Filing Number: 792248
|
| Filing Accepted: 11/14/2024 |
| Last/Business Name
*
|
|
|
DANIEL J. BUENZ INDIVIDUALLY AND AS A TRUSTEE OF CO-TRUSTEE OF THE JOINT TRUST AGREEMENT OF D
|
|
First Name |
|
|
|
| Street Address
*
|
|
350 VIA ESPLANADE |
| City, State Zip
*
|
|
PUNTA GORDA,
FL
33950
|
| Email Address
*
|
|
JULEBUENZ@YAHOO.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
DANIEL J. BUENZ INDIVIDUALLY AND AS A TRUSTEE OF CO-TRUSTEE OF THE JOINT TRUST AGREEMENT OF D |
|
First Name |
|
|
| Policy # * |
|
SJ31142492 |
|
Claim #* |
|
SL22207286 |
|
Attorney is Applicable
|
| Last Name* |
WILKES
First Name *
LEVI
Initial
|
| Street Address* |
|
925 FEDERAL HWY |
| City, State Zip* |
|
BOCA RATON
,
FL
33432
|
| Email Address * |
|
LWILKES@KPATTORNEY.COM |
|
|
| Insurer Type
*
|
|
Authorized Insurer
Unauthorized Insurer
|
|
|
| Insurer Name |
|
|
| Insurer Name* |
|
SLIDE INSURANCE COMPANY
|
| Insurer Name* |
|
|
| Street Address* |
|
|
| City, State Zip* |
|
,
|
|
NAIC Company Code 17227 |
|
|
| Name of individual responsible for violation (if any):*
KERRIE TOMASICH
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
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)(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)(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)(j) |
|
Altering or amending an insurance adjuster’s report without:
(I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and
(II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or
(III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
|
|
*
Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Loss settlement provision
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Hurricane Ian struck with Plaintiff’s property devastating the property and uprooting the Insureds way of life. The Insured reported damages to the Carrier shortly after Hurricane Ian. The Property lost power. On October 26, 2022, the field adjuster, Kris Bailey, for Defendant inspected the Property. Upon information and belief, Bailey created an original estimate of covered damages that was $24,876.13. On November 1, 2022, another field adjuster, Charles Murray, re-inspected the interior of the property and purportedly adjusted the Bailey Estimate (those bolded in Estimate to create a valuation of $37,189.42 replacement cost value and $35,523.11 of actual cash value.
How Mr. Murray came to his conclusions and valuations including why no depreciation for the roof was taken and why other amounts were depreciated are largely unknown as such methodology is not spelled out by the policy and appears to be unilaterally applied by the carrier by unknown and unspoken terms. Notably the adjusters found high wind damages to the screen enclosure, soffits and drywall collapse, garage door, outdoor piping from trees toppling, exterior lighting and fans, exterior wall debris impacts, rafters and other portions of the roofing system. This is significant given that in the midst of litigation with late disclosed expert opinions the Defendant attempts to contradict its own coverage decision on the claim by a paid actor and engineer—Adam Coon.
It should be noted that Mr. Murray’s inspection was a reinspection (of only the exterior) finding glaring errors with his predecessor, yet no effort was made by carrier to reassess the interior. There is no indication of Mr. Murray’s credentials in engineering or roofing or roof repairability, yet Mr. Murray does note:
There are a couple of rows on the lower rear elevation slope and on the lower left elevation slope that are adjacent to the roll roof that are loose and some of the tiles have shifted been lifted and shifted out of alignment.
What is clear from the Murray report is there is little or no regard for the wind speeds and how that might play out as far as damages (i.e. wind speeds exceeding design wind ratings for roof and windows). Defendant did have a “roof consultant” create a report which its report suggest 125mph at the subject location. It also acknowledges the roof tile present on the home was “ceetile” which is discontinued and no longer has product approval. None of the adjusters on behalf of the carrier undertook any investigation as to the availability of tile of even had the roofing knowledge to know whether building code and construction methods would allow the roof to be repaired. The Carrier took/takes the position that roof tiles can simply be harvested from slopes and put on others to avoid building code and statutory requirements.
a. Presuit Offer
On August 28, 2023, prior to initiating litigation the Plaintiff fulfilled its statutory requirement by providing the Defendant with the opportunity to resolve all liabilities in regards ot the claim (including bad faith) for $78,500. In response the Defendant made a single offer—not an undisputed payment—of only $20,635.00 to resolve all damages incurred.
II. Conduct of Carrier
The conduct of the Carrier and its agents in this case have put the Insured at a severe deficit and disadvantage regarding a policy which was meant to cover them and their property for this exact scenario—a devasting and memorable Hurricane for the state of Florida.
During the litigation process intentional delay and concealment of evidence with regards to the claim process ensued and prejudiced the Insured in the prosecution of its case including the late disclosure of expert opinions and concealment of documents created by its adjusters whom the coverage decision was based on. More than two-year have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy; has even refused to pay undisputed losses (as identified by its own pricing expert. The carrier is aware of damage sustained by the insured’s property and has not taken any meaningful ensuing action on the known covered loss.
The deposition taken of the Carrier’s field adjuster reveals unfair patterns and practices by the Carrier in regards to its engagement of field adjusters including the use of outside, uneducated adjusters on Florida law, construction practices and norms. Field adjusting office are hand picked to carry out a biased and predictable role for the carrier by going so far as running CLEs for the hand-picked companies on the way it wants its adjusters to act and inspect and estimate no matter how wrong the practice may be legally. The Carrier further layers delays and fault into the claim process by delegating that field adjusters cannot assess the discontinued nature of roof tiles and cannot make allocation for loss of use despite the dire circumstances of the Insured in these situations. Furthermore, its clear that multiple estimates and draft estimates were completed on the claim yet the Carrier fail to explain why the estimate of damages changed but instead kept such estimates completely hidden from the Insured.
During the litigation process it was furthermore learned that Adam Coon used misleading wind data for the property and which contradicted the carrier’s own determination that winds were in the range of 125 miles per hour. Further the Defendant took the bold approach of contradicting it own agents in using the paid for Mr. Coon to testify for them at trial that the roof sustained no wind damage.
III. Violations
The carrier’s actions are in violation of the Loss Settlement provision of the policy as well as the following Florida Statutes:
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)(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.
Through both Pre-suit documents and post-suit discovery the Carrier knows full well that it failed to pay for all covered expenses, and monies owed under the Policy. Instead of acknowledging that fact in litigation and putting funds in court registry and admitting liability it continues to litigate in bad faith and contrary to its own agents opinions.
626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims
This includes a lack of training on field adjusters and agents used by the carrier and the willingness to put agents with a lack of knowledge as to residential building methods in the line of duty.
626.9541(1)(i)(3)(b): Misrepresenting pertinent facts or insurance policy provisions relating to
coverages at issue.
The Carrier systematically unilaterally applies its own definition and formulas for depreciation which it fails to apply neutrally or consistently among its Florida clients. Upon information and belief, the carrier fails to put definitions and formulas into its policies so that it can underpay insureds and the insureds not have expressed language to point to in order to tell the Carrier their estimate was wrong. The carrier furthermore represents its policies and loss settlement provision do not require matching when Fla. Stat. 626.9744 mandates matching, which must be incorporated into the contract, and its own policy loss settlement provisions states it pays for “like construction, and use”.
Fla. Stat 626.9541 (i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims
The deposition of field adjusters in this matter revealed that’s adjusters were not provided weather data and such data was not part of his rudimentary analysis in determining the integrity of the roof and roof damages. A fundamental flaw and pattern and practice of the Carrier is to avoid determining accurate weather data for its agents and information regarding the building envelope as it might suggest or lead the adjuster to concerns that the roofing system was compromised due to wind thresholds being exceeded. Further adjusters, both field and desk, are ill educated on Florida’s matching statute and how that applies to discontinued roofing tiles as such application would surely hurt the bottom line profits of the Carrier.
Fla. Stat 626.9541 (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
The deposition of field adjusters in this matter revealed that’s adjusters were not provided weather data and such data was not part of his rudimentary analysis in determining the integrity of the roof and roof damages. A fundamental flaw and pattern and practice of the Carrier is to avoid determining accurate weather data for its agents and information regarding the building envelope as it might suggest or lead the adjuster to concerns that the roofing system was compromised due to wind thresholds being exceeded. Further adjusters, both field and desk, are ill educated on Florida’s matching statute and how that applies to discontinued roofing tiles as such application would surely hurt the bottom line profits of the Carrier.
Fla. Stat 626.9541 (i)(j) failing to explain changes in estimates created by the carrier and provide those estimates to the Insured.
The Defendant’s privilege log outlines several draft reports, sketches of damage and estimates which the carrier failed to share with the Insured. These documents being created by persons who were relied upon in the adjustement of the claim on the insurance company and its agent creating issues of transparence and probable issues of misrepresentation.
The Carrier is clearly not treating the insured with good faith claims conduct (pre or post lawsuit); failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insured; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insured’s interests; refusing to pay the full amount owed to the insured despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insured, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days.
All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $ 91,820.66, less any cashed prior payments and less the applicable policy deductible; and 2.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made as required under chapter 627 and 3) Agree to pay the reasonable attorney’s fees and expenses incurred the Insureds current and pending lawsuit. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier.
Please do not hesitate to contact the undersigned or Paula Souza at (561)-892-9748 if you have any questions or concerns.
Sincerely,
Levi Wilkes
Attorney at Law
|
|
*
|
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
|