Filing Number: 792327
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| Filing Accepted: 11/14/2024 |
| Last/Business Name
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ALEXANDRE; PIERRE
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First Name |
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VILA; NADGE |
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| Street Address
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2758 BARCLAY LN |
| City, State Zip
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KISSIMMEE,
FL
34743-60
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| Email Address
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VILAPOUCHON@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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ALEXANDRE; PIERRE |
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First Name |
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VILA; NADGE |
| Policy # * |
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7709HR018465 |
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Claim #* |
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427127-GP |
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Attorney is Applicable
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| Last Name* |
BRAZ
First Name *
TAMARA
Initial
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| Street Address* |
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8865 COMMODITY CIR. STE. 12 |
| City, State Zip* |
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ORLANDO
,
FL
32819
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| Email Address * |
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TBRAZ@THELAWGICALFIRM.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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NATIONWIDE MUTUAL INSURANCE COMPANY
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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 23787 |
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| Name of individual responsible for violation (if any):*
? LATRINA IVERY, CLAIMS SPECIALIST ON BEHALF OF NATIONWIDE MUTUAL INSURANCE CO.
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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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Other
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Improper Investigation
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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)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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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.
H0003FL0716
***
SECTION I – PROPERTY COVERAGES
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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[.]
***
H0003FL0716
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SECTION I – PERILS INSURED AGAINST
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A. Coverage A – Dwelling And Coverage B – Other Structures
1. We insure against direct physical loss to property described in Coverages A and B[.]
***
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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.
On or about April 29, 2023, Vila Alexandre and Nadge Pierre (Complainants) suffered a loss to their Property, located at the address listed above. After discovering the damage, Complainants reported the loss to Nationwide Mutual Insurance Company (“Insurer”) on or about January 31, 2024.
Throughout the Insurer’s investigation, Complainants have fully cooperated with the Insurer and fully performed all duties and obligations under the policy by providing all information within Complainants custody, possession and control.
The Insurer, however, has failed to fulfill its duties under the Policy and Florida law.
Shortly after the loss was reported, an inspection of the Property took place by Latrina Ivery (“Field Adjuster”), on or about February 1, 2024. A cursory inspection of the Property resulted in the creation of an estimate, finding the damage to total $956.66, which is under the Complainants’ deductible of $2,500.
The Insurer issued a coverage determination on or about February 7, 2024, just 6 days after the inspection, finding that there was “weather related damage” to the Property, and that coverage “is afforded under your policy subject to the applicable deductible”.
Insurer also stated that any additional damage found to the property was a result of wear and tear in the form of “granule loss and blistering”.
The Field Adjuster was not retained, tasked, or qualified to determine or assess the cause of the reported loss. Yet, she was tasked with causation of this loss. The Field Adjuster has no other qualifications aside from her Florida 6-20 License which only provides the licensee the ability to (1) Determine the amount of a claim, loss, or damage payable under an insurance contract, or (2) Settle the claim, loss, or damage.
Further, the claim investigation lasted a mere 7 days. The Insurer only took into account their Field Adjusters unqualified findings. There was no opportunity for the Complainants to provide additional documentation.
As a result, the investigation was rushed and lacked a thorough evaluation of the claim, which led to an inaccurate assessment of the loss and unfair denial of coverage, and an underpayment for the damage that was found.
Following this, the Complainants retained The Lawgical Firm for assistance in handling their claim, on or about April 18, 2024.
The Loss Consultant on behalf of the Complainants conducted a visual inspection of the Property with which an estimate and photos were taken on or about April 30, 2024.
On or about May 8, 2024, personnel from The Lawgical Firm sent the Insurer the Loss Consultant’s estimate and photos.
The following day, in response to the Loss Consultant’s evidence, the Field Adjuster responded via email stating, “The suggested photos do not show signs of hail derived damages. The suggested photos show blistering and granule loss which the policy will not afford coverage for. At this time, our coverage determination remains the same”.
Here, Insurer, again, relies solely on the unqualified opinions of a field adjuster. Pursuant to Fla. Stat. 626.9541(1)(i)(3)(a), the Insurer has failed to adopt proper investigation standards as there was not an expert consulted with, nor was there a proper supplemental review of all information.
Notwithstanding this correspondence, Complainants executed a Sworn Proof of Loss (“SPOL”) on or about May 14, 2024. Complainants and their agents then sent the Complainants’ SPOL and resent the Loss Consultant’s estimate, in efforts to have this supplemental information properly considered by the Insurer.
Complainants and their agents have obliged to all obligations under the policy to timely resolve the case, as well as supplying supplemental information to further the claim to a solution.
Despite these efforts, the Insurer failed to respond, leaving the Complainants' claim unresolved. The Insurer is also not in compliance with Fla. Stat. 627.70131(1)(a), which outlines a 7-day acknowledgment period for receipt of correspondence.
This lack of proper action has contributed to the ongoing dispute between the parties regarding the full extent of the damage. Further, the lack of response is not in accordance with 626.9541(1)(i)(3)(e), which provides that an Insurer has 30 days to re-issue a coverage determination.
This policy is not in line with the Insurer’s duty of “fair and honest treatment of the claimant” as it seeks only to protect the Insurer’s interests.
Overall, it is clear that the Insurer wholly failed to investigate causation, having only sent adjusters who are only qualified to document the condition of the Property, and assign repair values.
Based on the events described above, it is clear that Insurer conducted an improper investigation by an inexperienced and poorly trained adjuster to intentionally minimize its liability, contrary to the policy and Florida law’s requirements.
Moreover, Insurer has misrepresented pertinent facts and/or insurance policy provisions relating to coverages at issue and delayed the resolution of the claim by engaging in conduct to deny or reduce recovery to the Insureds. These tactics are believed to be the general business practices of this Insurer.
Insurer can cure its bad faith conduct by: 1) accepting the Insureds’ damage claim as compensable, and agreeing to pay the claim in accordance with the policy in the amount of $42,177.77, plus interest, prior to the expiration of the cure period, 2) reviewing and responding to all communications from the Insureds and their agents, including the request for a complete copy of the Policy.
PLEASE GOVERN YOURSELF ACCORDINGLY.
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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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