Filing Number: 790256
|
| Filing Accepted: 11/5/2024 |
| Last/Business Name
*
|
|
|
HOUSING AUTHORITY OF BARTOW
|
|
First Name |
|
|
|
| Street Address
*
|
|
P.O. BOX 1413 |
| City, State Zip
*
|
|
BARTOW,
FL
33881
|
| Email Address
*
|
|
JIM@JENKINSLAWPL.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
HOUSING AUTHORITY OF BARTOW |
|
First Name |
|
JAMES |
| Policy # * |
|
B0621TPPHA000223 |
|
Claim #* |
|
1159183 |
|
Attorney is Applicable
|
| Last Name* |
JENKINS, III
First Name *
JAMES
Initial
|
| Street Address* |
|
275 96TH AVE N., SUITE 5 |
| City, State Zip* |
|
ST. PETERSBERG
,
FL
33702
|
| Email Address * |
|
JIM@JENKINSLAWPL.COM |
|
|
| Insurer Type
*
|
|
 Authorized Insurer
 Unauthorized Insurer
|
|
|
| Insurer Name |
|
|
| Insurer Name* |
|
AXA XL INSURANCE COMPANY UK LIMITED
|
| Insurer Name* |
|
|
| Street Address* |
|
|
| City, State Zip* |
|
,
|
|
NAIC Company Code |
|
|
| Name of individual responsible for violation (if any):*
ANY AND ALL ADJUSTERS AND/OR REPRESENTATIVES HIRED BY THE CARRIER THAT WERE INVOLVED IN THE CLAIMS PROCESS
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
|
Claim Denial
|
|
|
Claim Delay
|
|
|
Unfair Trade Practice
|
|
|
Other
:
Not adjusting claims and evaluating the loss properly, promptly, and fairly
|
|
|
*
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.
|
|
| 626.9541(1)(i)(3)(a) |
|
Failing to adopt and implement standards for the proper investigation of claims.
|
|
| 626.9541(1)(i)(3)(c) |
|
Failing to acknowledge and act promptly upon communications with respect to claims.
|
|
| 626.9541(1)(i)(3)(g) |
|
Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
|
|
*
Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
INSURING AGREEMENT - SECTION B
In consideration of the payment of premium as specified in the Schedule, and subject to the terms,
conditions and exclusions of this Policy, the Underwriters agree to cover the Property Insured against risks
of direct physical loss or physical damage occurring during the Period of Insurance.
PROPERTY DAMAGE - SECTION C
This Policy insures the following property, unless otherwise excluded elsewhere in this Policy, located at
an Insured Location or within 1,000 feet thereof, to the extent of the interest of the Insured in such property.
A. Real Property, including new buildings, additions under construction at an Insured Location and
refurbishment of Insured Locations, in which the Insured has an insurable interest.
LOSS ADJUSTMENT AND SETTLEMENT - SECTION E
LOSS ADJUSTMENT/PAYABLE
Loss, if any, will be adjusted with and payable to the Insured, or as may be directed by the Insured…
***
SETTLEMENT OF CLAIMS
The amount of loss, except for Accounts Receivable coverage, for which the Underwriters may be liable will
be paid within 30 (thirty) days after:
A. proof of loss as described in this Policy is received by the Underwriters…
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
This claim arises from an insurance dispute as the result of losses that occurred on or about June 22, 2023 at the properties located at Sunset Apartments, 1060 Woodlawn Avenue, Bartow Florida 33831 and Carver Village Apartments, 1060 Golfview Avenue, Bartow, Florida 33831 (“Properties”). Certain Underwriters at Lloyds, London, AXA EX Insurance Company ("AXA") and Starr Insurance Companies ("Starr") insured the property pursuant to policies of insurance B0621TPPHA000223 (87%) and SLSTPTY11800823 (13%) for the policy period of Mary 1, 2023 through May 1, 2024. The Insured, Housing Authority of Bartow reported the claim to the carrier(s) related to damages caused by a wind and hail event.
Following receipt of the denial letter, the Insured notified AXA that they were not in agreement with the engineer’s findings and a public adjuster was retained to assist them with the claim going forward. On June 17, 2024, the public adjuster notified AXA of its involvement, on July 8, 2024, submitted an estimate for repairs along with photographs of the damages, and then on July 9 2024 submitted a Sworn Proof of Loss that totaled $1,124,547.66. The photographs submitted by the public adjuster clearly show evidence of wind, debris and/or hail damage to the roof system and exterior of the Properties. The estimate for the Properties prepared by the public adjuster totals $1,129,565.70 and includes the replacement of the roof systems as well as repairs to the exterior of the Properties.
Following receipt of the Sworn Proof or Loss and documentation submitted by the public adjuster, on August 13, 2024, AXA requested a reinspection of the property which was scheduled and completed on August 29, 2024. Following the inspection, AXA ceased communication with the Insured and/or the Insured’s public adjuster. On October 15, 2024, the Insured’s public adjuster sent AXA a request for an update on the claim and status. However, as of the date of this filing, AXA has not responded to the Insured and/or the public adjuster. Thus, the Insured is not aware of any additional information necessary for the process of the claim.
As such, this notice is given in order to perfect the right to pursue the civil remedy authorized by section 624.155, Florida Statutes. It is clear that the carrier(s) have not acted honestly or fairly towards its Insured. AXA's Wrongful Conduct and Omissions Include, but are not limited to the following:
1. Claim Delay;
2. Not conducting full and prompt investigation;
3. Not treating the policy holder with good faith claims conduct;
4. Looking for ways to reduce recovery to the Insureds;
5. Not adjusting the claim and evaluating the loss properly and fairly to provide full and prompt indemnity to the Insureds;
6. Failing to implement proper standards for the adjustment and investigation of claims;
7. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interest before the policyholder's interest; and
8. Establishing severity control initiates and otherwise establishing a culture of not fully and promptly paying claims following losses.
In Florida, the work of adjusting insurance claims engages the public trust. Since the beginning of this claim the representatives on behalf of the carrier(s) have approached this investigation in a manner prejudicial to the Insured. AXA is using either untrained or improperly trained adjusters in connection with this claim. AXA has breached this duty in the adjustment of the Insureds’ claim of loss as AXA has failed and/or refused to thoroughly, accurately, and completely investigate, evaluate, and pay the Insured’ s insurance claim for damages. The issues in this claim are examples of
AXA's unfair trade practices, improper investigation and adjustment of the claim, and unfair claim settlement practices. This is wrongful conduct and directly violates the purpose of insurance coverage.
Additionally, there may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of AXA's claim file and standards and procedures for the adjustment and investigation of claims.
To cure the defects outlined in this Civil Remedy Notice, AXA must do the following:
1. Create and implement adequate guidelines for the proper investigation and evaluation of claims to avoid the statutory violations set forth above in the future;
2. Act fairly and honestly toward Insured and adjust the subject claim in good faith in attempting to settle the claim;
3. Tender all insurance monies due to the Insured for the loss; and
4. Cease and desist all present and future bad faith actions with regard to the Insured’s claim.
Failure to cure all defects during the 60-day safe harbor period may result in additional extra-contractual damages.
|
|
|
*
|
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
|