Filing Number: 791400
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| Filing Accepted: 11/11/2024 |
| Last/Business Name
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SMITH
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First Name |
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MICHAEL AND LAUREN |
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| Street Address
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13836 54TH LANE, NORTH |
| City, State Zip
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ROYAL PALM BEACH,
FL
33411
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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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SMITH |
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First Name |
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MICHAEL AND LAUREN |
| Policy # * |
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FLP437899 |
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Claim #* |
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1345943-241013 |
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Attorney is Applicable
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| Last Name* |
DANIELS
First Name *
MONICA
Initial
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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
,
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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ASI PREFERRED INSURANCE CORP.
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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 13142 |
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| Name of individual responsible for violation (if any):*
SANDRA HUESING AND ANY AND ALL OTHER 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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Claim Denial
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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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)(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.
AGREEMENT
We will provide the insurance described in this policy in return for the premium and compliance with all applicable
provisions of this policy.
COVERAGE A – Dwelling
We cover:
1. The dwelling on the "residence premises" shown
in the Declarations, including structures attached
to the dwelling; and
2. 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."
This coverage does not apply to land, including land
on which the dwelling is located.
SECTION I – CONDITIONS
10. 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.
Michael and Lauren Smith (the “Insureds”) purchased an insurance policy from ASI Preferred Insurance Company (“Insurer”), with Policy number FLP437899 (the “Policy”), to cover their property located at 13836 54th Lane, North, Royal Palm Beach, Florida 33411 (the “Property”). On September 28, 2022, Hurricane Ian struck the Property. The excessive winds from Ian caused overwhelming damage to the roof and portions of the interior. The Insureds immediately reported the loss to Insurer, mitigated the damages, and complied with all applicable post-loss obligations. They also hired a public adjuster to help guide them through this difficult time.
The Insurer assigned claim number 1345943-241013 (the “Claim”) to the claim, as well as claims adjuster Sandra Huesing. The Insurer inspected the Property and prepared a woefully deficient initial estimate that failed to address the full scope of damages and repairs necessary to return the Property to its pre-loss condition. The Insurer’s evaluation of the Property’s loss was insultingly low given the observable damages. As a result of Ian, the Property’s roof needs to be replaced. The Insurer opened coverage for the damages resulting from Hurricane Ian; however, it denied coverage for the roof.
The Insureds’ public adjuster provided the Insurer with a true and accurate estimate of the related damages, extensive photographs and videos of the damages, a properly executed sworn proof of loss, and complied with all of the Insurer’s requests for documentation and information. The Insurer acknowledged coverage and admitted liability for damages to the Property. The Insureds dispute that the meager amount unilaterally determined by the Insurer is sufficient to restore their 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. Without sufficient funds to repair their property, the Insureds continue to suffer additional damages. The Insurer failed to make any meaningful effort to inspect the Property or adjust the Claim 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 undervalued the claim and only contemplated a fraction of the amount of Insureds’ damages. The scope of the damages considered by the Insurer is an insult to the Insureds and is far less money 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 biased and inexperienced individuals who approached the loss with an eye towards underpayment. The actions taken by the Insurer in the handling and adjustment 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 biased and inexperienced adjusters and failing to properly and timely pay for obvious damages owed to its Insureds. 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, and then grossly undervalued the claim. Insurer has failed to provide the Insureds with qualified representatives to ensure the claim was initially adjusted, evaluated, and paid 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 Insureds, t(s); (2) tender all insurance monies due and owing to the Insureds for Mitigation/Remediation services incurred as a result of the Claim; and (3) ensure that payment made would be adequate to place the Insureds and their Property back in the pre-loss condition. 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 giving 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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