Civil Remedy Notice of Insurer Violations
Login

Filing Number:     788361
Filing Accepted:  10/23/2024
         Print Filing
Complainant
Last/Business Name *  
APEX ROOFING (A/A/O SOLVEIG H. BOHLING)   First Name  
Street Address * 6 LAMOYNE LANE
City, State Zip * PALM COAST, FL 32137
Email Address * LILLESOL@CFL.RR.COM
Complainant Type: * Insured
Insured
Last/Business Name*   APEX ROOFING (A/A/O SOLVEIG H. BOHLING)   First Name  
Policy # * FHP0002898 Claim #* CLM00582937
Attorney
Attorney is Applicable
Last Name* GONZALEZ First Name * ANTHONY Initial
Street Address* 925 S. FEDERAL HWY
City, State Zip* BOCA RATON , FL 33432
Email Address * AGONZALEZ@KPATTORNEY.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   AUTO CLUB INSURANCE COMPANY OF FLORIDA
NAIC Company Code 12813
 
Name of individual responsible for violation (if any):* CLAIMS DEPARTMENT
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

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

The carrier was put on notice of the claimant’s windstorm event claim. Subsequently, the claimant prepared a loss package in the amount of $49,354.29 needed to restore the property back to its pre-loss condition. Whereas, the carrier has failed to appropriately investigate the insured’s loss in a timely manner, document the damage in good faith, come to a fair coverage determination and promptly pay the claim. In turn, the claimant has complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insured. About one thousand and ninety-five days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. Specifically, the carrier is only offering to pay one-third of the retail cost of the roof of the insured property despite agreeing that the roof needed to be replaced under the policy. The carrier has offered no explanation or basis for their grossly deficient payment and the claimant has undertaken all reasomnable efforts to avoid litigating this matter. The carrier is aware of the damage sustained by the insured’s property and has not taken any meaningful ensuing action. It is clear that the carrier is not treating the claimant with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the claimant; failing to implement proper standards for the adjustment and investigation of claims and placing the company’s interests before the claimant’s interests; not training, supervising or managing adjusters properly so that prompt and full payments are made; refusing to pay the full amount owed to the claimant despite the fact that the damages are covered under the policy; looking for ways to delay full recovery or any recovery to the claimant; and refusing to provide coverage for the claimant’s loss in a timely manner. The carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $ 49,354.29, less any prior payments and less any applicable policy deductible; and 2.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier. Please do not hesitate to contact the undersigned or Kimberly Morales at 561-892-9915 if you have any questions or concerns. Sincerely, Anthony Gonzalez Attorney at Law
Comments
User Id Date Added Comment
ebrooksherproperty@kpattorney.com 12-05-2024 This filed Civil Remedy Notice is hereby withdrawn pursuant to a settlement agreement between the claimant and the insurance carrier.
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