Filing Number: 789229
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| Filing Accepted: 10/29/2024 |
| Last/Business Name
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BEDSON
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First Name |
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BRAD AND MEGAN |
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| Street Address
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2247 NW 11TH AVE. |
| City, State Zip
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GAINESVILLE,
FL
32605
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| Email Address
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MBEDSON@ATT.NET |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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BEDSON |
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First Name |
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BRAD AND MEGAN |
| Policy # * |
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77 09 HR 036656 |
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Claim #* |
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909945-GP |
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Attorney is Applicable
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| Last Name* |
DIAZ
First Name *
JESSE
Initial
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| Street Address* |
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950 S WINTER PARK DR., STE 207 |
| City, State Zip* |
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CASSELBERRY
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FLORIDA
32707
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| Email Address * |
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JESSE@PRIORITYJUSTICE.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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NATIONWIDE MUTUAL 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 23787 |
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| Name of individual responsible for violation (if any):*
NATIONWIDE'S CLAIMS DEPARTMENT
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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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Unfair Trade Practice
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Other
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Bad Faith
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Claim Delay
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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)(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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| 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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| 626.9541(1)(i)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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| 626.9541(1)(i)(3)(j) |
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Altering or amending an insurance adjuster’s report without:
(I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and
(II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or
(III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
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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.
Policy Provisions:
Based on information and belief, the following policy provisions are relevant to this civil remedy notice.
SECTION I — PROPERTY COVERAGES
In the H 00 03 FL policy only, Coverage A — Dwelling is deleted and replaced by the
following:
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".
2. We do not cover land or the replacement, rebuilding, restoration or value of such land.
In the H 00 03 FL policy only, Coverage B — Other Structures is deleted and replaced by the following:
7. Loss Assessment
a. We will pay up to the Loss Assessment coverage limit shown on the Declarations for
your share of loss assessment charged during the policy period against you, as
owner or tenant of the "residence premises", by a corporation or association of
property owners. The assessment must be made as a result of direct loss to
property, owned by all members collectively, of the type that would be covered by
this policy if owned by you, caused by a Peril Insured Against under Coverage A,
other than:
(1) Earthquake; or
(2) Land shock waves or tremors before, during or after a volcanic eruption.
The most we will pay with respect to any one loss, regardless of the number of
assessments during the policy period is the maximum of:
(1) $2,000; or
(2) The amount equal to your unit-owner's loss assessment coverage limit as a
result of the same direct loss to property. The maximum amount of any unit
owner's loss assessment coverage that can be assessed for any loss shall be an
amount equal to that unit owner's loss assessment coverage limit in effect 1 day
before the date of the occurrence that gave rise to the loss. Such coverage is
applicable to any loss assessment regardless of the date of the assessment by
the association. Any changes to the limits of a unit owner's coverage for loss
assessments made on or after the day before the date of the occurrence are not
applicable to such loss.
An insurer providing loss assessment coverage to a unit-owner is not required to
pay more than an amount equal to that unit-owner's loss assessment coverage limit.
We will only apply one deductible per building, to the total amount of any one loss
to the property described above, regardless of the number of assessments.
b. We do not cover loss assessments charged against you or a corporation or
association of property owners by any governmental body.
c. Any reduction or elimination of payments for losses because of any deductible
applying to the insurance coverage of the association or corporation collectively is
not covered under this Additional Coverage, regardless of the cause.
d. Paragraph Q. Policy Period under Section I — Conditions does not apply to this
coverage.
This coverage is additional insurance.
This coverage is excess over other valid and collectible insurance covering the
corporation or association of property owners.
11. Ordinance Or Law
a. You may use up to 25% of the limit of liability, or higher limit if shown on the
Declarations, that applies to Coverage A — Dwelling and provides coverage for the
increased costs you "incur" due to the enforcement of any ordinance or law which
requires or regulates:
(1) The construction, demolition, remodeling, renovation or repair of that part of a
covered building or other structure damaged by a Peril Insured Against;
(2) The demolition and reconstruction of the undamaged part of a covered building
or other structure, when that building or other structure must be totally
demolished because of damage by a Peril Insured Against to another part of that
covered building or other structure; or
(3) The remodeling, removal or replacement of the portion of the undamaged part of
a covered building or other structure necessary to complete the remodeling,
repair or replacement of that part of the covered building or other structure
damaged by a Peril Insured Against.
b. You may use all or part of this ordinance or law coverage to pay for the increased
costs you "incur" to remove debris resulting from the construction, demolition,
remodeling, renovation, repair or replacement of property as stated in a. above.
D. Loss Settlement
In this Condition D., the terms "cost to repair or replace" and "replacement cost" do not
include the increased costs incurred to comply with the enforcement of any ordinance or
law, except to the extent that coverage for these increased costs is provided in E.11.
Ordinance Or Law under Section I — Property Coverages. Covered property losses are
settled as follows:
1. Property of the following types:
a. Personal property;
b. Awnings, carpeting, household appliances, outdoor antennas and outdoor equipment,
whether or not attached to buildings;
c. Structures that are not buildings; and
d. Grave markers, including mausoleums;
Initially we will pay no more than the "actual cash value" of the property to be replaced.
You are to use the initial payments to finance the purchase of replacement property,
then provide us with receipts of your replacement purchases. Upon our receipt of the
receipts of your replacement purchases, we will issue additional payments that are
consistent with the receipts until you submit all receipts, up to the policy limits for
replacement cost.
J. Loss Payment
We will adjust all losses with you. We will pay you unless some other person is named in the
policy or is legally entitled to receive payment. Loss will be payable upon the earliest of the
following:
1. 20 days after we receive your requested proof of loss and reach written agreement with
you;
2. 60 days after we receive your requested proof of loss and:
a. There is an entry of a final judgment; or
b. There is a filing of a mediation settlement with us; or
3. Within 90 days after we receive notice of an initial, re-opened or supplemental property
insurance claim from you, we shall pay or deny such claim or a portion of the claim
unless the failure to pay such claim or a portion of the claim is caused by factors beyond
our control which reasonably prevent such payment.
Our failure to comply with this subsection shall not form the sole basis for a private
cause of action against us.
For losses insured on a replacement cost basis, loss will be adjusted on the basis of
replacement cost to the lesser of:
1. The limit of liability shown on the declarations page;
2. The reasonable and necessary cost to repair the damaged, destroyed, or stolen covered
property; or
3. The reasonable and necessary cost to replace the damaged, destroyed, or stolen
covered property.
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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.
Insured(s) Name: Brad Bedson and Megan Bedson
Insured Address: 2247 NW 11th Ave., Gainesville, FL 32605-5203
EMAIL: MBedson@att.net
Policy Number: 77 09 HR 036656
Claim Number: 909945-GP
DOL: February 04, 2024
On February 04, 2024, the Insureds, Brad Bedson and Megan Bedson, suffered damage to their home located at 2247 NW 11th Ave., Gainesville, FL 32605-5203 because of wind and hailstorm. The date of loss should not be in dispute, as NOAA’s Jacksonville station verified quarter-sized hail in Gainesville, FL. Available public weather reports found quarter-sized hail with 25 mph winds and included 60 mph gusts on the reported date of loss. Concurrently, the Insureds provided Nationwide with a video they recorded showing the hail hitting their home during the storm.
Prior to the loss, Nationwide Mutual Insurance Company (“Nationwide”), had issued a policy of insurance (Policy No.: 77 09 HR 036656) for the Insured’s property. Said policy was in full force and effect on the date of loss and afforded coverage for damage caused by wind and hail.
Nationwide was timely notified of the loss by the Insureds and assigned claim number 909945-GP. In fact, the claim was first reported to Nationwide during the date of loss, February 4, 2024. However, Nationwide’s August 9, 2024, Coverage Determination letter, erroneously claims that the first reported on August 2, 2024, seven (7) days before their investigation conclusion.
During Nationwide’s investigation, the Insured made their property available for inspection, provided facts, videos of the storm’s impact, and information surrounding the loss, and complied with Nationwide’s adjustment of the claim. Nevertheless, Nationwide denied the claim stating that their “review showed that there is no evidence of wind or hail damage to your roof. There is evidence of wear, tear, deterioration and rot which is excluded under your policy as outline above. We expressly reserve all other rights, defenses, or contentions, which are available to us under the policy of insurance, by law or otherwise, and do not waive any such rights or defenses which we now have or which may become known to us in the future.
If you have information about this claim that may affect our current
decision, please forward it to us as soon as possible.”
On October 13, 2024, to better represent their interest, the Insureds hired a Public Adjuster, Mr. David Zadezensky, of Claims Recovery Solutions. On October 15, 2024, Mr. Zadezensky visually inspected the Insureds’ residence, photographing and documenting the condition of the dwelling and the cause of loss.
The subject roof was replaced in late December 2005, it is 19 years old, and no shingles of matching quality, color, or size are known. In the alternative, Nationwide has failed to order an ITEL report (or similar report) for the subject roof shingles to determine whether shingles of the same, kind, color, and size are available for repairs.
Originally, Nationwide hired Seek Now Claims Adjusters to reinspect the property. While at all times applicable, Mr. Zadezensky provided photos, the date of loss video, roof measurements, and an Xactimate showing the price and scope of the wind and hail damage suffered.
On October 15, Nationwide’s Desk Adjuster, Annette Davis, wrote “We will not be requesting a second inspection but if you have evidence, you feel supports hail damages, please feel free to submit the evidence for review”. on October 17, 2024, in response to Mr. Zadezensky’s request for a copy of Nationwide’s inspection report, Ms. Davis wrote “We use a 3rd party vendor to inspect the property and document any potential damage. They do not have any authority over the file, they are there to inspect only. We do not release their report as it is considered work product.” As such, Nationwide has failed to provide the Insureds with an adequate explanation of their coverage determination. Instead, Nationwide provided the Insureds and their representatives with conclusory statements accompanied by a laundry list of general policy provisions.
On October 23, 2024, Ms. Davis said, “Thank you for the additional documentation. We have reviewed the additional submission and disagree with your findings. We are standing on our denial based on the exclusions of the policy which we have sent to our insured and yourself in prior emails. Mr. Zadezensky, replied, “We disagree with your assessment of the claim and ask that a licensed adjuster or contractor inspect the damages to get another opinion on it. We will continue to pursue this claim and attempt in good faith to settle it. Please note our 2nd request to Seek Now’s inspection report.”
Lastly, on October 24, 2024, Ms. Davis wrote, “We have completed a thorough inspection in which a licensed adjuster has reviewed and cannot confirm hail or wind damage to the roof. We will not be sending for a second inspection. If you have further evidence to support your claim, we will be happy to review. Again, we are standing on our denial based on our investigation and review of the claim.” Mr. Zadezensky replied, “We sent videos showing hail coming down on the date of loss at the house and there are missing shingles, are you or Nationwide stating that those damages are not there? Is there a possibility that your unlicensed representative who inspected the damage could have missed the damages? Are you stating that Nationwide does not want to investigate the claim further? Please reply to this email so we can move forward with the next steps as it does not appear that Nationwide wants, in good faith, to resolve this claim for Mr. and Mrs. Bedson. Lastly, we would like to see what your representative photographed and noted on his report. We ask again (third request) for the inspection report from Seek Now.” As such, Nationwide has failed to
To date, Nationwide has not performed an ITEL report for the subject loss, although they admit that it was needed. As such, Nationwide has refused to acknowledge and afford coverage for the full roof replacement as required under the Policy’s “pre-loss condition” indemnification mandate, and applicable Florida’s matching statute (Fla. Stat. 626.9744), and since the roof predates 2007, the 25% rule, FBC 706.1.1(5) is applicable to the loss.
Despite fully cooperating with Nationwide’s investigation, Nationwide has capriciously limited coverage for the Insured’s insurance claim even though there was clear evidence of storm damage to covered property. Nationwide has failed to tender undisputed funds as required. Nationwide came to its coverage determination by ignoring relevant facts and information provided by the Insured and their Public Adjuster that established the damages to the roof and exterior of the residence were unquestionably the result of a covered wind and hail.
Nationwide and its agent, Seek Now Adjusters/Ladder Assist either underplayed or misrepresented the findings from its own inspections in order to avoid having to tender payment on a claim that it knows should be covered pursuant to the terms of the Policy.
It is clear that Nationwide has not acted honestly or fairly towards its Insured. Nationwide and its representatives have failed to conduct a proper investigation of the loss, misrepresented the scope and cause of damages at the residence, and misapplied exclusions in the policy in order to deny coverage for the Insureds’ claim. It has become a general business practice of Nationwide to not implement proper claims handling procedures, to hire consultants that routinely ignore or intentionally misidentify relevant evidence, and to not settle claims in good faith when under all circumstances it should have. Failed to provide adequate explanation as the basis of their coverage determination, and the need for additional for As is the case here, it is a pattern and practice for Nationwide to arbitrarily deny claims without conducting reasonable investigations based on the information and evidence available to it.
To cure this civil remedy notice, Nationwide must immediately acknowledge in writing that the insureds’ roof was damaged by wind and hail and that replacement of the roof is covered by the policy. With that, Nationwide needs to tender $16,349.06 in Actual Cash Value and then another $5,197.20 if Depreciation is recoverable. The written acknowledgment and payment should be mailed to Quattrochi, Torres & Taormina, P.A., Jesse J Diaz, Esq. at 950 S Winter Park Dr. Suite 207, Casselberry, FL 32707. A copy of this Civil Remedy Notice is provided to the Insured, as required by law.
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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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