Filing Number: 786088
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| Filing Accepted: 10/8/2024 |
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| Street Address
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8520 GULF BLVD #22 |
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NAVARRE,
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32566
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| Email Address
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HOCKEYMECH@LIVE.COM |
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Insured |
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| Last/Business Name* |
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MILLER |
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First Name |
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LINDA |
| Policy # * |
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PIV148685 |
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Claim #* |
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938809 |
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Attorney is Applicable
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| Last Name* |
KRAPF
First Name *
GRANT
Initial
W
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| Street Address* |
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2790 SUNSET POINT RD |
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CLEARWATER
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FL
33759
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| Email Address * |
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GRANT@KRAPFLEGAL.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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UNDERWRITERS AT LLOYD'S, LONDON
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| Insurer Name* |
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NAIC Company Code |
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| Name of individual responsible for violation (if any):*
ALLEN GREEN, AMY VAN HAASEN, MIKE ZIMMERMAN, TIMOTHY O'BRIEN, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, CERTAIN UNDERWRITERS AT LLOYD'S, LONDON AND HDI GLOBAL SPECIALTY SE WHO WAS INVOLVED IN THE CLAIM.
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Claim Delay
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Unfair Trade Practice
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Other
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Not treating the Insured with good faith claims conduct
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Other
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Looking for ways to deny full recovery to the Insured
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Other
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Looking for ways to delay full recovery to the Insured
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Other
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Failing to properly investigate the Insured's loss
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Other
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Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
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Other
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Not training, supervising, or managing adjusters properly so that prompt and full payments are made,
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Other
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Not adjusting claims and evaluating loss properly
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Other
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Shifting the burden of insuring the loss to the Insured
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Other
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Intentionally misstating the terms, conditions, and benefits of the insurance policy to the insured
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Other
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Failing to implement proper standards for the adjustment and investigation of claims
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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)(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)(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)(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.
627.70131(7)(a) Within 90 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer which reasonably prevent such payment. The insurer shall provide a reasonable explanation in writing to the policyholder of the basis in the insurance policy, in relation to the facts or applicable law, for the payment, denial, or partial denial of a claim. If the insurer's claim payment is less than specified in any insurer's detailed estimate of the amount of the loss, the insurer must provide a reasonable explanation in writing of the difference to the policyholder. Any payment of an initial or supplemental claim or portion of such claim made 90 days after the insurer receives notice of the claim, or made more than 15 days after there are no longer factors beyond the control of the insurer which reasonably prevented such payment, whichever is later, bears interest at the rate set forth in s. 55.03. Interest begins to accrue from the date the insurer receives notice of the claim. The provisions of this subsection may not be waived, voided, or nullified by the terms of the insurance policy. If there is a right to prejudgment interest, the insured must select whether to receive prejudgment interest or interest under this subsection. Interest is payable when the claim or portion of the claim is paid. Failure to comply with this subsection constitutes a violation of this code. However, failure to comply with this subsection does not form the sole basis for a private cause of action.
627.4137(1)(e) - Each insurer which does or may provide liability insurance coverage to pay all or a portion of any claim which might be made shall provide, within 30 days of the written request of the claimant, a statement, under oath, of a corporate officer or the insurer's claims manager or superintendent setting forth the following information with regard to each known policy of insurance, including excess or umbrella insurance: a copy of the policy.
627.70131 (1)(a) - upon the Insurer receiving a communication with respect to a claim, the insurer shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgement. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer's claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer. As used in this subsection, "agent" means any person to whom an insurer has granted authority or responsibility to receive or make such communications with respect to claims on behalf of the insurer. This subsection shall not apply to Claimants represented by counsel beyond those communications necessary to provide forms and instructions.
Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language. "It is an accepted principle of law that when parties contract upon a matter which is the subject of statutory regulation, the parties are presumed to have entered into their agreement with reference to such statute, which becomes a part of the contract, unless the contract discloses a contrary intention." Westside EKG Assocs. v. Found. Health, 932 So. 2d 214, 216 (Fla. 4th DCA 2005), aff'd, 944 So. 2d 188 (Fla. 2006).
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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.
Certain Underwriters At Lloyd's, London and HDI Global Specialty SE (the "Insurer") has committed the following in handling the Insured's claim: 1) failing to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) failing to render a claims determination within ninety (90) days; 9) failing to acknowledge and act promptly upon communications with respect to claims; and 10) failure to provide a copy of the insurance policy within 30 days.
On or about September 16, 2020, while the subject policy was in full force and effect, the insured property suffered a loss caused by Hurricane Sally. The areas impacted include but are not limited to the roofing system, exterior surfaces, HVAC system, electrical systems, master bedroom, third floor living room, second floor bedrooms, garage, foyer, master bathroom, master shower, master vanity area, master walk in closet, master hallway, master hallway closet, stairways, laundry room, kitchen, pantry, living room, bar, first floor bedrooms, and first floor bathrooms. The Insured timely submitted a claim on September 19, 2020, to the Insurer for damage caused by Hurricane Sally and the ensuing damage therefrom. Thereafter, the Insurer assigned claim number 938809 to the loss and sent a field adjuster to inspect the property. Notably, the Insurer never sent a claim acknowledgement letter or a reservation of rights letter after receiving notice of the claim. The Insurer retained a field adjuster who was supposed to inspect the property on October 3, 2020. However, neither the Insurer's corporate representative nor the Insurer's desk adjuster could testify as to why this inspection did not occur, which represents just one example of the Insurer's faulty, inadequate, and delayed evaluation of the Insured's claim. Instead, the field adjuster eventually inspected the property on October 15, 2020 nearly a month after the Insured reported her claim.
Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. However, when the field adjuster conducted his inspection of the insured property, he failed to conduct a thorough and adequate investigation. Despite obvious interior water damage and a tarp on the roof, the field adjuster failed to inspect the roof directly. He never physically stepped foot on the roof. Instead, he only took photographs from the ground and reviewed drone photographs taken by the Insured's contractor. Furthermore, despite the obvious water damage, the field adjuster did not feel it was necessary to inspect the Insured's home for mold or use a moisture meter.
The events that transpired next are muddled and contradictory based on the desk adjuster and corporate representative's deposition testimonies, which further demonstrates the Insurer's mismanaged and bad faith evaluation of the Insured's claim. According to the corporate representative's deposition testimony, on November 13, 2020, the field adjuster provided the Insurer a copy of his report, photographs and a valuation report. On December 14, 2020, the Insurer received a letter of representation, repair estimate, and photographs from the Insured's public adjuster, which included 570 pages of material in total. The Insurer sent the field adjuster these materials the same day. The field adjuster created an estimate dated January 26, 2021, for $2,362.29, which failed to exceed the policy deductible. The corporate representative further testified the Insurer did not receive a letter of representation from the Insured's legal counsel until January 2021.
According to the desk adjuster's deposition testimony, on November 11, 2020, the field adjuster provided the Insurer a copy of his report, photographs and a valuation report. She reviewed these documents on December 6, 2020. In the interim, she received documents from the Insured's public adjuster on November 3, 2020 not December 14, 2020. She also testified that the public adjuster's materials were sent to the field adjuster who then prepared an estimate on November 10, 2020. She additionally testified that she received a letter of representation from the Insured's legal counsel on November 25, 2020 not in January 2021. She made a recommendation to issue a partial denial on the claim on January 28, 2021 133 days after the Insured reported her claim.
Regardless of the discrepancies in the deposition testimonies, it is undisputed the Insurer never retained an engineer pre-suit to inspect the property, never reinspected the property after receiving 570 pages of material from the public adjuster, never conducted a recorded statement, never conducted an examination under oath, never requested a sworn proof of loss, and never sent a claims determination letter, even to date. Furthermore, the Insurer never acknowledged or responded to the public adjuster's letter of representation in violation of Fla. Stat. 627.70131(1)(a).
Undisputedly, the Insurer violated Fla. Stat. 627.70131(7)(a) which required the Insurer to, "[w]ithin 90 days . . . of receiv[ing] notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer which reasonably prevent such payment." The Insured reported her claim on September 19, 2020. The lawsuit was filed on February 4, 2021 more than 90 days later.
The Insurer's corporate representative testified that the Insurer never rendered a claims determination because the Insured filed a Civil Remedy Notice and a lawsuit. However, the Insurer has an ongoing obligation to adjust claims pursuant to Tristar Lodging, Inc. v. Arch Speciality Ins. Co., 434 F. Supp. 2d 1286, 1298 (M.D. Fla. 2006), which holds that "[t]he filing of a lawsuit does not extinguish the Insurer's obligations under the Policy to adjust and pay the claim." This is further exacerbated in this matter as the Insured has no control on the Insurer's adjustment of the claim. "[I]n exchange for this relinquishment of control over settlement and the conduct of the litigation, the insurer obligates itself to act in good faith in the investigation, handling, and settling of claims brought against the insured." Berges v. Infinity Ins. Co., 896 So. 2d 665, 682 83 (Fla. 2004).
As demonstrated by the Insurer's answers to the Insured's interrogatories, the Insurer failed to timely provide the Insured with a copy of the insurance policy within 30 days after requested by the Insured through her representatives. Each Insurer which does or may provide liability insurance coverage to pay all or a portion of any claim which might be made shall provide, within 30 days of the written request of the Insured, a statement, under oath, of a corporate officer or the insurer's claims manager or superintendent, a copy of the policy. Fla. Stat. 627.4137(1)(e).
The conduct outlined above is done within the Insurer's routine course of the business.
There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer's claim file and standards and procedures for the adjustment and investigation of claims.
In short, the Insurer is not acting with due regard for the Insured's interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer's actions and inactions have continued to frustrate and delay the resolution of the Insured claim.
The Insurer's actions amount to but are not limited to the following:
1. Claim delay
2. Not treating the Insured with good faith claims conduct
3. Looking for way to reduce recovery to the Insured
4. Looking for ways to deny recovery to the Insured
5. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured
6. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's' interests
7. Placing the financial interest of the Insurer over that of the health and safety of the Insured
8. Shifting the burden of investigating onto the Insured
9. Conducting inadequate investigations
10. Failing to render a written claims determination to the Insured within 90 days pursuant to Florida Statute 627.70131
11. Failing to acknowledge and act promptly upon communications with respect to claims
12. Failure to provide a copy of the insurance policy within 30 days
Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must:
(1). Admit full coverage for the Insured's loss.
(2). Tender full benefits owed to the Insured under the insurance contract.
A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com.
Via E-mail:
Certain Underwriters At Lloyd's, London
and HDI Global Specialty SE
200 East Gaines Street
Tallahassee, FL 32399
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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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