Filing Number: 793302
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| Filing Accepted: 11/19/2024 |
| Last/Business Name
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| Street Address
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2218 STONEMILL DRIVE |
| City, State Zip
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ORLANDO,
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32837
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| Email Address
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EFRB@ME.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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MUNOZ |
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First Name |
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DAVID |
| Policy # * |
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NP1085870 |
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Claim #* |
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HO0001047034 |
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Attorney is Applicable
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| Last Name* |
LEWIS
First Name *
REBECCA
Initial
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| Street Address* |
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708 E. COLONIAL DR., SUITE 103 |
| City, State Zip* |
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ORLANDO
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FL
32803
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| Email Address * |
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RL@WEKLAW.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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STILLWATER 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 25180 |
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| Name of individual responsible for violation (if any):*
UNKNOWN
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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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Unsatisfactory Settlement Offer
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Claim Denial
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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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| 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)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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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)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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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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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.
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
b. 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".
2. We do not cover land, including land on which
the dwelling is located.
B. Coverage B – Other Structures
1. We cover other structures on the "residence
premises" set apart from the dwelling by clear
space. This includes structures connected to
the dwelling by only a fence, utility line, or
similar connection.
SECTION I – PERILS INSURED AGAINST
A. Coverage A – Dwelling And Coverage B –
Other Structures
1. We insure against risk of sudden and accidental direct
physical loss to property described in Coverages A and B.
D. Loss Settlement
In this Condition D., the terms "cost to repair or
replace" and "replacement cost" do not include
the increased costs incurred to comply with the
enforcement of any ordinance or law, except to
the extent that coverage for these increased costs
is provided in E.11. Ordinance Or Law under
Section I – Property Coverages. Covered property
losses are settled as follows:
1. Property of the following types:
a. Personal property;
b. Awnings, carpeting, household appliances,
outdoor antennas and outdoor equipment,
whether or not attached to buildings;
c. Structures that are not buildings; and
d. Grave markers, including mausoleums;
at actual cash value at the time of loss but not
more than the amount required to repair or
replace.
2. Buildings covered under Coverage A or B at
replacement cost without deduction for
depreciation, subject to the following:
a. If, at the time of loss, the amount of
insurance in this policy on the damaged
building is 80% or more of the full
replacement cost of the building
immediately before the loss, we will pay the
cost to repair or replace, without deduction
for depreciation, but not more than the least
of the following amounts:
(1) The limit of liability under this policy that
applies to the building;
(2) The replacement cost of that part of the
building damaged with material of like
kind and quality and for like use; or
(3) The necessary amount actually spent to
repair or replace the damaged building.
If the building is rebuilt at a new premises,
the cost described in (2) above is limited to
the cost which would have been incurred if
the building had been built at the original
premises.
b. If, at the time of loss, the amount of
insurance in this policy on the damaged
building is less than 80% of the full
replacement cost of the building
immediately before the loss, we will pay the
greater of the following amounts, but not
more than the limit of liability under this
policy that applies to the building:
(1) The actual cash value of that part of the
building damaged; or
(2) That proportion of the cost to repair or
replace, without deduction for
depreciation, that part of the building
damaged, which the total amount of
insurance in this policy on the damaged
building bears to 80% of the
replacement cost of the building.
c. To determine the amount of insurance
required to equal 80% of the full
replacement cost of the building
immediately before the loss, do not include
the value of:
(1) Excavations, footings, foundations,
piers, or any other structures or devices
that support all or part of the building,
which are below the undersurface of the
lowest basement floor;
(2) Those supports described in (1) above
which are below the surface of the
ground inside the foundation walls, if
there is no basement; and
(3) Underground flues, pipes, wiring and
drains.
d. We will pay no more than the actual cash
value of the damage until actual repair or
replacement is complete. Once actual
repair or replacement is complete, we will
settle the loss as noted in 2.a. and b.
above.
However, if the cost to repair or replace the
damage is both:
(1) Less than 5% of the amount of
insurance in this policy on the building;
and
(2) Less than $2,500;
we will settle the loss as noted in 2.a. and
b. above whether or not actual repair or
replacement is complete.
e. You may disregard the replacement cost
loss settlement provisions and make claim
under this policy for loss to buildings on an
actual cash value basis. You may then
make claim for any additional liability
according to the provisions of this Condition
D. Loss Settlement, provided you notify us,
within 180 days after the date of loss, of
your intent to repair or replace the
damaged building.
D. Loss Settlement
In Form HO 00 03
The following is added to the last paragraph in paragraph 1:
Actual cash value means the lesser of repair or replacement
cost at the time of loss less applicable depreciation for
physical deterioration and obsolescence.
In Form HO 00 03
Paragraph 2.d. is replaced by the following:
d. We will settle the loss as follows:
We will settle the loss as noted in 2.a. and b. of this
provision. If 2.a. is not applicable, we will settle the
loss as follows:
(1) We will initially pay the actual cash value of the
building damage, minus any applicable
deductible.
(2) We will then pay the necessary amounts
actually spent to repair or replace the damaged
building as work is performed and expenses are
incurred.
(3) If a total loss, we will pay the replacement cost
amount without deduction for depreciation.
Actual cash value as used in b. (1) and d. means
the lesser of repair or replacement cost at the
time of the loss less applicable depreciation for
physical deterioration and obsolescence.
Paragraph 2.e. is deleted.
In Form HO 00 06;
Paragraph 2. is replaced by the following:
2. Coverage A - Dwelling, at the actual cost to repair or
replace.
In this provision, the terms "repaired" or "replaced" do
not include the increased costs incurred to comply with
the enforcement of any ordinance or law, except to the
extent that coverage for these increased costs is provided
in D.10. Ordinance Or Law under Section I - Property
Coverages.
J. 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 and:
1. Reach an agreement with you;
2. There is an entry of a final judgment; or
3. There is a filing of an appraisal award with us.
I. Our Option is replaced by the following:
I. Our Option
In Form HO 00 03:
If at the time of loss, the damaged property is:
a. not insured for Replacement Cost Loss Settlement as
outlined in Section I - Conditions, Loss Settlement,
and we give you written notice within 30 days after
we receive your signed, sworn proof of loss, we may
repair or replace any part of the damaged property
with material or property of like kind and quality.
b. insured for Replacement Cost Loss Settlement as
outlined in Section I - Conditions, Loss Settlement,
we will pay the amount of loss as noted in Paragraph
D.2.d.(1) of the Loss Settlement provision.
If at the time of loss:
a. The Personal Property Replacement Cost Loss
Settlement – Florida endorsement is made a part of
this Policy, we will pay the amount of loss as noted in
Paragraph C. of that endorsement.
In Forms HO 00 04 and HO 00 06:
If at the time of loss:
a. The Personal Property Replacement Cost Loss
Settlement – Florida endorsement is not made a part
of this Policy, and we give you written notice within
30 days after we receive your signed, sworn proof of
loss, we may repair or replace any part of the damaged
personal property with material or property of like
kind and quality.
b. The Personal Property Replacement Cost Loss
Settlement – Florida endorsement is made a part of
this Policy, we will pay the amount of loss as noted
in Paragraph C. of that endorsement.
J. Loss Payment is replaced by the following:
J. 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 upon the
earliest of the following:
1. 20 days after we receive your proof of loss and reach
written agreement with you;
2. 60 days after we receive your proof of loss and:
a. There is an entry of a final judgment; or
b. There is a filing of an appraisal award or a
mediation settlement with us.
3. If payment is not denied, within 90 days after we
receive notice of an initial, reopened or supplemental
claim. However, this provision (J.3.) does not apply
if factors beyond our control reasonably prevent
such payment.
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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.
Patricia Santos and David Munoz ("Insureds") purchased an insurance policy ("Policy") from Stillwater Insurance Company ("Stillwater" or “Carrier”) with effective coverage on the date of loss, on or about September 28, 2022, and Policy number NP1085870 to insure their property located 2218 Stonemill Drive, Orlando, Florida 32837 (the "Property").??
On or about September 28, 2022, the Property suffered from extensive damages to the roof, exterior, and interior due to Hurricane Ian ("Loss"). Stillwater was notified of the Loss immediately upon discovery and was granted access to the property in order to complete their inspection. Stillwater acknowledged the claim and assigned claim HO0001047034 ("Claim") to the Loss.
On or about October 14, 2022, Stillwater sent field adjuster, Tim Brissey, to inspect the subject property. As a result of the adjuster’s inspection, on October 28, 2022, Stillwater issued its claims decision for the Loss. As evidenced by an estimate sent to the Insureds, dated October 28, 2022, Stillwater determined the total value of the loss was $3,361.72 which was below the applicable deductible. However, Stillwater’s coverage determination failed to properly account for the money needed to repair the interior damages and improperly failed to pay for the replacement of this roof due to the extensive damage caused by Hurricane Ian.
After Stillwater issued its coverage determination letter which stated the damages were below the deductible, the Insureds retained the services of a public adjuster. The Insureds’ public adjuster investigated and adjusted the loss and determined the total value of the loss to be $103,531.27.
The Insureds, realizing that Stillwater’s adjustment of the loss was not a fair or an honest adjustment of the loss reached out to Stillwater in order to have it reconsider its position.
On September 29, 2023, Stillwater sent field adjuster, Brett Rhodes, to inspect the subject property. As a result of the adjuster’s inspection, on October 3, 2023, Stillwater issued another claims decision for the Loss. This time they determined that the total value of the loss was $8,723.55 as evidenced by an estimate sent to the Insureds, dated October 2, 2023. Stillwater issued a payment to the Insureds in the amount of $3,201.00 after applying depreciation and applying the wrong deductible in the amount of $5,360.00. Pursuant to the subject policy, the deductible for hurricane losses is $4,960.00, not $5,360.00. Further, the payment failed to properly account for the money needed to repair the interior damages and improperly failed to pay for the replacement of the roof due to the extensive damage caused by Hurricane Ian. Neither estimate provided to the Insureds by Stillwater included any coverage for the damages to the roof caused by Hurricane Ian and neither coverage determination letter offered an explanation as to why coverage was being denied for the damages to the roof.
Despite Stillwater being provided plenty of evidence (including photographs, comparative estimates and bids, and near immediate access to the property upon discovery of the loss) showing that a Hurricane so severely damaged this property that it will require repairs as well as a roof replacement, Stillwater continues to refuse to provide additional money in order to begin these repairs.
Stillwater’s adjustment of the loss was not a fair or an honest adjustment of the loss. Stillwater’s adjustment of the loss was intended to provide the illusion of a fair adjustment, to avoid full payment to the Insureds. Stillwater knows or should know that its adjustment of the Loss is not a fair or honest assessment of the Loss, yet Stillwater has refused to attempt to settle the Loss with the Insureds and their representatives. Stillwater has made the practice of valuing a claim near or below the value of an insured’s deductible to avoid having to fairly and honestly adjust and pay for losses.
Further, Stillwater failed to assign an adequate adjusting team (field adjuster, contractor consultants, and desk adjusters) to handle the size and scope of the loss. Stillwater does not have appropriate standards in place to be able to investigate claims such as the Loss at the Insureds’ Property. Stillwater’s failure to have appropriate standards led to the assignment of an inadequate adjusting team, which ultimately led to Stillwater’s unfair and dishonest adjustment of the Loss. The Insureds, at their own expense, retained a qualified adjusting team to investigate the Loss. The experienced adjusting team arrived at a drastically different conclusion than Stillwater’s inadequate adjustment team – specifically, Stillwater determined the total value of the loss to be $8,723.55, whereas the experienced and qualified adjusting team retained by the Insureds determined the total value of the Loss to be $103,531.27.
To date, Stillwater has failed to accept and fully perform its obligations under the operable insurance contract. The Property remains damaged because the Insureds have not been paid the necessary, covered insurance proceeds sufficient to return the Property to its pre-loss condition.
By stating the above detailed facts, it is clear that Stillwater has violated 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 Insureds and with due regard for their interest;
• 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)(c) Failing to acknowledge and act promptly upon communications with respect to claims, by failing to respond to the Insureds’ public adjuster, and Insureds’ counsel with respect to supplemental requests for payments;
• 626.9541(1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the Insureds and/or their public adjuster of the basis in the insurance policy, in relation to the facts or applicable law, for the offer of a compromise settlement;
This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should Stillwater fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, Stillwater must: (1) Immediately tender all proceeds due and owing to the Insureds that are fairly owed to the Insureds under the insurance policy that would reasonably compensate the Insureds in order to put the loss property back to its pre-loss condition; the Insureds’ representative has provided their estimate and roof bids for the repairs in the total amount of $103,531.27 (2) Immediately afford coverage for the repairs to the subject property roof and interior necessary to put the property back into its pre-loss condition (3) Agree to reimburse the Insureds’ reasonable attorneys’ fees and costs for having to become involved to resolve the claim; and (4) Agree to reimburse the Insureds for interest on the amount of benefits that was found to be?due and owing to the Insured, relating back to the date of loss
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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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