Filing Number: 793975
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| Filing Accepted: 11/25/2024 |
| Last/Business Name
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BIRCHWOOD I & II ASSOCIATION, INC.
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First Name |
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| Street Address
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24540 HARBORVIEW RD. |
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PORT CHARLOTTE,
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33950
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LITIGATION@THEFREEMANLAWFIRMPA.COM |
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Insured |
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BIRCHWOOD I & II ASSOCIATION, INC. |
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First Name |
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| Policy # * |
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HCP007201 |
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Claim #* |
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H107676 |
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Attorney is Applicable
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| Last Name* |
FREEMAN
First Name *
BRIAN
Initial
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4245 FOWLER STREET |
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FORT MYERS
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FLORIDA
33901
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LITIGATION@THEFREEMANLAWFIRMPA.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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HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY
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NAIC Company Code 14407 |
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| Name of individual responsible for violation (if any):*
ALEXSANDRA SIMOES
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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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Claim Delay
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Unfair Trade Practice
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Other
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Bad Faith
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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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| 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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| 626.9541(1)(i)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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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.
The Insured is in possession of a copy of the Insurance Policy and believes its Insurance Policy language relevant to the violations includes all applicable policy coverages, loss payment provisions, valuation provisions and other terms and conditions of Policy No. HCP007201-1. In particular, the Insured refers to the following policy coverages and included insurance policy language:
A. Coverage
We will pay for direct physical loss of or damage to
Covered Property at the premises described in the
Declarations caused by or resulting from any Covered
Cause of Loss.
1. Covered Property
Covered Property, as used in this Coverage
Part, means the type of property described in
this section, A.1., and limited in A.2., Property
Not Covered, if a Limit of Insurance is shown in
the Declarations for that type of property.
a. Building, meaning the building or structure
described in the Declarations, including:
(1) Completed additions;
(2) Fixtures, outside of individual
4. Loss Payment
a. In the event of loss or damage covered by
this Coverage Form, at our option, we will
either:
(1) Pay the value of lost or damaged property;
(2) Pay the cost of repairing or replacing the
lost or damaged property, subject to b.
below;
(3) Take all or any part of the property at an
agreed or appraised value; or
(4) Repair, rebuild or replace the property
with other property of like kind and quality,
subject to b. below.
We will determine the value of lost or damaged
property, or the cost of its repair or
replacement, in accordance with the applicable
terms of the Valuation Condition in
this Coverage Form or any applicable provision
which amends or supersedes the
Valuation Condition.
b. The cost to repair, rebuild or replace does
not include the increased cost attributable
to enforcement of any ordinance or law
regulating the construction, use or repair of
any property.
c. We will give notice of our intentions within
30 days after we receive the sworn proof of
loss.
d. We will not pay you more than your financial
interest in the Covered Property.
e. We may adjust losses with the owners of
lost or damaged property if other than you.
If we pay the owners, such payments will
satisfy your claims against us for the owners'
property. We will not pay the owners
more than their financial interest in the Covered
Property.
f. We may elect to defend you against suits
arising from claims of owners of property.
We will do this at our expense.
g. We will pay for covered loss or damage to
Covered Property within 30 days after we
receive the sworn proof of loss, if you have
complied with all of the terms of this Coverage
Part and:
(1) We have reached agreement with you
on the amount of loss; or
(2) An appraisal award has been made.
If you name an insurance trustee, we will
adjust losses with you, but we will pay the
insurance trustee. If we pay the trustee, the
payments will satisfy your claims against
us.
h. A party wall is a wall that separates and is
common to adjoining buildings that are
owned by different parties. In settling covered
losses involving a party wall, we will
pay a proportion of the loss to the party wall
based on your interest in the wall in proportion
to the interest of the owner of the adjoining
building. However, if you elect to repair
or replace your building and the owner
of the adjoining building elects not to repair
or replace that building, we will pay you the
full value of the loss to the party wall, subject
to all applicable policy provisions including
Limits of Insurance, the Valuation
and Coinsurance Conditions and all other
provisions of this Loss Payment Condition.
Our payment under the provisions of this
paragraph does not alter any right of subrogation
we may have against any entity, including
the owner or insurer of the adjoining
building, and does not alter the terms of the
Transfer Of Rights Of Recovery Against
D. The Loss Payment Condition dealing with the
number of days within which we must pay for
covered loss or damage is replaced by the
following:
Provided you have complied with all the terms of
this Coverage Part, we will pay for covered loss or
damage upon the earliest of the following:
(1) Within 20 days after we receive the
sworn proof of loss and reach written
agreement with you;
(2) Within 30 days after we receive the
sworn proof of loss and:
(a) There is an entry of a final judgment;
or
(b) There is a filing of an appraisal
award with us; or
(3) Within 90 days of receiving notice of an
initial, reopened or supplemental claim,
unless we deny the claim during that
time or factors beyond our control
reasonably prevent such payment. If a
portion of the claim is denied, then the
90-day time period for payment of claim
relates to the portion of the claim that is
not denied.
Paragraph (3) applies only to the
following:
(a) A claim under a policy covering
residential property;
(b) A claim for building or contents
coverage if the insured structure is
10,000 square feet or less and the
policy covers only locations in
Florida; or
(c) A claim for contents coverage under
a tenant's policy if the rented
premises are 10,000 square feet or
less and the policy covers only
locations in Florida.
3. Replacement Cost
a. Replacement Cost (without deduction for
depreciation) replaces Actual Cash Value in
the Loss Condition, Valuation, of this Coverage
Form.
b. This Optional Coverage does not apply to:
(1) Personal property of others;
(2) Contents of a residence; or
(3) Works of art, antiques or rare articles,
including etchings, pictures, statuary,
marbles, bronzes, porcelains and bric-abrac.
Under the terms of this Replacement Cost
Optional Coverage, personal property
owned indivisibly by all unit-owners, and the
property covered under Paragraph A.1.a.(6)
of this Coverage Form, are not considered
to be the personal property of others.
c. You may make a claim for loss or damage
covered by this insurance on an actual cash
value basis instead of on a replacement
cost basis. In the event you elect to have
loss or damage settled on an actual cash
value basis, you may still make a claim for
the additional coverage this Optional Coverage
provides if you notify us of your intent
to do so within 180 days after the loss or
damage.
d. We will not pay on a replacement cost basis
for any loss or damage:
(1) Until the lost or damaged property is
actually repaired or replaced; and
(2) Unless the repairs or replacement are
made as soon as reasonably possible
after the loss or damage.
e. We will not pay more for loss or damage on
a replacement cost basis than the least of
(1), (2) or (3), subject to f. below:
(1) The Limit of Insurance applicable to the
lost or damaged property;
If a building is rebuilt at a new premises, the
cost described in e.(2) above is limited to
the cost which would have been incurred if
the building had been rebuilt at the original
premises.
f. The cost of repair or replacement does not
include the increased cost attributable to
enforcement of any ordinance or law regulating
the construction, use or repair of any
property.
e. Increased Cost Of Construction
(1) This Additional Coverage applies only to
buildings to which the Replacement
Cost Optional Coverage applies.
(2) In the event of damage by a Covered
Cause of Loss to a building that is Covered
Property, we will pay the increased
costs incurred to comply with enforcement
of an ordinance or law in the
course of repair, rebuilding or replacement
of damaged parts of that property,
subject to the limitations stated in e.(3)
through e.(9) of this Additional Coverage.
(3) The ordinance or law referred to in e.(2)
of this Additional Coverage is an ordinance
or law that regulates the construction
or repair of buildings or establishes
zoning or land use requirements
at the described premises, and is in
force at the time of loss.
(4) Under this Additional Coverage, we will
not pay any costs due to an ordinance
or law that:
(a) You were required to comply with
before the loss, even when the building
was undamaged; and
(b) You failed to comply with.
(5) Under this Additional Coverage, we will
not pay for:
(a) The enforcement of any ordinance or
law which requires demolition, repair,
replacement, reconstruction, remodeling
or remediation of property due
to contamination by "pollutants" or
due to the presence, growth, proliferation,
spread or any activity of
"fungus", wet or dry rot or bacteria;
or
(b) Any costs associated with the enforcement
of an ordinance or law
which requires any insured or others
to test for, monitor, clean up, remove,
contain, treat, detoxify or neutralize,
or in any way respond to, or
assess the effects of "pollutants",
"fungus", wet or dry rot or bacteria.
(6) The most we will pay under this Additional
Coverage, for each described
building insured under this Coverage
Form, is $10,000 or 5% of the Limit of
Insurance applicable to that building,
whichever is less. If a damaged building
is covered under a blanket Limit of Insurance
which applies to more than one
building or item of property, then the
most we will pay under this Additional
Coverage, for that damaged building, is
the lesser of: $10,000 or 5% times the
value of the damaged building as of the
time of loss times the applicable Coinsurance
percentage.
The amount payable under this Additional
Coverage is additional insurance.
(7) With respect to this Additional Coverage:
(a) We will not pay for the Increased
Cost of Construction:
(i) Until the property is actually repaired
or replaced, at the same
or another premises; and
(ii) Unless the repairs or replacement
are made as soon as reasonably
possible after the loss or
damage, not to exceed two
years. We may extend this period
in writing during the two years.
(b) If the building is repaired or replaced
at the same premises, or if you elect
to rebuild at another premises, the
most we will pay for the Increased
Cost of Construction, subject to the
provisions of e.(6) of this Additional
Coverage, is the increased cost of
construction at the same premises.
(c) If the ordinance or law requires relocation
to another premises, the most
we will pay for the Increased Cost of
Construction, subject to the provisions
of e.(6) of this Additional Coverage,
is the increased cost of construction
at the new premises.
(8) This Additional Coverage is not subject
to the terms of the Ordinance Or Law
Exclusion, to the extent that such Exclusion
would conflict with the provisions of
this Additional Coverage.
(9) The costs addressed in the Loss Payment
and Valuation Conditions, and the
Replacement Cost Optional Coverage,
in this Coverage Form, do not include
the increased cost attributable to enforcement
of an ordinance or law. The
amount payable under this Additional
Coverage, as stated in e.(6) of this Additional
Coverage, is not subject to such
limitation.
2. "Specified causes of loss" means the following:
fire; lightning; explosion; windstorm or hail;
smoke; aircraft or vehicles; riot or civil commotion;
vandalism; leakage from fire-extinguishing
equipment; sinkhole collapse; volcanic action;
falling objects; weight of snow, ice or sleet; water
damage.
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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.
During the policy period, on September 28, 2022, the Insured’s eight (8) residential buildings located at 24540 Harborview Road, Port Charlotte, FL 33950 (“buildings”), owned by the named Insured, Birchwood I & II Condominium Association, Inc. ("Insured"), suffered severe windstorm related physical and structural damage as a direct result of Hurricane Ian, an event covered under the subject insurance policy. Please see policy language above that indicates coverage for hurricane/windstorm damage to the Insured’s buildings and roof systems.
Subsequent to Hurricane Ian, the Insured immediately reported the loss to its insurance carrier, Heritage Property & Casualty Insurance Company ("Insurer"). Since the beginning of the claims process, the Insured fully cooperated in the Insurer's investigation of the Insured’s hurricane/windstorm damage claim.
Despite overwhelming evidence the Insured’s eight (8) residential buildings and roof systems had been significantly physically and structurally damaged by Hurricane Ian, all covered losses under the subject insurance policy; the Insurer unreasonably and improperly investigated and evaluated the amount of damage to the Insured’s buildings and roof systems and intentionally delayed its investigation of the Insured’s hurricane/windstorm damage claim. Even more egregious, Heritage has not even provided a coverage determination to the Insured as required by Florida Statutes §627.70131(7)(a). In short, Heritage performed a completely inadequate and untimely investigation of the damage to the Insured’s buildings and roof systems, violated Florida law and breached its insurance policy with the Insured.
Dennis James, C.G.C. (“Mr. James”), of Triad Restoration, documented severe physical and structural damage to the Insured’s roof systems and buildings and suggested a full investigation be performed by a licensed Florida Professional Engineer of the damage to the Insured’s buildings, roof systems, windows and doors which the Insurer failed and refused to perform. Subsequently, Mr. James provided the Insured with a damage estimate of $1,131,064.66, which is the necessary cost to repair the hurricane/windstorm damage to the Insured’s eight (8) buildings, completely replace the Insured’s roof systems and return its buildings to their pre-loss condition. Mr. James’ damage estimate provided detailed, line-item costs for all of the necessary items and applicable taxes for the complete replacement of the Insured’s roof systems and all repairs necessary to return the Insured’s buildings and roof systems to their pre-loss condition.
Despite receipt of Mr. James’ detailed damage estimate, the Insurer did not extend coverage for the damages set forth in Mr. James’ damage estimate. The Insurer failed and refused to extend full coverage for the Insured’s clearly evident hurricane/windstorm damage, indicating the Insurer does not have proper standards for investigating the proper scope and amount of damage caused by a covered loss. The Insured provided all the evidence necessary supporting the actual costs associated with the complete replacement of its buildings’ roof systems and the amount necessary to restore its buildings to their pre-loss condition. However, despite this evidence and information, the Insurer failed and refused to pay for the Insured’s complete roof systems replacements and other physical and structural damage to the Insured’s buildings as a direct result of Hurricane Ian.
On October 31, 2022, the Insurer sent correspondence to the Insured requesting the Insured submit to an Examination Under Oath (“EUO”). The Insurer requested an arduous, overly broad, unduly burdensome, abusive and harassing document request the Insurer demanded the Insured provide prior to the EUO being conducted. The Insurer’s list included:
- Any and all corporate resolutions appointing a representative to present, act on behalf of, testify for, and execute agreements regarding the claim and any work performed related tothe claim.
- All applications for property insurance for the past seven (7) years.
- The floor plan(s) for the premises.
- The architectural plan(s) for the premises.
- Photographs, including but not limited to, all depictions of the subject premise’s alleged damages, including video.
- Articles of Incorporation for all corporations that the Condominium Association owns, operates, or maintains an interest in.
- The Condominium Association’s corporate income taxes for all corporations it owns, operates, or maintains an interest in, with supporting documentation, for the last seven (7) years.
- Profit & Loss Statements for the last seven (7) years of all corporations that the
Condominium Association owns, operates, or maintains an interest in.
- All receipts and/or records for any item that was damaged as a result of the incident of
September 28, 2022.
- All documents that explain or outline the type of business that the Condominium
Association owns, operates, or maintains an interest in, including but not limited to,
resumes, brochures, ads, etc.
- Inventory list for the items damaged or destroyed in the incident that occurred on
September 28, 2022.
- List of names, addresses, and phone numbers for all companies that supplied or sold the
items and/or property that was allegedly damaged or destroyed in the incident of
September 28, 2022.
- List of names, addresses, and phone numbers for all companies that performed repair/
replacement/ and/or mitigation work to the property that was allegedly damaged or
destroyed in the incident of September 28, 2022.
- All incident reports for the damage that occurred on September 28, 2022.
- Any and all leases regarding, relating to, or involving the Condominium Association from 2019 through the present date.
- The entire closing package, including but not limited to, the purchase and sale agreement, mortgage, contract, note, inspections, photos, engineer’s reports, etc., for sales of units from 2019 to the present.
- All records, including checks and any other documents that reflect the form of payment
used to purchase items damaged for the premises on September 28, 2022.
- All records, including checks and any other documents that reflect the form of payment
used to purchase items claimed damaged as a result of incident of September 28, 2022.
- All invoices from companies or individuals for items that were allegedly damaged by the incident September 28, 2022.
- All documents from companies or individuals reflecting balances due and owing by the
Condominium Association at the time of the incident, and three (3) years prior to the
alleged incident.
- All electricity bills for the premises in question at the time of the incident and three (3)
years prior to the alleged incident.
- All records indicating any debts for which the Condominium Association is responsible at the time of the incident and three (3) years prior to the alleged incident.
- All engineering, inspections and any other reports, records or documents substantiating
the incident or damage that occurred on September 28, 2022.
- All photographs depicting the premises prior to the date of the incident.
- All photographs depicting the premises on the date of the incident and after the incident through today.
- All photographs depicting the damage that occurred as result of the incident of September 28, 2022.
- All bills, receipts or invoices for repair, replacement or mitigation done to the premises and contents as a result of the incident.
- All minute books, including all books and records of the Condominium Association
relating to minutes at the time of the incident, seven (7) years prior to the alleged incident, through to today’s date.
- The articles of incorporation of the Condominium Association or, if the Condominium
Association is not incorporated, copies of the documents creating the Condominium
Association.
- The bylaws, resolutions, and corporate minutes of the Condominium Association at the time of the incident, seven (7) years prior to the alleged incident, and through today’s date.
- The recorded declaration of the Condominium Association.
- House rules and regulations which have been promulgated by or relating to the
Condominium Association.
- Financial records relating to the Condominium Association’s funds, including financial
statements of the Condominium Association, and source documents from the
incorporation of the Condominium Association, from three (3) years prior to the alleged
incident through the present date.
- All insurance policies, including excess and umbrella insurance policies, which cover or
may cover the Condominium Association, from 2019 through the present date.
- All application for policies of insurance, including excess and umbrella insurance policies, which cover or may cover the Condominium Association, from 2019 through the present date.
- A roster of unit owners and their addresses and telephone numbers.
- Leases of the common elements and other leases to which the Condominium Association
is a party.
- Employment contracts and service contracts between the Condominium Association and any contracting party in which the Condominium Association or the unit owners have an obligation or responsibility, directly or indirectly, to pay some or all of the fee or charge of the person or companies performing the service.
- All contracts to which the Condominium Association is a party from 2019 through to the present.
- All maintenance contracts and management contracts, including any contracts providing for the operation, maintenance, or management of the Condominium Association or property serving the unit owners of the Condominium Association for 2019 through the present.
- All individuals and entities, including independent contractors, employed by the
Condominium Association at the time of the incident and three (3) years prior to the alleged incident through the present date.
- All permits relating to the Condominium Association from 2019 through the present day, including all permit applications and supporting documentation.
- All contracts and agreements with all public adjusters or their representatives, employees, or agents regarding this claim.
- Any and all estimates or invoices for repairs of damages that are the result of the alleged loss.
- Copies of invoices for any and all previous work or maintenance completed on the roofs at issue.
- Any and all documentation provided by the restoration or remediation company, including but not limited to, invoices, dry logs, photos, assignment of benefits, certificates of satisfaction or direction of payments (if water mitigation was completed).
- Permit access to your residence by vendors who allegedly investigated the loss including, but not limited to, roof contractor(s), engineer(s), etc.
- Call logs for any unit owners who stated they had damages to their unit from this incident on September 28, 2022.
Clearly, a vast majority of the documents requested by the Insurer have absolutely no relevance to the Insured’s hurricane/windstorm damage claim. The Insurer’s request was obviously a dilatory tactic by the Insurer that makes compliance an impossibility so the Insurer can later claim the Insured did not comply.
Moreover, the Insurer did not perform a legally sufficient hurricane/windstorm damage investigation by failing to perform a substantial structural damage investigation and determination as required by the Florida Building Code. The Insurer’s failure to perform this very important substantial structural damage determination further indicates the Insurer did not comply with the basic requirements inherent in the proper investigation of hurricane/windstorm damage claims, and instead performs inadequate, untimely and incomplete investigations in order to effectively improperly partially deny claims by failing to render a timely coverage determination as required by Fla. Stat. §627.707131(7)(a). Instead of providing the Insured a coverage determination on its hurricane/windstorm damage claim, the Insurer has made attempts to settle the claim for pennies on the dollar. The Insurer retained a financially biased engineering firm, Intertek, to inspect the Insured’s Buildings on multiple occasions. However, any report or documentation from Intertek has not been provided to the Insured. In this particular case, the Insurer failed and refused to provide a timely, nevertheless, any coverage determination to the Insured despite numerous requests by the Insured for a coverage determination.
The work of adjusting insurance claims in Florida engages the public trust. In the instant case, the Insurer breached this duty through its complete failure to provide a timely coverage determination within ninety (90) days from the first notice of loss as required by Fla. Stat. §627.70131(7)(a), and complete failure to properly investigate the hurricane/windstorm damage claim of the Insured. The Insurer's complete failure to properly inspect, adjust and timely pay the Insured’s hurricane/windstorm damage claim, failure to communicate with the Insured, and improper handling of the Insured’s hurricane/windstorm damage claim clearly indicates the Insurer failed to adopt and implement proper standards for the investigation, evaluation and adjustment of claims; failed to properly train, manage, supervise and promote claims adjusters so Insureds receive good faith, fair and prompt adjustment of claims; and failed to conduct a full and fair investigation of this hurricane/windstorm damage claim.
The Insurer also breached its duty to the Insured by failing to timely and promptly pay the correct indemnity owed to its Insured. This duty is owed by the Insurer to its Insured and is inherent in the insurance claims process. The Insured promptly provided all necessary documentation, evidence and information for a timely resolution of its hurricane/windstorm damage claim, including an itemized damage estimate and extensive documentation of the damage to the Insurer which clearly shows the Insured’s roof systems must be completely replaced. To date, the Insurer failed to provide timely and prompt payment for the Insured’s damages, nevertheless, make a timely coverage determination.
To date, the Insured performed all conditions precedent required of it under the
subject insurance policy with the Insurer and under Florida law. However, the Insurer, its agents and retained counsel have failed and refused to properly investigate, adjust and pay the Insured’s hurricane/windstorm damage claim and failed to tender all insurance proceeds due and owing to the Insured under the subject insurance policy. Due to the Insurer's intentional delay of the Insured’s hurricane/windstorm damage claim, the Insured was forced to obtain legal counsel at a significant cost and expense to attempt to recover what it is legally owed under its insurance policy with the Insurer.
The concept of insurance is that it is the insurer's granting of timely and prompt indemnity or security against a contingent loss. Fla. Stat. § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insured’s may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. The Insurer failed to comply with its duty to indemnify the Insured.
The Insurer failed and refused to timely investigate, adjust and pay the Insured’s hurricane/windstorm damage claim. The Insurer failed and refused to pay any insurance proceeds to date owed to the Insured as required by the insurance policy and Florida law. Refusal and failure to pay the Insured’s hurricane/windstorm damage claim, when under all the circumstances it could have and should have done so had it acted fairly and honestly towards the Insured is a clear breach of the insurance policy and a violation of Florida Law. Furthermore, the Insurer obtained information related to the hurricane/windstorm damage of the Insured’s Buildings and roof systems from Intertek, which it has intentionally withheld from the Insured.
Based on the foregoing actions and omissions, the Insurer engaged in wrongful claims handling conduct, including but not limited to, the following:
1. Improper and untimely claim denial;
2. Improper claim delays;
3. Failure to respond to communications from its Insured within fourteen days;
4. Not conducting a full and fair investigation of the Insured’s claim;
5. Looking for ways to deny recovery to the Insured;
6. Looking for ways to delay recovery to the Insured;
7. Failing to pay the necessary amounts due and owing to restore the Insured’s buildings and roof systems to their pre-loss condition;
8. Not adjusting the claim and not evaluating the loss properly, promptly and fairly so as to provide full and prompt indemnity to its Insured;
9. Failing to implement proper standards for the adjustment and investigation of insurance claims;
10. Failing to pay the requisite monies owed for the Insured’s loss, despite receipt of supporting documentation;
11. Failing to share its damage estimates and reports from Intertek with the Insured;
12. Not training, supervising or managing adjusters and independent contractors properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholders’ interests by attempting to deny or minimize payments owed;
13. Establishing severity control initiatives and otherwise establishing a culture of not fully and promptly paying claims following losses.
The Insurer violated the statutes set forth above based on the conduct described herein. The Insurer failed and refused to timely tender insurance proceeds required by its insurance policy with its Insured. In addition, the Insurer failed to reasonably and properly settle and resolve the Insured’s hurricane/windstorm damage claim for money damages when under all
the facts and circumstances, it could have and should have done so if it had acted fairly and honestly towards its Insured. The Insurer's improper actions are well documented and have occurred with such frequency as to constitute a general business practice and were made in a reckless disregard for its Insured’s rights. The Insurer placed its interest above and before the Insured’s interest in this matter.
Therefore, to cure the defects outlined in this Civil Remedy Notice, the Insurer must do the following:
A. Immediately pay the Insured’s hurricane/windstorm damage claim in the amount of the Mr. James’ damage estimate of $1,131,064.66, plus interest, less the applicable deductible.
B. Agree to tender any recoverable depreciation once it has been incurred per the terms of the insurance policy.
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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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