Filing Number: 789821
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| Filing Accepted: 11/1/2024 |
| Last/Business Name
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LITTLE
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First Name |
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NANCY AND GORDON |
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| Street Address
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401 N. OXFORD DRIVE |
| City, State Zip
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ENGLEWOOD,
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34223
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| Email Address
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NLITTLE428@HOTMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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LITTLE |
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First Name |
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NANCY AND GORDON |
| Policy # * |
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PFL356639-05 |
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Claim #* |
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CFL22586147 |
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Attorney is Applicable
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| Last Name* |
SAVAGE
First Name *
SHELBY
Initial
L.
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| Street Address* |
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1700 W. MAIN ST., SUITE 100 |
| City, State Zip* |
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PENSACOLA
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FL
32502
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| Email Address * |
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SSAVAGE@TWWLAWFIRM.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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PEOPLE'S TRUST 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 13125 |
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| Name of individual responsible for violation (if any):*
LANEY RHEA; RONALD JACKSON; TINA KEMPS; SARAH DAVIS; TRAVIS HUBBARD; CAROLINA QUINONES; PATRICK CUNNINGHAM; AARON BRENEMAN; ARIELLE MOLINET PETERS; JESSICA MYLES
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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 Delay
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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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)(e) |
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Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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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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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
A. We cover:
1. The dwelling on the "residence premises" shown in the Declarations, including structures attached to the dwelling
B. Coverage B – Other Structures
1. We cover other structures, when premium for Coverage B is shown on the Declarations page, on the "residence premises" set apart from the dwelling by clear space. This includes structures connected to the dwelling by only a fence, utility line, or similar connection.
D. Loss Settlement
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; and
c. Structures that are not buildings;
at actual cash value at the time of loss but not more than the amount required to repair or replace.
2. Buildings under Coverage A or B at replacement cost without deduction for depreciation, subject to the following:
a. If, at the time of loss, the amount of insurance in this policy on the damaged building is eighty percent (80%) or more of the full replacement cost of the building immediately before the loss, we will pay the cost to repair or replace, after application of deductible and without deduction for depreciation, but not more than the least of the following amounts:
(1) The limit of liability under this policy that applies to the building;
(2) The replacement cost of that part of the building damaged for like construction and use on the same premises; or
(3) The necessary amount actually spent to repair or replace the damaged building.
d. We will initially pay at least the actual cash value of the insured loss less any applicable deductible. We will then pay the necessary amounts actually spent to repair or replace the damaged building as work is performed and expenses are incurred. If a total loss of the covered dwelling occurs, we shall pay the replacement cost coverage without reservation of any depreciation in value, subject to policy limits.
J. Our Option
At our option:
1. For losses settled on an actual cash value basis, we may repair or replace any part of the damaged property with material or property of like kind and quality.
2. For losses covered under Coverage A – Dwelling, insured fore Replacement Cost loss Settlement as outlined in SECTION I – CONDITIONS, Loss Settlement, we may repair the damaged property with material of like kind and quality without deduction for depreciation.
9. Our right to repair or replace, and our decision to do so, is a material part of this contract and under no circumstances relieves you or us of our mutual duties and obligations under this contract.
S. Appraisal:
Where “we” elect to repair:
1. If “you” and “we” fail to agree on the amount of loss, which includes the scope of repairs, either may demand an appraisal as to the amount of loss and the scope of repairs.
2. The scope of repairs shall establish the work to be performed and completed by Rapid Response Team, LLC™. Such repair is in lieu of issuing any loss payment to “you” that otherwise would be due under the policy. The amount of loss shall establish only the initial amount paid to Rapid Response Team, LLC™ by “us”, and any additional amounts required to complete repairs shall be “our” responsibility and will be paid to Rapid Response Team, LLC™ without regard to policy limits or the amount of initial payments.
This Civil Remedy Notice is also grounded in People’s Trust Insurance Company’s statutory duty to act in good faith and deal fairly with its insured when handling claims.
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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.
The policyholders, Nancy and Gordon Little (collectively “Little”), sustained losses to their property located at 401 N. Oxford Drive, Englewood FL 34223 caused by and following Hurricane Ian as referenced in this Civil Remedy Notice. Little timely notified People’s Trust Insurance Company (“People’s Trust”) of the claim.
In addition to the numerous statutory violations and wrongful conduct outlined in Little’s first Civil Remedy Notice (DFS No. 701021, filed on June 20, 2023) and restated below, People’s Trust has also recently committed the following statutory violations and wrongful acts since the filing of the first Civil Remedy Notice:
This matter went to appraisal to determine the amount of the loss and cost to repair. In March 2024, an appraisal award was entered in the amount of $158,233.65 actual cash value, and $170,620.02 replacement cost value under Dwelling, Other Structures, Matching, and Screen Enclosure. The appraisal award itself states that it is “valid and binding upon all parties.” People’s Trust designated their contractor—Rapid Response Team, LLC (RRT)—to perform the repairs. People’s Trust violated the right to repair provision in the policy by failing to enact repairs in a timely and efficient manner and in good faith. Although the appraisal award was entered in March 2024, People’s Trust did not complete the necessary replacement of Little’s roof until September 2024, six months later. This unacceptable delay caused additional damage to occur inside the home because the covered damage the building sustained caused the envelope to be compromised, allowing additional water and outdoor elements to intrude and damage the home.
Further, People’s Trust has also failed to comply with its own policy provision to accept the appraisal award as valid and binding and an establishment of the scope of repairs to be performed by People’s Trust’s selected contractor, RRT. Although the appraisal award required the replacement of certain windows in the home and People’s Trust is obligated to repair the home in accordance with the Florida Building Code, People’s Trust has breached this portion of its right to repair obligation by refusing to upgrade Little’s windows to hurricane grade windows as required by the Florida Building Code.
In addition, People’s Trust has also recently assigned the file to a new RRT project manager—Shannon, to replace the former Emily—who has informed Little that a new estimate needs to be created. This conduct violates People’s Trust’s obligation to treat the appraisal award as valid and binding and repair the home to its pre-loss condition in accordance with the appraisal award. People’s Trust’s attempt to circumvent the appraisal award and further delay and stall this claim has been in bad faith and has caused Little additional harms and losses over and above the amount owed by People’s Trust for the necessary repairs.
Once People’s Trust invoked its right to repair and moved forward with the appraisal process, People’s Trust was bound by the appraisal award and the scope determination made by the umpire. People’s Trust was under an obligation to enact the repairs within a reasonable time and perform the repairs in good faith with quality materials and workmanship. People’s Trust’s failure to perform the repairs within a reasonable time and in accordance with the scope set forth in the appraisal award constitutes a breach of the right to repair provision and an intentional handling of this claim in bad faith.
As stated in Little’s first Civil Remedy Notice (DFS No. 701021, filed June 20, 2023), during the initial stages of the claim adjustment process, Little’s claim was passed from desk adjuster to desk adjuster—four total—causing unacceptable delay and disorganization each time the claim was passed to a new adjuster who would have to get up to speed on the claim. This process required Little to resubmit evidence that had previously been provided to People’s Trust multiple times, causing further delay and inefficient handling of this claim. This passing of the claim from one adjuster to another also hindered Little’s ability to reach their assigned desk adjuster to receive updates on the claim, with many of their inquiries and messages going completely unanswered, if not outright ignored. People’s Trust’s willful or negligent failure to ensure open and constant communication with its insureds violated both its duty under the policy to timely adjust this claim and its duty under Fla. Stat. § 626.9541(1)(i)(3)(c) to acknowledge and act promptly upon communications with respect to claims. People’s Trust’s dilatory, inefficient, and unacceptable adjustment of this claim in this manner also shows People’s Trust has failed to implement and follow adequate guidelines for the proper investigation to evaluate claims and the appropriate training and supervision of its employees and adjusters resulting in the statutory violations identified in this Civil Remedy Notice above.
In addition to its wrongful handling of communications on this claim, People’s Trust has also uncovered or been presented with ample evidence showing the accurate scope of covered damage and the cost to repair it. However, People’s Trust ignored or dismissed this evidence and claimed damage was either not caused by a covered peril or was limited, excluded, or not as extensive as the evidence showed in an effort to wrongfully minimize the claim value so People’s Trust could save money on this claim. This conduct was in bad faith and has caused both significant delay of payment in full on the claim as well as additional harms and losses to Little over and above the amount owed under the policy of insurance.
People’s Trust’s initial inspection of the property was conducted on October 22, 2022, and Little was informed an estimate of the damages would be forthcoming. However, this did not happen in a timely manner. Weeks upon weeks passed with Little attempting to get an update on the claim, to no avail, and no estimate was provided. People’s Trust did not complete its estimate until two months after the inspection and almost three months after the hurricane. This delay was unacceptable and caused significant delays and difficulties on this claim. People’s Trust estimate of the covered damage was also grossly inaccurate and failed to identify all items of damage and accurately estimate the cost to repair it. People’s Trust’s field adjuster was either not sufficiently trained or experienced to identify and estimate all damage caused by wind or his estimate was improperly or erroneously adjusted by the desk adjuster to result in an estimate that was inaccurate, far too low, and not supported by patent evidence at the property showing the damages were much greater.
Specifically, People’s Trust’s determination that the entirety of the covered damage to Little’s dwelling and other structures amounted to only $10,758.62 was grossly inaccurate and constituted an active effort by People’s Trust to ignore evidence and minimize the claim value so People’s Trust could avoid its obligation to pay Little the full and fair value of this claim. People’s Trust’s estimate did not identify or accurately estimate the cost to repair the extensive wind damage to the property including, but not limited to, damage to the roof, which was struck by a felled tree, the soffits which were blown out, the living room interior and ceiling, the pool deck, a leaking bathroom and bedrooms, and approximately eleven trees which were felled by wind and removed from the property. People’s Trust also wrongfully minimized the damage to Little’s one thousand square foot guest house which had soffits blown out, shingles removed, and water coming down the walls. People’s Trust’s attempt to invoke its right to repair while limiting the repairs to this severely inadequate amount of $10,758.62 was in bad faith with the goal of avoiding its full obligation to Little.
In finally submitting its late estimate and initial coverage decision to Little, People’s Trust also instructed Little, if they disagreed with People’s Trust’s coverage decision, their only option was to submit a sworn proof of loss. People’s Trust issued this demand fully aware of the consequences that accompany an insureds’ failure to produce a timely, accurate sworn proof of loss. People’s Trust’s decision to issue such a burdensome request in such a short time after a catastrophic storm—when local, skilled contractors and estimators are incredibly hard to locate and retain—was a strategic tactic intended to harass and bully its own policyholders. Rather than adjust the claim in Little’s best interest with the goal of identifying all covered damage and finding all coverage available to repair it, People’s Trust chose to weaponize its policy provisions and use them to place steep demands on Little with severe consequences during an already trying and difficult time.
As a result of People’s Trust’s efforts to wrongfully minimize the claim value and limit its obligation to Little, Little was forced to incur costs in hiring a local, reputable, skilled public adjuster to prepare a thorough and accurate estimate of $163,983.42 replacement cost value on the dwelling and $18,947.67 on other structures, which represents a far more accurate estimate of the cost to repair the entirety of the covered damage. Had People’s Trust adjusted the claim initially in good faith and in Little’s best interest, People’s Trust’s inspection and estimate would have resulted in a fair amount of compensation that would not have forced Little to have to hire a public adjuster to protect their interests and right to be paid in full on the claim. People’s Trust’s conduct in this regard—showing a lack of concern for its inadequate adjustment of this claim and its failure and/or refusal to pay Little what it knows is the true amount required to repair the property—has been in bad faith. People’s Trust’s minimal initial payment on this claim and delay of full payment on the claim also shows People’s Trust hopes Little will tire of its delay and stall tactics and eventually accept less than the full amount they are owed on the claim.
Comparing People’s Trust’s $10,758.62 estimate of the covered damage to Little’s dwelling and other structures to Little’s public adjuster’s estimate of $182,931.09 in damage to the dwelling and other structures, People’s Trust’s estimate amounts to less than 6% of the actual claim value. An estimate this inexplicably low could only have been reached in bad faith with the goal of ignoring ample and credible evidence showing the accurate scope of covered damages and the cost to repair them and wrongfully minimizing the claim value. People’s Trust’s inaccurate and erroneous estimate of the damages has caused serious delay on this claim and additional harms and losses to Little and violated People’s Trust’s contractual and statutory obligation to adjust this claim in good faith and Little’s best interest.
Although Little submitted a sworn proof of loss to People’s Trust supported by their public adjuster’s detailed estimate and photo report, People’s Trust did not give this evidence a prompt or meaningful response. Numerous initial attempts by Little’s public adjuster to reach Little’s desk adjuster to discuss the sworn proof of loss and significant disparity in the estimates went unanswered and/or ignored by People’s Trust. Once a desk adjuster could be reached, the same pattern ensued requiring the new adjuster to be brought up to speed and a request was issued for documents and photos that been previously submitted to People’s Trust, causing further delay on this claim. Although a reinspection was finally scheduled to afford People’s Trust a second opportunity to identify all covered damage and, this time, prepare an accurate estimate of the cost to repair the damage, People’s Trust’s unacceptable delay of action and payment and/or repair on this claim have been in bad faith, to the detriment of Little.
Although People’s Trust prepared a second estimate, dated May 12, 2023, following the reinspection, People’s Trust only increased its estimate of the covered damages up from its original $10,758.62 to $41,212.25—comprised of $32,843.62 replacement cost value on the dwelling and $8,368.63—this estimate still woefully underestimates the scope of covered damage and the cost to repair it. People’s Trust’s revised estimate only constitutes 23% of the actual claim value and does not fulfill its obligation to pay Little the full and fair value of this claim. People’s Trust’s increase of its estimate of the damages in stairstep increments evidences an intent to exhaust and bully Little in hopes they will eventually accept less than they are entitled to on this claim.
In addition to the statutory violations outlined above, consistently throughout People’s Trust’s adjustment of this claim, People’s Trust failed to respond timely to communications, emails, and inquiries from both its insureds and their public adjuster in violation of both its duty under the policy to timely adjust this claim and its duty under Fla. Stat. § 626.9541(1)(i)(3)(c) to acknowledge and act promptly upon communications with respect to claims. People’s Trust’s decision to ignore and/or refuse to engage in open communication regarding this claim shows an intent by People’s Trust to hinder Little’s ability to defend and preserve their claim. This conduct has been a bad faith attempt to put Little at a disadvantage so People’s Trust can pay less than the full and fair value of the claim.
People’s Trust’s failure and/or refusal to settle the insurance claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards Little is wrongful conduct. As a result of People’s Trust’s wrongful conduct, Little was and still is forced to expend out of pocket monies to submit their insurance claim, e.g., retaining a public adjuster to prepare an accurate estimate and legal counsel to file this Civil Remedy Notice in hopes of finally forcing People’s Trust to honor its obligations under the insurance policy to pay the entirety of the insurance proceeds due and owing to Little.
People’s Trust is obligated to Little to tender all insurance proceeds owing and due and/or commence repairs under an accurate scope of the covered damages to restore the property to its pre-loss condition. People’s Trust’s failure or refusal to fulfill these obligations to Little has been in bad faith and is a breach of the insurance agreement which requires People’s Trust to promptly pay or repair the property and put Little back into the position they were in prior to the loss as quickly as possible.
To date, People’s Trust has failed to timely pay or deny the claim in full or repair the property in direct violation of Fla. Stat. § 627.70131. People’s Trust’s actions, in this regard, have been in bad faith.
It is clear from People’s Trust’s failure to issue the benefits owed and its intentional attempt to avoid its full obligations to Little, that People’s Trust has engaged in a pattern of fraudulent and dilatory tactics to the prejudice and harm of Little. To cure the defects outlined in this Civil Remedy Notice, People’s Trust must:
(1) Immediately tender all undisputed insurance proceeds to Little with statutory interest owed;
(2) Act fairly and honestly towards Little and with due regard for their interest in attempting to settle this claim;
(3) Immediately tender all insurance monies due and owing to Little with statutory interest; and
(4) Pay Little the fair value of their insurance claim.
People’s Trust Insurance Company’s address is 18 People’s Trust Way, Deerfield Beach, FL 33441.
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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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