Civil Remedy Notice of Insurer Violations
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Filing Number:     791576
Filing Accepted:  11/12/2024
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Complainant
Last/Business Name *  
WOODHAM   First Name   MICHAEL AND ISIS MASOUD
Street Address * 3639 LAKE VIEW DR
City, State Zip * APOPKA, FL 32703-61
Email Address * DATABOY@MAC.COM
Complainant Type: * Insured
Insured
Last/Business Name*   WOODHAM   First Name   MICHAEL AND ISIS MASOUD
Policy # * 0762043088 Claim #* 7008155605-1-1
Attorney
Attorney is Applicable
Last Name* LINE First Name * KACI Initial A
Street Address* 2431 LEE ROAD
City, State Zip* WINTER PARK , FL 32789
Email Address * KACI@TAGUSLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   TRUCK INSURANCE EXCHANGE
NAIC Company Code 21709
 
Name of individual responsible for violation (if any):* GREG KRABBENHOFT AND ALL ADJUSTERS, SUPERVISORS, MANAGEMENT, AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY TRUCK INSURANCE EXCHANGE INVOLVED IN THIS CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
* 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.
624.155(1)(b)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
624.155(1)(b)(3) 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.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(e) 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.
626.9541(1)(i)(3)(f) 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.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The complainant will abbreviate the full policy language for purposes of brevity while clearly identifying the significant portions so the Respondent may identify the full language... THIS VIOLATION REFERENCES THE DEFINITIONS CONTAINED WITHIN THE POLICY AND ITS AMENDMENTS AND ENDORSEMENTS THAT PERTAIN TO COVERAGES FOR ROOF AND WATER DAMAGES (INDIVIDUALLY AND COLLECTIVELY) TO THE PROPERTY OF MICHAEL WOODHAM AND ISIS MASOUND. THIS VIOLATION ALSO REFERENCES COVERAGES - COVERAGE A - DWELLING AND ALL APPLICABLE PORTIONS OF THE POLICY, INCLUDING BUT NOT LIMITED TO AMENDMENTS AND ENDORSEMENTS. THIS VIOLATION ALSO REFERENCES THE COVERAGE B - OTHER STRUCTURES PORTION OF THE POLICY, INCLUDING BUT NOT LIMITED TO AMENDMENTS AND ENDORSEMENTS. THIS VIOLATION ALSO REFERENCES PERILS INSURED AGAINST COVERAGE A - DWELLING AND COVERAGE B OTHER STRUCTURES, ITS APPLICABLE PORTIONS OF THE POLICY, INCLUDING BUT NOT LIMITED TO AMENDMENTS AND ENDORSEMENTS. THIS VIOLATION ALSO REFERENCES THE ORDINANCE AND LAW PORTION OF THE POLICY THAT WAS PURCHASED WITH PREMIUM DOLLARS PAID TO TRUCK INSURANCE EXCHANGE. THIS VIOLATION ALSO REFERENCES SECTION I - CONDITIONS - SUBSECTION 3 LOSS SETTLEMENT AND ITS APPLICABLE PORTIONS OF THE POLICY, INCLUDING BUT NOT LIMITED TO AMENDMENTS AND ENDORSEMENTS. THIS VIOLATION ALSO REFERENCES FUNGI, WET OR DRY ROT OR BACTERIAL COVERAGE ENDORSEMENT.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Section I Property Coverages provides coverage for the claim and there are no exclusions that apply. TRUCK INSURANCE EXCHANGE has failed to issue payment pursuant to the Loss Settlement Provision. On or about, July 14, 2024, during the coverage period while the policy was in full force and effect, the subject property sustained a sudden and accidental covered loss as a result of a hail and windstorm causing extensive damage to the property. TRUCK INSURANCE EXCHANGE (“TRUCK”) received timely notice of the claim and assigned claim number 7008155605-1-1. TRUCK performed a cursory inspection of the property that failed to retain the experts necessary to identify the repairs necessary to restore the property to its pre-loss condition. TRUCK continued the intentional path of claim delay and underpayment by failing to implement policies and procedures for payment of clearly covered claims. TRUCK time and time again, relies upon “cookie-cutter” reports that less than ironically state the cause of the damage to be identical to those exclusions found inside of TRUCK’s policy of insurance. TRUCK continues to fail to promptly settle the claim when its obligation to settle has, under all the circumstances, become reasonably clear. There is no question the roof of the Insured’s home was stuck by hail and winds so severe that caused damage and requiring a full roof replacement, replacement of soffit, fascia, gutters, windows, skylights, and interior repairs. Despite this, TRUCK denied coverage for the clearly covered loss. TRUCK continues to rely upon more restrictive definitions of damage that is not contained within the policy and appears to only look for damage that would not be covered while intentionally not photographing or documenting the extensive covered damage. However, TRUCK continues to use more restrictive definitions of definitions of “hail” to deny a hail claim. Furthermore, TRUCK intentionally did not photograph multiple damaged area of the Insured’s property and did not use clearly damaged property areas while determining the covered loss. TRUCK relies upon the report and estimate of its adjuster which bears little to no relationship to the actual, visible damage to the roof and its necessary repair/replacement. It is clear that TRUCK has put its own interest over that of its insured and has made this case about protecting its bottom line as opposed to living up to the contract of insurance it was paid premium dollars for. The insurer’s conduct in this case occurs with such frequency as to constitute a general business practice. TRUCK knows it has failed to issue proper payment for the clearly covered loss to include damages and repairs covered by the policy and Florida law. Moreover, TRUCK has failed to comply with its loss settlement provision. Rather than issuing the proper payment or attempting to reach an agreement with its insured, TRUCK is delaying and denying the claim. Upon information and belief, TRUCK performs the subject actions as a business practice, including delaying and denying the claim and issuing "low ball" payments in an attempt to dissuade its insureds from pursuing the claim to the detriment of its insureds to increase financial profits. TRUCK INSURANCE EXCHANGE can cure the violations contained herein by issuing a payment for all contractual damages owed, per estimates of $56,128.33 plus interest, costs, and attorney’s fees. This willful and wanton business practice in reckless disregard for the right of insurer’s insureds and is a violation of Florida Statute 624.155(1)(B)(1) which states it is an unfair claims settlement practice in “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 interest.” This willful and wanton business practice of insurer, in reckless disregard for the rights of its insureds, is in violation of Florida Statute 624.155(1)(B)(3), which defines unfair claims settlement practices to include “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.” This willful and wanton business practice of insurer, in reckless disregard for the rights of its insureds, is in violation of Florida Statute 626.9542(1)(I)(3)(a), which defines unfair claims settlement practices to include “failing to adopt and implement standards for the proper investigation of claims.”
Comments
User Id Date Added Comment
cheryl.perez@farmersinsurance.com 12-19-2024 December 19, 2024 Via E-Mail Adelphi Group PLLC 2431 Lee Road Winter Park, FL 32789 Delivered by email to: kaci@taguslaw.com RE: Michael Woodham and Isis Masoud Claim No.: 7008155605-1 Dear Kaci Line, This correspondence is Truck Insurance Exchange’s (“Truck”) response to the Civil Remedy Notice of Insurer Violation No. 791576 filed on behalf of Complainant on November 12, 2024. Complainant alleges that Truck violated various subsections within Sections 624.155 and 626.9541, Florida Statutes, pertaining to Claim No. 7008155605-1 under an insurance policy issued by Truck to Complainant. Truck welcomes the opportunity to respond to the Notice’s allegations. The Notice fails to comply with the specific notice and information requirements set forth in Section 624.155, Florida Statutes, and Form DFS-10-363. Florida law requires strict compliance with the specific notice and information requirements of section 624.155, Florida Statutes. This notice is invalid due to the failure to include statutorily required information as follows: • The notice includes multiple statutory sections that are not relevant. On the merits, Truck avers it handled Complainant’s claim correctly, fairly, in good faith and with due regard for their interests under Complainant’s policy. On September 25, 2024 Truck received notice of the subject claim, wind damage to the roof of Complainant’s property with a claimed date of loss of July 14, 2024. Truck conducted a prompt and thorough investigation into this claim. On October 1, 2024 our claim representative completed the inspection as scheduled in the presence of our insured and their contractor, 3MG Roofing. The inspection found covered and non-covered damage. The covered damage includes minor wind damage to one roofing shingle which allowed rain to leak causing damage to the garage and den. The non-covered damage includes wear and tear to the roof with rain leaking which damaged the Florida Room and kitchen. Wear and tear along with resulting damage is excluded from coverage under the policy. We explained these findings to our insured and provided a partial denial letter of explanation along with our estimate for the covered repairs on October 2, 2024. That same day, we received photo documentation produced by the contractor 3MG Roofing. After completing our review, on October 4, 2024 we advised our position regarding coverage remains unchanged. We also renewed our request for photos of the condition of the roof prior to the tar application. Complainant has failed to provide any evidence to support their assertion that Truck failed to properly adjust this claim. The only facts that Complainant alleges to support their allegations that Truck violated Florida law and handled Complainant’s claim in bad faith is that Truck’s adjustment of the claim did not result in payment of Complainant’s exorbitant demand. Truck’s policy only covers accidental direct physical loss or damage to the property that is not otherwise excluded, which is further limited by the conditions and coverage limits of the policy. In accordance with these terms, Truck properly adjusted this claim. Accordingly, contrary to Complainant’s apparent contention, Truck’s coverage determination was made in good faith. While this response is meant to be comprehensive, Truck’s response is based on the limited information provided in the Notice filed by Complainant. Also, this letter or any act or failure to act on the part of Truck or any agent or representative of Truck should not be construed as a waiver of any rights or defenses, including but not limited to proper notice and service, available to it by contract or at law as all such right and defenses are hereby specially reserved. We trust that this response addresses the allegations raised in the Notice. Please contact me if you have any questions or should you wish to discuss this matter further. Sincerely, Cheryl Perez, Company Employee Adjuster General Claims Adjuster (913) 274-0230 Truck Insurance Exchange
Acknowledgement
* 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.

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DFS-10-363
Rev. 10/14/2008