Filing Number: 786167
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| Filing Accepted: 10/8/2024 |
| Last/Business Name
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ROVIRA
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First Name |
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GLENN & TARA |
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| Street Address
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2900 SW 84TH AVENUE |
| City, State Zip
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DAVIE,
FL
33328
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| Email Address
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GLENN_ROVIRA@YAHOO.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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ROVIRA |
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First Name |
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GLENN & TARA |
| Policy # * |
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625734 |
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Claim #* |
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941389 |
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Attorney is Applicable
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| Last Name* |
CHAVIN
First Name *
VALORIE
Initial
S
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| Street Address* |
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12955 BISCAYNE BLVD., SUITE 201 |
| City, State Zip* |
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NORTH MIAMI
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FL
33181
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| Email Address * |
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VCHAVIN@CMSLAWGROUP.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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HOMEOWNERS CHOICE PROPERTY & CASUALTY INSURANCE COMPANY, INC.
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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 12944 |
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| Name of individual responsible for violation (if any):*
KRISTA JOHNSON
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Claim Denial
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Claim Delay
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Unfair Trade Practice
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Other
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Violation of Florida Administrative Code
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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)(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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Glenn and Tara Rovira (the “Insured”) paid for a policy of insurance with Citizens Property Insurance Company bearing policy number 625734 insuring the property located at 2900 SW 84th Avenue, Davie, Florida 33328 (the “Property”) with a policy term from November 15, 2023, through November 15, 2024. On September 29, 2023, Citizens notified the Insured that a private-market insurance company, Homeowners Choice Property and Casualty Insurance Company, Inc. (the “Insurance Company” or the “Carrier”), would offer coverage beginning on November 21, 2023. The Homeowners Choice policy provides coverage for damages to the Insured’s property, including for the significant damage sustained as the result of heavy wind and hail. The Insured’s home suffered a significant loss on March 3, 2024, when a severe storm brought heavy winds and torrential rain and pelted the Property with massive hailstones that dented and damaged the roof. The policy insuring the Property provides coverage for damages sustained as the result of wind and hailstorms, so the Insured submitted a claim to the Insurance Company to address the overwhelming damage to the Property. Rather than properly adjusting the loss and paying the Insured to repair the storm-related damage, the Insurance Company elevated its own interests over those of its Insured when it failed to exercise care in the adjustment of the claim by refusing to acknowledge obviously covered damages and wrongfully denied coverage for the loss. To date, the Insured is still without the compensation he needs and to which he is entitled.
The Insured does not have a complete copy of the Policy. Therefore, the specific language at issue cannot be quoted. However, the Policy provides coverage for loss caused by windstorm and hail.
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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.
On March 3, 2024, the insured Property suffered substantial damage when a severe storm brought high winds, heavy rains, and large hailstones up to 1.5 inches in diameter that pelted the roof of the Property resulting in visible indents and granular loss to the roof. Prior to the storm, the roof of the Property was sound; in fact, an inspection of the roof conducted just six months earlier in September 2023 confirmed the roof was in good condition. However, the sheer force of the storm on March 3, 2024, ravished the roof as evidenced by the large hailstone indentations. Following the storm, the Insured conferred with neighbors in surrounding homes who all experienced the same devastating hail damage to their roofs, all of which required total roof replacement. Dismayed, the Insured engaged SmartRoof to inspect the Property and prepare an estimate of the costs associated with repairing the hail damage to the roof. SmartRoof identified considerable hail-related damage to the Insured’s roof and documented its findings in a comprehensive report with photographs. It prepared a good faith estimate to replace the roof that totals $34,384.41.
The Insured submitted a claim to the Insurance Company to address the damage. He provided the Insurance Company with copies of the SmartRoof estimate, report and photographs documenting the hail damage to the Property, together with video the Insured took during the storm depicting the conditions that impacted the Home on the date of loss. Instead of properly adjusting the Insured’s loss and timely paying the Insured for the damage so he could make the necessary repairs to his home, the Insurance Company began its efforts to avoid its contractual obligations to fully compensate the Insured for the claim. The Insurance Company relied upon an unqualified and outcome-oriented field adjuster who approached the loss with an eye towards denial. The field adjuster, who is not a licensed roofer, conducted a cursory inspection on April 29, 2024, that lasted no more than ten minutes. He consulted with the roofer from SmartRoof, who also attended the inspection, and was presented with clear evidence of hail damage including large indentations on the roof and granular loss. The adjuster was also advised of the multiple neighboring homes that suffered similar damages necessitating total roof replacements. Nevertheless, the Insurance Company’s field adjuster ignored the evidence and baselessly concluded that the damage that he observed was the result of wear and tear. Even though the field adjuster is unqualified to determine the cause of the damage, the Insurance Company failed to obtain an opinion of a qualified licensed roofer and instead relied solely on its field adjuster’s judgement.
Following the inspection, the Insurance Company issued its coverage determination letter denying coverage for the loss. The denial letter, which incorrectly states that the claim relates to “possible damage due to pipe deterioration,” relies entirely on the field adjuster’s inexpert opinion that he failed to observe storm or hail related damage during his perfunctory inspection. Entirely disregarding the clear evidence of readily observable hail indentations on the roof, and the evidence of the same type of damage the surrounding homes, the Carrier maintained an unsupported position that the damage to the Insureds’ property was simply the result of wear and tear. It is clear that the Insurance Company approached the loss with the aim towards denial, failed to conduct an adequate investigation, and deprived its Insured of a fair evaluation of the claim. The Insurance Company misrepresented the cause of the damage and the coverages available under the policy, and wholly ignored the clear hail damage to the Property that was not only apparent during the field adjuster’s inspection, but also documented in the SmartRoof report and photographs. Dismayed by the Carrier’s refusal to acknowledge the hail damage to the roof, the Insured expressed disagreement with the findings and requested that the Carrier reevaluate its position. The Insured provided a copy of the National Weather Service Hailstorm Report verifying the presence of a hailstorm on the date of loss, together with additional photographs and videos taken during the hailstorm depicting the damage to the Property. He also invited the Carrier to reinspect the Property with a third-party engineer to provide an unbiased evaluation of the damage. Without retaining a qualified expert to conduct a reinspection or otherwise considering the Insured’s submitted evidence, the Insurance Company refused to reconsider its previous decision and stood on its wrongful denial of coverage.
The Insured did everything possible to assist in the Carrier’s investigation and to provide comprehensive evidence demonstrating the storm’s impact and resulting damage to the Property, but the Carrier failed to uphold its contractual obligations to its Insured. The Insurance Company’s unfounded denial and refusal to accept coverage and issue payment for the loss has caused an excessive delay in the Insured’s ability to repair his home – leaving the Insured more susceptible to damage from the elements. The Carrier’s refusal to resolve the claim forced the Insured to retain an attorney to protect his contractual rights under the insurance policy. The Insured has and will continue to incur and unnecessarily suffer damages, including costs to prosecute this claim, attorney’s fees, and delay damages if the Insurance Company does not retain competent, qualified, and unbiased representatives, participate in good faith adjustment practices, and communicate with its Insured’s representative(s) to negotiate a fair compromise of the claim within 60 days of the filing of this Civil Remedy Notice.
The failure of the Insurance Company to fully and completely compensate the Insured demonstrates either inexcusable negligence or an intentional decision to elevate its own interests over those of its Insured. The Insurance Company’s refusal to properly investigate, adjust, and fully compensate the Insured for the claim evidences the Insurance Company’s violation of section 626.9541(1)(i)(3)(a) and (d), Florida Statutes, which require the Insurance Company to “adopt and implement standards for the proper investigation of claims” and to conduct “reasonable investigations based upon available information.” 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 failure to acknowledge and act promptly upon communications with respect to claims constitutes a violation of 626.9541(1)(i)(3)(c).
The Insurance Company failed its Insured in refusing to properly investigate the claim, refusing to retain qualified experts to properly determine the cause of the loss, ignoring evidence of covered damages, and making express misrepresentations to its Insured relating to the cause of his loss and the coverage available under the Policy. All available information leads to one conclusion—the Insured’s home was damaged by a covered loss for which he is entitled to full and complete compensation. Yet, the Insurance Company shirked its responsibilities in efforts to deprive its Insured of his contractual right to a fair adjustment and payment. The actions taken by the Insurance Company in the handling and adjustment of the Insured’s claim 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.
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 his 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. 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; (Fla. Stat. 626.9541(1)(i)(3)(f))
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)).
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 Insured back into a pre-loss condition; .
B. Correct all misrepresentations made to the Insured, including the cause of the Insured’s loss, the scope of the Insured’s loss, and the coverages available under the Policy issued to its Insured;
C. Timely communicate with the Insured’s representative(s) to complete the adjustment of the Insured’s loss by participating in good faith negotiations to reach an agreement relating to the parties’ dispute over coverage, scope and amount of the Insured’s loss;
D. Immediately issue payment for statutory interest for any late payments and owed profit/overhead;
E. Act fairly and honestly towards the Insured and with due regard for his interests;
F. Hire a fair, unbiased, and qualified adjuster(s) and expert(s) to properly assess the Insured’s damages;
G. Timely and substantively respond to the Insured’s communications;
H. Provide a written explanation and detail of the payments issued;
I. 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;
J. Participate in good faith claims adjustment to avoid the Insured incurring unnecessary costs of appraisal, ADR, 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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