Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 787652

Filing Accepted: 10/20/2024

Print Filing

Complainant

Last/Business Name *

ZALEWSKI

First Name

RAFAL

Street Address *

6660 EASTON DR

City, State Zip *

SARASOTA, FL 34238

Email Address *

AHB@PREMPROPLAW.COM

Complainant Type: *

Insured

Last/Business Name*		ZALEWSKI		First Name		RAFAL
Policy # *		BCVBR066507		Claim #*		68862JPO

Attorney

Attorney is Applicable

Last Name*	BOWEN First Name * ALEXANDER Initial
Street Address*		1314 EAST LAS OLAS BLVD, SUITE 1004
City, State Zip*		FORT LAUDERDALE , FLORIDA 33301
Email Address *		TEAM@PREMPROPLAW.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		UNDERWRITERS AT LLOYD'S, LONDON
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code

Name of individual responsible for violation (if any):* ANY AND ALL ADJUSTERS, SUPERVISORS, MANAGEMENT, ATTORNEYS AND INDIVIDUALS ASSOCIATED WITH THE CLAIM
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Denial
	Claim Delay
	Unsatisfactory Settlement Offer
	Unfair Trade Practice

* Statutory provision(s) which the insurer allegedly violated.

	626.9541(1)(i)(2)		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.
	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)(c)		Failing to acknowledge and act promptly upon communications with respect to claims.

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Section I Property Coverages of the appliable policy provides coverage for the reported claim. The Insured has complied with all policy conditions, and there are no exclusions that apply. The Insured believes the Policy language relevant to the violations includes all applicable policy coverages, loss payment provisions, loss settlement provisions, valuation provisions and other terms and conditions of the subject policy. In particular, the Insured refers to the following policy language: Building and Personal Property Coverage Form: “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”; 4. Loss Payment: “g. We will pay for covered loss or damage within 30 days after we receive the sworn proof of loss, if you have complied with all of the terms of this Coverage Part and: …. (2) An appraisal award has been made.” Certain Underwriters at Lloyd’s, London has failed to issue insurance benefits to its Insured pursuant to the Loss Settlement, Loss Payment, and other Provisions in the applicable policy.

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

In this claim, Certain Underwriters at Lloyd’s, London (“Carrier”) exhibited a blatant, unacceptable failure to properly investigate a claim, in violation of Florida law, and committed clear bad faith in refusing to properly pay Rafal Zalewski (“Insured”) for the Insured’s claim, and neglecting and delaying the claim as long as possible in order to increase its profits to the detriment of its Insured. On or about September 28, 2022, while the policy was in full force and effect, the Insured’s property located at 6660 Easton Dr, Sarasota, FL 34238, sustained a covered loss as the result of Wind Damage, including but not limited to, substantial wind and water damage. The Insured timely reported the claim to Certain Underwriters at Lloyd’s, London (“Carrier”), and Carrier assigned claim number 68862JPO. The Insured complied with all post-loss duties under the policy to report the claim and protect the property from further harm. The insured’s representative also provided Carrier with all pertinent claim-related documentation, including photographs of the damages and an estimate to restore the property to its pre-loss condition. Carrier, however, hired a results-oriented adjuster and engineer to find that a lot of the damage was not due to the hurricane, completely ignoring the fact the property had exhibited no other issues prior to the hurricane. Through their actions, Carrier is continuing to improperly delay the claim and participate in unfair claim settlement practices in violation of Section 626.9541(1)(i), Florida Statutes. Carrier failed to comply with the terms set forth in its policy to pay for damages caused by this covered loss. Rather than issuing the proper payment or attempting to reach an agreement with its insureds, Carrier ignored the insured’s claim, failed to properly investigate, attempted to keep a 6-figure loss under the Insured’s deductible before they had representation, hired a results-oriented engineer to perform a bogus inspection and claim that a lot of the damage was not due to the hurricane, and continued to drag its feet to resolve this claim. In order to understand the bad faith committed by Carrier, it is necessary to understand a timeline of the events in this claim. Hurricane Ian came through as a Category 4 hurricane and caused widespread damage throughout the State of Florida on September 28, 2022. After the hurricane, the claim was quickly reported to the Carrier. The Carrier attempted to take advantage of the Insured and lowball the coverage evaluation after the hurricane. Upon information and belief, Carrier deliberately kept its coverage estimate dated December 1, 2022 under the $20,000.00 deductible to avoid paying out any money on the claim. Carrier sent a coverage letter dated December 21, 2022 stating in part that “no settlement will be forthcoming as the net claim is less than the applicable deductible.” The Carrier ignored the Insured’s request for proper payment of the claim and did not respond to communications in violation of Section 626.9541(1)(i)(3)(c), as well as Florida Statutes Section 627.70131. Due to the Carrier’s unreasonable coverage determination, Carrier’s actions in handling the claim, and the Carrier’s lowball estimate, the Insured was forced to seek proper representation to prevent them from being further taken advantage of by the Carrier. They contacted Executive Claim Solutions, a Public Adjusting Firm, for a review of their claim as things just did not seem right. Public Adjuster Jesse Goldstein then made contact and after a quick review of the claims documentation and the insurance policy was able to identify that this claim was not handled properly in good faith. Upon his inspection of the property, Mr. Goldstein found serious damage to the property which was not accurately accounted for by the Carrier. The PA’s estimate was approximately $180,000 – which represented an amount which was over $160,000 over the Carrier’s estimate. When the Carrier refused to agree to the PA’s estimate, it had an engineer go out to the property. The engineer – clearly biased in favor of the Carrier – ignored a lot of the damage and said a lot of the damage was unrelated to Hurricane Ian despite never visiting the property at any other point in time. This led to Carrier slightly revising its estimate to just over the deductible, which led to the first payment of just $2,820.50 based on Carrier’s May 25, 2024 estimate. Due to the complete lowball evaluation of the covered damages again, appraisal was invoked to determine the amount of the covered loss. Just a couple of months after Carrier’s lowball estimate was drafted, the appraisal award was signed which reflected a total Replacement Cost Value of the covered damages at $185,065.20 – an amount which was HIGHER than the PA’s estimate. Clearly, based on the award itself, Carrier acted in bad faith in lowballing the estimate of covered damages multiple times. On top of this, Carrier then sent an appraisal award payment letter which stated that there was no coverage for Other Structures in its appraisal award payment letter, even though it paid for the pool cage that was labeled Other Structures in the appraisal award estimate and the award itself. Carrier changed what the appraisers defined in the award which is impermissible because appraisal sets the amount of the loss and Carrier cannot change the award or any part of it. Carrier covered the pool cage which is attached to the Dwelling, but did not cover the foundation which was included in the Dwelling portion of the appraisal award estimate – even though it is also attached to the Dwelling just like the pool cage. Based on the above facts, to date, Carrier has committed violations of: (1) Florida Statute Section 626.9541(1)(i)(3)(a) by failing to adopt and implement standards for the proper investigation of claims as evidenced by its desk adjusters who appear to be trained to delay timely payment of insurance benefits owed and avoid providing proper indemnification to its insured, (2) Section 626.9541(1)(i)(3)(b) by misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue as evidenced by Carrier misrepresenting the coverage under the policy and not paying out for proper costs for repairing the Insureds’ property, and (3) Section 626.9541(1)(i)(2) by Carrier making a material misrepresentation to the Insured for the purpose and with the intent of effecting settlement of such claims, loss, or damage under the policy on less favorable terms than those provided in, and contemplated by, such contract or policy, as evidenced by Carrier materially misrepresenting the policy coverages for the building and changing the appraisal award Dwelling amount listed in the award, and Carrier deliberately dragging out the claim as long as possible and only deciding to pay the Insured any money AFTER the Insured was forced to retain a public adjuster, and Carrier also ignored obvious contradictory evidence that much more money was owed to the Insured for the loss provided to Carrier by the insured’s public adjuster through photographic evidence. This is unconscionable and a gross violation of ethical standards by Carrier and evidence of bad faith claims handling by the Carrier who should have evaluated and fairly provided coverage for the true cost of the damages associated with Hurricane Ian damages at the property. Carrier sent a lowball payment by providing minimal coverage for the extensive damages caused to its Insured’s property from Hurricane Ian by not providing proper coverage in an attempt to take advantage of its Insured for its own benefit and profits. Carrier also ignored and dismissed the Insured’s representative’s communications as set forth above in violation of Florida Statutes Section 626.9541(1)(i)(3)(c), Florida Statutes. Carrier’s agents – including adjusters and management – have ALL continued to delay this claim and harmed the Insured by Carrier not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so. Upon information and belief, Carrier also violated Section 626.9541(1)(i)(3)(a) by failing to adopt and implement standards for the proper investigation of claims because management of Carrier redlined this claim and ignored the investigation findings and evidence of hurricane damage from wind in a deliberate attempt to delay and underpay the claim as evidenced by the above facts. Carrier ended up providing coverage for this claim, but Carrier and its management deliberately delayed and underpaid this claim multiple times, and Carrier low balled the true cost to fix the damages associated with this catastrophic Hurricane Ian claim that caused significant damages to the Insured’s property. At this point in time, Carrier has still refused to pay the proper covered damages under the Insured’s claim, leaving the Insured stuck with a damaged property, unable to make repairs or do anything with the properties. Despite clear evidence of extensive damages to the properties, it appears that the Carrier is ignoring obvious damages without any contradictory evidence to unreasonably delay the claim, and avoid paying for the full cost of the damages to repair the Insured properties. Because of Carrier’s delay in this claim, the Insured has been irreparably damaged. Furthermore, at this time, labor and materials costs to complete the work necessary to restore the properties to their pre-loss condition have skyrocketed since Hurricane Ian, and the Insured has been harmed significantly by Carrier’s delaying and improperly paying the Insured’s Hurricane Ian claim. Moreover, the Carrier failed to comply with its loss settlement provision. Rather than issuing the proper payment or attempting to reach an agreement with its Insured, the Carrier ignored the Insured’s request for funds to properly restore the property to its pre-loss condition and continued to drag its feet. Upon information and belief, Carrier performs the subject actions as a general business practice in order to increase financial profits, and Carrier has failed to adopt and implement standards for the proper investigation of claims in violation of Section 626.9541(1)(i)(3)(a), Florida Statutes. It is believed that future bad faith discovery would reveal an extensive history of delay of claims similar to that of the Insured and other insureds across the state of Florida, as this conduct may be a business practice of the Carrier. It is believed that future bad faith discovery may reveal an extensive history of underpayments of claims similar to that of the Insured and other insureds across the state of Florida, as this conduct may be a business practice of the Carrier. Carrier in this claim also misrepresented pertinent facts or insurance policy provisions relating to coverages at issue because Carrier ignored obvious damages to the property from Hurricane Ian, which is a covered loss, by not providing coverage for what the policy covers and claiming it does not have to pay for the reasonable damages accounted for the Insured’s public adjuster by wind despite the significant evidence provided to Carrier by the Insured’s public adjuster, which is in violation of Section 626.9541(1)(i)(3)(b), Florida Statutes. The Carrier could very quickly see the damage caused by this major hurricane which was evidenced by the photographs of the property and could have easily researched the effects of the hurricane in the area and the extremely high wind speeds associated with the hurricane at the Insured’s property, but yet the Carrier did not provide appropriate coverage for this claim in bad faith. This Notice is given in order to perfect the right to pursue the civil remedy authorized by Fla. Stat. Sec. 624.155(1)(a), including any and all bad faith/extra contractual damages, should Carrier fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. The Insured also intends to seek punitive damages against Carrier as it appears that Carrier’s violations occur with such frequency as to evidence a general business practice in order to increase financial profits and the violations were willful, wanton, and malicious and were in reckless disregard for the rights of the Insured. While no specific “cure amount” is required for this Civil Remedy Notice to be valid, Carrier can cure the violations contained herein by: (i) issuing a payment for all contractual damages owed under the policy for the claim by issuing payments to the Insured based on the appraisal award totaling $185,065.20 RCV, less the applicable policy deductible, depreciation in the award, and prior payments for this claim for a net payment of $35,135.33; and (ii) make payment of interest owed under Florida law as a result of the actions/inactions of Carrier.

Comments

User Id		Date Added		Comment
ba@premproplaw.com		11-19-2024		This Notice is hereby withdrawn pursuant to a mutually agreed settlement between the parties.

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