Filing Number: 788910
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| Filing Accepted: 10/28/2024 |
| Last/Business Name
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PILLARISETTY
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First Name |
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SANDEEP |
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| Street Address
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2853 WINDSOR HILL DRIVE |
| City, State Zip
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WINDERMERE,
FL
34786
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| Email Address
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WITHHELD |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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PILLARISETTY |
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First Name |
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SANDEEP |
| Policy # * |
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OIC30059016-03 |
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Claim #* |
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22FLHOV0011730 |
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Attorney is Applicable
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| Last Name* |
DANIELS
First Name *
MONICA
Initial
E
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| Street Address* |
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560 VILLAGE BOULEVARD, SUITE 110 |
| City, State Zip* |
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WEST PALM BEACH
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FLORIDA
33409
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| Email Address * |
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MDANIELS@THEDANIELS-LAWGROUP.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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OLYMPUS INSURANCE COMPANY
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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 12954 |
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| Name of individual responsible for violation (if any):*
RYAN KOMANETSKY, ANDREA SAULS, MICHAEL LANE, HAROLD SPEESE, ZOE WHITE, MATTHEW SOMMERS, “ROSS”, RELLIM CONTRACTING LLC, AND ANY AND ALL ADJUSTERS, MANAGERS, SUPERVISORS, AND INDIVIDUALS ASSOCIATED WITH 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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Unfair Trade Practice
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Unsatisfactory Settlement Offer
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Claim Delay
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Claim Denial
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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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| 624.155(1)(b)(3) |
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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.
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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)(f) |
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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.
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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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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.
SECTION I – PROPERTY COVERAGES
A. Coverage A – Dwelling
1. We cover:
a. The dwelling on the "residence premises" shown in the Declarations, including structures
attached to the dwelling; and
b. Materials and supplies located on or next to the "residence premises" used to construct,
alter or repair the dwelling or other structures on the "residence premises".
SECTION I – PERILS INSURED AGAINST
A. Coverage A – Dwelling And Coverage B –
Other Structures
1. We insure against risk of direct physical loss to property described in Coverages A and B.
SECTION I – CONDITIONS
H. Our Option
If we give you written notice within 30 days after we receive your signed, sworn proof of loss, we may repair or replace any part of the damaged property with material or property of like kind and quality.
I. Loss Payment
We will adjust all losses with you.
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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.
Sindhu Golla and Sandeep Pillarisetty (the “Insureds”) purchased an insurance policy from Olympus Insurance Company (“Insurer”), with Policy number OIC30059016-03 (the “Policy”), to cover their property located at 2853 Windsor Hill Drive, Windermere, FL 34786 (the “Property”). On November 10, 2022, a hurricane, to wit, Hurricane Nicole struck the Property. The excessive winds from Hurricane Nicole caused overwhelming damage to the roof and various interior areas of the property. The Insureds immediately reported the loss to Insurer, and complied with all applicable post-loss obligations. The Insurer assigned claim number 22FLHOV0011730 (the “Claim”) to the claim.
The Insurer inspected the Property, determined that the roof needed to be replaced and numerous interior damages needed to be repaired, and, ultimately, Insurer selected the option in the Policy to complete repairs at the subject property in lieu of rendering coverage payments for same. However, Insurer’s selected contractor, Rellim Contracting LLC (“Insurer’s Contractor”), caused additional damage to Insureds’ home due to the improper operating of a crane and the improper installation of the roofing system, resulting in damage to the property’s interior, driveway, and even the new roofing system.
Despite Insurer’s Contractor admitting that the damage at the subject property was a result of their actions, Insurer has refused and/or failed to complete the repairs necessary to return the Property to its pre-loss condition. As such, Insureds were forced to hire a public adjuster to assist them with their damages and the claims process.
The Insureds provided the Insurer with a true and accurate estimate of the damages, extensive photographs of the damages, and complied with all of the Insurer’s requests for documentation and information. The Insurer acknowledged coverage, admitted liability, invoked the repair option, selected Insurer’s Contractor, who further damaged the property, and, now, Insurer refuses to restore the Property to its pre-loss condition.
The Insureds understandably became extremely frustrated by the Insurer’s clear delay tactics, failure to properly indemnify them for this Claim in a timely fashion, and failure to adjust the Claim in good-faith. To combat any further attempts by the Insurer to delay the Claim and its failure to make the Insureds whole, the Insureds had no choice but to retain legal counsel to assist with the Claim. Without repairing their property, the Insureds continue to suffer additional damages. The Insurer failed to return the Property to its pre-loss condition despite the Insureds expressing their clear disagreement with the Insurer’s handling of the Claim. Despite providing all necessary documentation to the Insurer to make good on its duty to restore the Insureds to their pre-loss condition, Insurer grossly handled the claim and only contemplated a fraction of the amount of Insureds’ damages given the additional damages caused by Insurer’s Contractor. The scope of the repairs completed by the Insurer’s Contractor is an insult to the Insureds and is far less than necessary to complete the repairs to their Property.
The Insurer’s refusal to properly investigate, adjust and fully compensate the Insureds for this Claim undoubtedly evidences the Insurer’s violation of Section 626.9541(1)(i)(3)(a), Florida Statutes, which requires the Insurer to “adopt and implement standards for the proper investigation of claims.” All available information leads to one conclusion – the Property was damaged by a covered cause of loss for which the Insureds are entitled to full and complete compensation. The Insurer’s obligation to promptly settle the Insureds’ claim is undeniable, and therefore, the Insurer has also violated Fla. Stat. Section 624.155(1)(b)(1) and 624.155(1)(b)(3).
The Insurer’s conduct continues to be egregious because the Insurer retained a contractor who failed to provide labor, services and/or materials in a workmanlike manner, e.g. improper installation of roofing system and improper operating of a crane. The actions taken by the Insurer in the handling of the Claim are willful, wanton, and in disregard for the rights of the Insureds, and have occurred with such frequency as to indicate a general business practice in violation of the law. This practice includes the Insurer hiring a contractor who caused additional damage to the Property, and subsequently refusing to remedy those additional damages in returning the property to its pre-loss condition. The Insurer’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 the insured and with due regard for her or his interests;”
B. “Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue”;
C. “Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear;”
D. “Failing to adopt and implement standards for the proper investigation of claims;”
E. Claim Delay;
F. Unsatisfactory Settlement Offers; and
G. Unfair Trade Practices.
In addition to the above statutory violations, the Insurer’s adjuster violated the following ethical requirements of the 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.
The Insureds are dutiful customers who made it a priority to pay their insurance premiums and to ensure that in such an event as the one here, their property would be covered. The Insureds timely filed their claim and fulfilled all post-loss obligations. Insurer acknowledged the loss, assigned a claim number, inspected the property, accepted coverage for the loss, invoked the repair option, selected Insurer’s Contractor, who further damaged the property, and, now, Insurer refuses to restore the Property to its pre-loss condition. Insurer has failed to provide the Insureds with qualified representatives to ensure the claim was initially adjusted, evaluated, and repaired properly. To deny the Insureds the benefit of the bargain after they have satisfied all of their obligations is morally and ethically reprehensible, and reeks of Unfair Trade Practice. Insurer is putting its profits ahead of its contractual and statutory obligations.
In Florida the work of adjusting insurance claims engages the public trust. The Insurer has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees. The Insurer has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insureds’ insurance claim and damages. Therefore, the Insurer breached its statutory and ethical duties, and has put profits ahead of the duties it owed to its Insureds when they most needed the insurance coverage they had paid for.
Florida Statute § 624.02 defines “insurance” as a contract where one undertakes to indemnify another or pay or allow specified amounts, or determinable benefit, upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly. This timely and prompt payment allows the insured to mitigate their damages and place them back to the position they were in prior to the loss, as quickly as possible. The Insurer breached this duty. The Insurer has refused and failed to tender all insurance proceeds to the Insureds upon demand. The Insurer’s refusal and/or failure to settle the insurance claim when it, under all circumstances, should have done so, is wrongful conduct. The Insurer is failing to promptly settle the Insureds’ claim as it is required to do so by contract, in order to influence settlements.
To cure the defects outlined in this civil remedy notice, the Insurer must (1) immediately, and under no circumstances no later than sixty days from the date of this civil remedy notice, tender all insurance monies due and owing to the Insured under the Policy, specifically $448,176.06 pursuant to the public adjuster’s repair estimate, less applicable deductible; (2) ensure that payment made would be adequate to place the Insureds and their Property back in the pre-loss condition; and (3) reimburse the Insured’s attorney’s fees and costs, since the Insured was forced to hire legal counsel in order to receive adequate payment. Should the Insurer fail to comply with the demands set forth in this civil remedy notice, the Insurer must prepare to pay the full cost of its failure to rightfully indemnify the Insureds, including all future damages that come about as a result of the Insurer’s failure to comply with the demands set forth in this civil remedy notice. This Notice is given in order to perfect the right to pursue the civil remedy authorized by section 624.155(3)(b), Florida Statutes.
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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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