obtain an up-to-date payment amount necessary to cure these violations. Complainant requests relief under all Florida Statutes cited in this CRN. Pursuant to Section 624.155(3)(b)5, this notice is given in order to perfect the Insured’s right to pursue all civil remedies authorized by this section and Florida Law. A COPY OF THIS FORM SUBMITTED TO THE FDFS HAS BEEN PRINTED OUT AND PROVIDED TO THE PARTIES PROVIDING THEM NOTICE OF THE FILING OF THE CIVIL REMEDY NOTICE
Comments
User Id Date Added Comment
emurphy@rc.com 11-11-2024 The parties have reached a settlement of this claim and the DFS is free to close its file.
Acknowledgement
* 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.




DFS-10-363
Rev. 10/14/2008