Filing Number: 792009
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| Filing Accepted: 11/13/2024 |
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PUBLIC ADJUSTER
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First Name |
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BAY AREA |
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PO BOX 55369 |
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SAINT PETERSBURG,
FL
33732
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JENNIFER@BAYAREAPA.COM |
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Insured |
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INC. |
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First Name |
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THE VILLAS CONDOMINIUM ASSOCIATION |
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D42313300 001 |
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Claim #* |
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KY22K2177032 |
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Attorney is Applicable
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 Authorized Insurer
 Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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WESTCHESTER SURPLUS LINES INSURANCE COMPANY
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,
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NAIC Company Code 10172 |
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| Name of individual responsible for violation (if any):*
DUSTIN KOWAL
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| Type of Insurance
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Commercial Property & Casualty
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| Reason for Notice
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Claim Denial
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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)(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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Reference to specific policy language that is relevant to the violation
SECTION I - PROPERTY COVERAGES
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
SECTION I - PERILS INSUREDAGAINST
A. Coverage A - Dwelling And Coverage B -
Other Structures
1. We insure against risk of direct physical loss to
property described in Coverages A and B.
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 60 days after we receive your proof of
loss
In addition, it is believed that the following policy provisions are applicable:
Duties in event of loss policy provision
All terms, conditions and sections of the insurance policy, including, but not limited to:
Section 1 of the insurance policy
Property coverages
Section 1 - perils insured against
Coverage A- dwelling
We insure against risk of direct physical loss to property described in coverages A and B.
FLORIDA ADMINISTRATIVE CODE SECTIONS VIOLATED
In addition to the statutory violations referenced above, the Insured states that Westchester Surplus Lines Insurance
Company violated the following Florida Administrative Code Sections:
69B-220.201(3)(a)
69B-220.201(3)(b)
69B-220.201(3)(c)
69B-220.201(3)(e)
69B-220.201(3)(f)
69B-220.201(3)(m)
Adjuster shall disclose all financial interests and any direct or indirect aspect of an
adjusted transaction.
An adjuster shall treat all claims equally. An adjuster shall not provide favored treatment to any
claimant. Adjuster shall adjust all claims strictly in accordance with the insurance contract.
An adjuster shall never approach investigations, adjustments, and settlements in a manner
prejudicial to the insured.
An adjuster shall handle every adjustment and settlement with honesty, integrity, and allow fair
adjustment or settlement to all parties without any remuneration to himself except to that which he
is legally entitled.
An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in
achieving a proper disposition thereof.
An adjuster shall not knowingly fail to advise a claimant of their rights in accordance with the
terms and conditions of the contract and applicable laws of the state of Florida.
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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.
In Florida, the work of adjusting insurance claims engages the public trust. Westchester Surplus Lines Insurance
Company has breached the public’s trust by its adjustment of The Villas Condominium Association, Inc.’s (“Insured”) claim
of loss.
The Villas Condominium Association, Inc.’s consists of 282 individual dwellings that occupy twenty five multi-unit
residential buildings. The community has a club house for the; offices, meetings, workout room
and community use, which resides next to the community pool that also has a pool building
consisting of; bathrooms, showers and pumps for the pool. Next to the clubhouse is the mailbox
building, garbage station, entrance and a community lake for residents to enjoy. At the rear of the
community there is a maintenance garage for storing the office golf carts and maintenance
equipment. The community was considered a gem in the area and was highly sought after, at it’s
location in Hillsborough County, Florida and was at one point a very highly desired community to
live in. Unfortunately, due to the events surrounding how Westchester Surplus Lines Insurance
Company has delayed, denied or otherwise attempted to profit from the community’s loss, the
community is no longer a highly desired community to reside in and has unfortunately suffered
tremendous financial hardship and loss after experiencing a sudden and unexpected loss in the
community and filing a claim against their insurance policy with Westchester Surplus Lines
Insurance Company in which Westchester Surplus Lines Insurance Company drafted a partial
denial for. Ultimately adjusting the claim where no money exchanged as tendered payment.
The results of the partial denial would ultimately result in large financial losses across the community. Owner’s residing in
units that experienced water intrusion were forced to walk away from their units or take a huge
financial loss by selling the unit in a “fire” sell to the lowest possible offer, unimaginable to them at
the time of purchase. One owner passed away during the claim process and the unit remained
unremedied though mitigation efforts were performed. Even though the community made many
documented repairs and attempted in good faith to stop the water intrusion into the structure
through the roof, several effected units and unit owners would not experience relief from
damages and the units would become a financial burden and or a health risk to reside in. The
market value of the units have decline due to the unresolved dispute between the insured and the
carrier. In hopes to resolve the dispute the insured has taken many steps to cooperate with the
carrier and upon advise has hired their own public adjuster. This civil remedy is to make the state
aware of the circumstances surrounding the claim events and begin the dispute measures the
community has decided to take. A demand for appraisal will be made on behalf of the insured to
the carrier for which they are willing to continue to exclude building 1, 2 and 25 but all other
damages need to be accounted for.
The actions of Westchester Surplus Lines Insurance Company are a common business practice that they use to attempt
to profit from the insured’s loss. Starting with the initial inspection to the property. Westchester
Surplus Lines Insurance Company begins by assigning the claim to a third-party adjusting firm, in
this matter Westchester Surplus Lines Insurance Company assigns the claim to Sedgwick. The
practice of using a third-party adjustment firm gives the carrier plausible deniability to wrongdoing
should the claim not be correctly adjusted or should the adjustment be made with prejudice
against the insured. Often these types of results are sought after from carriers and in this case
Westchester Surplus Lines Insurance Company implemented this common business practice to
do just that. Sedgwick is a common adjusting firm used by carriers and their allegiance is to the
carrier. The carrier pays Sedgwick for their services. Sedgwick then assigns the claim to an
employed adjuster who assigns a field inspection adjuster. In this case the field inspection
adjuster is Scott LaRue an adjuster for Sedgwick. Scott LaRue then uses JS/HELD LLC, more
specifically Matthew T. Staffield a staff engineer. Matthew T. Staffield is accompanied by Stephen
Towne, Wesley Kendrick and Andrew Feliciano, all of whom were contracted to perform an
inspection and paid for services by Westchester Surplus Lines Insurance Company. All four
engineers from JS/HELD along with Scott LaRue would then contact John Romano, a
representative from the property’s management group, not a manager as they state in their report
but a simple employee of the management group, to conduct their inspection of the damaged
property. John Romano was not authorized to conduct affairs on behalf of the claim, he had
simply escorted the gentlemen across the property and the report makes mention that the actual
property maintenance crew had been used to gain access to the few units that were inspected by
the carrier’s assigned representatives.
The practice of using multiple inspectors is used to intimidate insureds. Often it is multiple persons for the carrier against
one unsuspecting individual whom finds themselves outnumbered, overwhelmed and intimidated
by the carrier’s representatives to elicit a sense of power over the insured rather than bilateral
equality. During this inspection period done by the carrier’s representatives, which occurred over
the course of only three days, the intimidation factor would not play a part on John Romano since
he was not part of the claim, yet a simple escort. The current board has no idea why or how John
Romano was mentioned in the claim report because he was merely an employee of the
management company that collected HOA dues and kept records on behalf of the association. As
well as, the insured does not know why Sedgwick contacted John Romano and not a
representative of the policy holder to assist in the inspection process. It can only be assumed that
John Romano acted only as an escort for the inspection to be performed and helped with
organize the maintenance team in efforts to comply with the inspection the carrier was to perform.
It is not known whether the adjuster and engineers asked any claim related questions or if they
were even concerned. They simply inspected the property in hopes that none of the actual policy
owners would in fact impart upon them actual information about the repairs and performance of
the community in efforts to protect the property since the date of loss. No mention of
conversations or imparted facts are mentioned in the report.
Florida state statute 69B-220.201 outlined statutes such as 69B-220.201(3)(c). An adjuster shall never approach
investigations, adjustments, and settlements in a manner prejudicial to the insured.
Examples of a common business practice that is often used by Westchester Surplus Lines Insurance Company can be
found in the reporting process, which is done with prejudice against the insured. The following
statements were made regarding the inspection followed by the prejudicial practice attempting to
thwart claim responsibility in efforts to profit from the insured’s loss.
Statement of findings from the engineer’s report states;
1 – Approximately 2,496 broken or cracked field and ridge cap tiles were found during the inspection.
However, the opinion of the engineer is that minimal damage occurred during the reported date of loss and only 48 ridge
cap and rake tiles were damaged during the date of loss yet they observed 2,496 broken or
cracked field and ridge cap tiles during the inspection. The opinion stated is completely prejudicial
against the insured.
2 – The engineer’s report goes on to state that visible repairs to 893 replaced field tiles were observed throughout the
roofs. Visible underlayment repairs were observed, several areas- mentioned in the report- spoke
of the temporary repairs made and broken tiles remain still throughout the roofs. Evidence
proving the insured made repairs…
The engineer however states that, though they witnessed these repairs (extensive efforts from the insured to temporarily
repair the roofs to prevent further water from intruding into the structure), none of the ceiling
stains and water intrusion in the units were a result of the damaged roof but rather from flashing
and or plumbing problems in the complex rather than the obvious extensive wind damage to the
roofs. The engineer also goes on to state that the repairs are done improperly. However, the
engineer never consults with the insured regarding the repairs and does not state anywhere in
the report any type of measures were taken to consult the insured but rather prejudicial opinions
rather than fact were laid out in the report. This is another common business practice done by the
adjuster’s whom represent the insured Westchester Surplus Lines Insurance Company.
3 – A total of 17 field tiles additional from the broken and cracked tiles were observed sitting down slope of their original
position on the roof was also stated in the report.
However, the engineer’s opinion was that these tiles were not a result of the reported date of loss windstorm but rather
installation deficiencies.
4 – The report mentions damage to buildings 2, and 25 as well as a new roof to building 1.
The engineer’s report states that the building wrap was observed on building 2 and 25 and that long term deterioration
was a factor of their observation of these two buildings. But building 1, 2 and 25 are not part of
the claim and the association has not included these buildings in their claim due to prior work
already in progress on the date of loss.
5 – The engineer makes reference to large areas of underlayment repairs. These were areas that the association at
minimal placed a second layer of water protection in efforts to prevent water intrusion from further
damaging the units due to a lack of material to execute replacing the tiles needed.
Then the engineer states that the broken tiles were laid back upon the referenced area which was in his opinion an
improper repair. This is yet another prejudicial statement made by the carrier’s representatives.
6 – The engineer states in the report that on April 10, 2021 wind speeds reported by NCEI were 50 miles per hour near
the subject property.
The engineer then goes on to state that on the date of loss April 11, 2021 that the wind speed was only 36 miles per hour
and those speeds were not strong enough to lift or move the tiles on the subject roofs. This is just
another example of how the carrier’s business practices use reporting to distort facts rather than
subject the claim to it’s merits.
7 – The engineer states that he did not calculate how much percentage of the roof’s undamaged surface area would need
to be displaced in efforts to make repairs and that the percentage of this surface area was not
considered in his approximate calculations to repair the roofs as he refers to the 25% rules.
However, the engineer states that the damaged portions of the roofs do not exceed the 25% rule, which means the roofs
should be repairable. While the thorough scope of actually making repairs was not calculated in
fact and the repairability factor of the roofs would most certainly exceed the 25% rule. Again, a
common business practice to manipulate facts in efforts to prejudice the finding against the
insured and curry favor for the carrier.
8 – The engineer states that tiles residing on the insured’s property are Monier Lifestyle Capri “W” tiles and that the tiles
are no longer being manufactured.
Then goes on to state that used tile pieces could be found in salvage yards which also makes repairing the roof a
possibility. Then goes on to name a secondhand supply yard which is over 107 miles away from
the subject property as having the replacement pieces in stock and that in efforts to match the
roofs color, the salvage yard also offers a service in which they will paint the tiles to match the
existing roof system. This is yet another example of a common practice exercised in efforts to
breach contract and prejudice the insured. The insured had already made temporary repairs with
non-matching tiles, this is how the engineer was able to count the 893 repaired tiles across the
community. The community had already exhausted seeking these salvage tiles in efforts to
protect the units from further water intrusion. However, expecting the community to fight over the
tiles located over 107 miles away from the property is an unreasonable and excessive
expectation placed upon the insured and yet is another example of business practice which
breaches contract. The selling of an insurance policy is a promise to restore the property back to
it’s pre-loss condition. Making claim determination, in opinion, while excluding fact, without
considering all the scope, without having the material to actually follow through with the
suggested repair opinion is a full on breach of contract and these common business practices are
against state statutes and completely prejudicial against the insured.
9 – The engineers report refers to all the residential buildings having damage.
In the engineer’s opinion, only 6 of the 25 were damaged on the date of loss. The engineer states that it is of opinion and
not fact that they decided prejudicially against the insured and in favor of the carrier that only 48
tiles were in fact damaged on the date of loss. Upon review of aerial views of the property, one
could not possibly account for the damages to the property in an accurate and truthful manner.
10- The engineer’s report states that “Missing, isolated soffit panels and rake tiles were sporadically observed throughout
the Association.
Prior to that statement the report states “The majority of the screens, soffit, fascia and gutter / downspout components
throughout the property were generally intact without evidence of detachment from wind forces.
As to allude that the property didn’t exhibit wind damages but hidden in their own report, in efforts
not to actually lose their license they stuff wind damage observations and merely suggest that the
property is not generally effected by wind but include the wind damage in the report. Again this is
an example of a common business practice in which the carrier’s engineer’s reporting exhibit
which breaches the policy contract and sets the impression that the carrier Westchester Surplus
Lines Insurance Company is not bound by the policy to cover the losses so that the carrier can
profit from the insured’s loss.
Though the engineer witnesses and documents 2,496 broken and damaged tiles, 893 replaced tiles, multiple repairs to
tiles, 17 shingles not seated in their original installed position across various buildings, his opinion
is that only 48 tiles were broken or misplaced on the date of loss. Again the state must conclude
that these common business practices of reporting damages but dismissing the full scope and
validity of damages are prejudicial against the insured and completely breach the policy contract.
The report drafted for the carrier Westchester Surplus Lines Insurance Company states many times that the subject
property has missing, broken, fractured, damaged and displaced tiles but then goes on to say that
the damages did not occur during the reported windstorm. It states that minimal damage occurred
during the windstorm and those damages appeared on only 6 of the 25 residential buildings. The
report contradicts itself over and over again and again. The report states that 893 field tiles had
been replaced. Yet makes no mention of the fact that the association made those repairs in
efforts to try and protect the property from further damage.
The common business tactics used by Westchester Surplus Lines Insurance Company also breach 69B
220.201(3)(c)
An adjuster shall never approach investigations, adjustments, and
settlements in a manner prejudicial to the insured An example of breaching this statute can been
seen in Westchester Surplus Lines Insurance Company written report and claim determination
drafted by Sedgwick to the insured, which states that out of the 29 buildings on property- only 7 of
the buildings reside in the determination. Though the engineer’s report states that 48 tiles or ridge
cap tiles were damaged on the date of loss, Sedgwick desk adjuster Dustin Kowal’s actual
coverage letter and dollar lines of coverage only account for 1 shingle per building for 6
residential buildings and the clubhouse, 7 total tile shingles. Not only did Sedgwick who was
working for Westchester Surplus Lines Insurance Company fail to include all of the property
damage accounted for in the engineer’s report, it would appear that they chose to willfully try
further to assist Westchester Surplus Lines Insurance Company by only writing for 7 out of the 48
tiles the engineer had already diminished the damages to, which is yet another attempt to profit
from the insured’s loss and breach of contract. There is a clear discrepancy between the report
findings and the actual coverage determination letter allocating a dollar sum to the damages.
These egregious attempts to assist the carrier in defrauding the insured from policy coverage are
in fact common business practices which allow Westchester Surplus Lines Insurance Company to
profit from the insured’s loss and gives shining examples of breach of contract.
69B-220.201(3)(f)
69B-220.201(3)(a)
An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence
in achieving a proper disposition thereof. A common tactic used by Westchester Surplus Lines
Insurance Company is the invoking of an EUO which causes claim delay. The process and
procedure was never explained to the insured nor was the insured ever informed of their
obligation or rights regarding the EUO. Once the carrier invoked the EUO, they then closed the
claim without notice to the policy holder. All of this common business practice only shows how
determined the carrier is to breach contract all in attempts to profit from the insured’s loss using
claim delay tactics.
Adjuster shall disclose all financial interests and any direct or indirect aspect of an adjusted
transaction. The third party adjuster’s never disclosed to the insured their financial interest in the
claim nor did the staff adjuster’s assigned by the carrier. No one disclosed how much or how little
they were being paid to adjust or whether they were enticed or incentivized by the carrier to do all
and any tactic to exclude them from obligation. It seems that the adjuster’s would inspect the
property for 3 consecutive days, no one works for free so one would have to beg the question as
to how much Sedgewick and JS/HELD were compensated for the wrongful denial and would they
have been compensated the same had they acted in a honest and truthful reporting manner?
Sedgewick has a common business practice of breaching all of the mentioned statutes in efforts
to preserve their position with the carrier. Sedgewick is not retained by the public who are
obligated to, rather only represents entities who are obligated to pay. Sedgewick has a financial
interest in preserving the relationship with Westchester Surplus Lines Insurance Company
the obliged parties to whom they commonly assist in manipulating reports and adjustments in
effort to have their employer profit from losses that they inspect. Review of Sedgewick’s report
and the actual written adjustment shows a dishonest representation through their own actions.
Had Sedgewick not violated 69B-220.201(3)(a), 69B-220.201(3)(c), 69B-220.201(3)(e), 69B
220.201(3)(f),69B-220.201(3)(m) there would be interior damages accounted for, chimney cap
and storm created openings accounted for and all the reported non disputed items mentioned in
the engineer’s report along with all the disputed items.
Westchester Surplus Lines Insurance Company has a business practice of using third-party adjusting firms to report and
assist in inspecting insured’s losses which create an atmosphere of intimidation, as well as the
ability to declare plausible deniability of damages because the third party didn’t report the
damages to them in honest and truthful manner. This is a common business practice
incorporated in their inspection tactics to breach contract and profit from insured’s losses. All the
adjusters and inspectors/engineers who were assigned were in fact compensated by the carrier
directly and under an agreed upon contract to financially compensate for services rendered. This
becomes evident when you see the same third-party firm and the same adjusters/engineers
assigned to a large percentage of Westchester Surplus Lines Insurance Company’s claims.
Statute 69B-220.201(3)(e) is clearly violated and evidence of that violation can be seen in
Sedgewick’s own reporting.
69B-220.201(3)(m)
An adjuster shall not knowingly fail to advise a claimant of their rights in accordance with the
terms and conditions of the contract and applicable laws of the state of Florida. Is another
common business practice that Westchester Surplus Lines Insurance Company does not
practice, that breaches the contractual obligations. At no time in any of the reporting are or in
correspondences does the Westchester Surplus Lines Insurance Company or Sedgewick inform
the insured’s of their rights. Such rights as representation to assist them with their claim process
or dispute tools listed within the policy and Florida statutes. The fact that Sedgwick would conduct
their inspection without any party to the policy present suggests that Sedgwick conducts the
inspection on behalf of Westchester Surplus Lines Insurance Company knowingly avoiding any
questioning or concerns the insured may have or could provide clarity to the facts not represented
in the engineer’s report, such as the fact that the policy holder already knew about the salvage
tiles and made many salvage repairs in attempt to protect the property postdate of loss but such
tiles were no longer available locally and all the temporary repairs were impossible to perform.
The report suggests that the insured go to salvage yards and find salvage pieces to repair the property. Then the report
admits that not all the repair scope was accounted for but the affected portions of the roofs were
under the 25% rule thus repairable This suggestion that the insured seek used salvage material
somewhere in a salvage yard is a breach of contract, it does not return the policy holder back to
pre-loss condition. The salvage yard mentioned in the report is over 107 miles away from the
subject property. Any and all excuses to exclude damages were exemplified in the engineer’s
report. All the interior damages were discounted yet not all the units were inspected. Even though
the engineer reports counts over 2400 broken and damaged tiles currently still on the roofs and
the engineer could visibly see the community attempted to protect the roof with multiple repairs,
the engineer’s report states that none of the damages were from the date of loss. Though the
salvage product would not in fact conform to building code 401.2, the engineer states that the
insured should go through great expense and time consumption to have salvage material glazed
to match the roof, knowing that the likelihood of the product would not conform to the current
roofs. Though the engineers report states that the on line inventory of the salvage tile is a quantity
of 3,007 units, there are no reasonable expectations that said product would be available for the
insured as well as the engineer notes that the actual size and scope of the repairs were in FACT
not accounted for in his report rather only the area in which the 2,496 field and ridge cap tiles
were calculated. The 893 temporary repairs already made were not calculated in that percentage
report. The 17 displaced tiles sitting on the roofs were not calculated in the percentage. The
underlayment areas that were missing tiles completely or had fractured tiles laid upon them were
not calculated into that percentage. By the engineer’s own words, the area in which would have to
be disturbed to make repairs were NOT calculated into the engineer’s percentage of effected roof
area. All these exclusions allowed the engineer to state that the effected portions of the roof did
not exceed the 25% rule thus the roofs were repairable. By using this exclusion tactic the findings
reported from the engineer are prejudicial to the insured and thus allows the carrier to assert that
the buildings were in fact repairable, allowing the carrier Westchester Surplus Lines Insurance
Company to profit from the insured’s loss. The engineer’s use this common business practice to
draft reports to distort and manipulate data reporting is made in effort to secure a financial
position with the carrier to insure their future value to the carrier as an ally rather than a truthful
reporting agency but rather an agency the carrier can rely to manipulate reporting for their benefit
and this business practice can be witnessed on a daily basis when reviewing Westchester
Surplus Lines Insurance Company claim department practices.
It can be concluded that had the engineer acted without prejudice to the insured that once you calculate the 2,496 plus
the 893 repaired, plus the 17 displaced, plus the many underlayment areas without tile, along with
the portion of the roofs that would have to be removed in efforts to make repairs to comply with
code, that the effected portions of the buildings would in FACT far exceed the 25% rule and that
the salvage yards in fact do not have enough items to perform these repairs and in fact the items
in salvage yards, by the engineer’s own admittance, do not comply with matching and would need
glazing in efforts to comply, if ever. It is rather easy to determine that the engineer’s report is
prejudicial and manipulates facts, uses opinions as a basis for determining the outcome of the
report. It is also clear that Sedgwick fully intended to defraud the policy holder from their claim
and assist the carrier in profiting from the loss by altering the line item estimate even further
beyond the engineer’s reporting.
Building codes 401.2 Conformance.
The work shall not make the building less conforming than it was before the repair was undertaken.
The sheer suggestion that the carrier determine that the insured seek used and discontinued material which would
ultimately cause the structure to be less conforming than prior to the repair is another breach of
contract and thus should be considered a common business practice by the carrier in efforts to
profit from the insured’s loss.
The carrier invoked their right to a policy provision commonly referred to as an examination under oath. This common
delay tactic creates an intimidation factor towards the insured. It also halts the claim process until
complied with. At no time was the insured informed of their rights regarding the EUO but rather
only the right for the carrier to invoke said common business practice because it was afforded to
them under the policy provisions. The insured was treated with hostility during the EUO and was
accused of inflating the damages to the property through the use of a public adjuster. In fact the
insured asked of the public adjuster to omit 3 of the buildings from the adjustment line items of
scope. Intimidation tactics to devalue the report were made by the carrier’s attorney during the
EUO. The EUO would finally be performed on October 16, 2024, over 2 years after the
carrier invoked the EUO provision.
Westchester Surplus Lines Insurance Company has common business practices found in this adjustment and others that
create a breach of contract willfully in efforts to profit from the loss of the trusting policy holders
who purchase policies from the carrier annually. Another common business practice that
Westchester Surplus Lines Insurance Company engages in is the exorbitant increase in policy
premium charges during the policy renewal period after a claim has been file. This common
business practice places the insured in a position of financial distress in addition to the loss for
which the insured file a claim for. This practice serves two purposes, one which is Westchester
Surplus Lines Insurance Company attempt to capture premiums with the lingering claim payment
potential which offsets their bottom line. Two, it may cause such discomfort that the insured seek
a different carrier for their policy needs which pushes the insured out of their “disputed claim”
policy and onto another carrier to which places the insured in a bad position should the insured
experience a new sudden and unexpected loss. At that point the old carrier would point their
finger at the new carrier stating the loss was new and the new carrier would point their finger at
the old carrier stating the loss was pre-existing. This insured did in fact experience this business
practice when renewing their policy recently. Unbeknownst to the insured and against their
instructions the insured’s agent did not in fact renew their policy but placed the policy with a
different carrier. The curious policy and business practice should be looked at closer because
these type of policies are layered and have a shared risk of coverage with several different
underwriters. The practice of attempting to increase the premium then push off the policy holder
who then gets a policy with another carrier isn’t an innocent practice it is intended to put the
insured in a vicarious position. Behind the Westchester Surplus Lines Insurance Company policy
there are many layered carriers who share in the responsibility of the reward of premium and the
risk of paying for a loss. Upon review of the layers you will find that the new policy the insured
finds themselves covered by, has several of the same layered risk underwriters to whom are now
pressuring the insured to have inspections performed. It can be assumed that these shared risk
carriers already have prior knowledge of the damages and could be seeking to use the threat of
dropping coverage as a tool to intimidate the insured into making premature repairs. Again this is
a clear business practice that is attempting to profit from the insured’s loss and breaches yet
another contract they find themselves in with some of the layered risk carriers. The current
carriers have prior knowledge of the condition of the property and any act by them or their current
shared partners is an attempt to defraud the insured while fighting a wrongful denial against them
on a different policy obligation might be considered collusion. The obligation for Westchester
Surplus Lines Insurance Company to pay the claim is clear, their own determination makes it
evident that, they willingly and willfully attempted to profit from the insured’s loss. Keep in mind
that the policy contractual agreement had been renewed many times over and that Westchester
Surplus Lines Insurance Company had been the policy provider for many years prior and after the
loss.
Westchester Surplus Lines Insurance Company has failed to create and implement adequate guidelines for the proper
investigation and evaluation of claims, claims handling, and for training and supervision of employees resulting in statutory
violations as set forth above in paragraph No. 5. Westchester Surplus Lines Insurance Company has failed and/or refused
to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim for damages.
Notwithstanding the Insured’s timely notification to Westchester Surplus Lines Insurance Company of the insurance claim,
Westchester Surplus Lines Insurance Company has failed or refused to settle the Insured’s claim in a timely manner
and/or adjust the loss with the Insured.
Westchester Surplus Lines Insurance Company has failed to promptly settle its Insured’s insurance claim when the
obligation to settle the insurance claim had become reasonably clear. To date, notwithstanding the Insured’s pleas
otherwise, Westchester Surplus Lines Insurance Company has continued to refuse to acknowledge its obligation to
conduct a proper investigation, and to tender the insurance monies due and owing its Insured under the policy.
This claim involves the Insured’s property located at 10401 Cross Creek Blvd. Tampa, FL 33647 which suffered a sudden
loss caused by wind and hail on or about April 11, 2021. The Insured made application for insurance benefits under the
Policy No. D42313300 001, under Claim No. KY22K2177032. Westchester Surplus Lines Insurance Company partially
accepted coverage for the loss, however, has failed to pay the full amount of benefits due to the Insured.
The insureds utilized the services of a licensed public adjuster who inspected the insureds’ property and
determined that the loss was a covered loss and had caused $ $18,250,563.43 in damages before the deductible. The
insureds’ public adjuster prepared an estimate for the insureds using XACTIMATE software that incorporated standard
industry pricing and accurately reflects the repairs necessary to return the insureds’ property to its pro-loss condition.
The Insured was, and still is, forced to expend out of pocket monies to submit the insurance claim, e.g., retaining legal
counsel and other experts to force Westchester Surplus Lines Insurance Company to honor its obligations under the
insurance policy and to pay all the insurance proceeds due and owing to the Insured.
Westchester Surplus Lines Insurance Company adjusted the loss and tendered insurance benefits of $0.00 and has
refused and/failed to tender additional insurance proceeds due and owing to the Insured. Westchester Surplus Lines
Insurance Company’s refusal and/or failure to settle the insurance claim when under all circumstances it could have and
should have done so had it acted fairly and honestly towards its Insured is wrongful conduct. Furthermore, the Insured
contends that Westchester Surplus Lines Insurance Company’s adjusters and/or representatives financially benefit from
such wrongful conduct.
Therefore, to cure the defects outlined in this Civil Remedy Notice, Westchester Surplus Lines Insurance Company must:
(1)
Westchester Surplus Lines Insurance Company must tender to the Insured, $ $18,250,563.43 less the
deductible, plus interest, fees and costs;
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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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