Filing Number: 794125
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| Filing Accepted: 11/25/2024 |
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POWER
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First Name |
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TED AND LESLIE |
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| Street Address
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1165 TAHITI PARKWAY |
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SARASOTA,
FL
34236
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| Email Address
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COACHTP@COMCAST.NET |
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Insured |
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| Last/Business Name* |
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POWER |
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First Name |
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TED AND LESLIE |
| Policy # * |
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PFL410181-04 |
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Claim #* |
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CFL24604542 |
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Attorney is Applicable
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| Last Name* |
ROSS
First Name *
VANESSA
Initial
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| Street Address* |
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1800 2ND STREET, SUITE 892 |
| City, State Zip* |
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SARASOTA
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FLORIDA
34236
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| Email Address * |
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ESERVICE@ROSSLEGALFL.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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PEOPLE'S TRUST INSURANCE COMPANY
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,
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NAIC Company Code 13125 |
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| Name of individual responsible for violation (if any):*
MARCUS ELLS FL LICENSE #G040080, AND ALL OTHER ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY PEOPLE'S TRUST INSURANCE COMPANY INVOLVED IN THE CLAIM.
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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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Claim Delay
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Unfair Trade Practice
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Other
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Other: Failure to properly investigate claim and with due regard to the Insured’s interest
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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)(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)(4) |
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Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
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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.
ADD’L STATUTES VIOLATED
§627.70131(7)(a)
Within 60 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer. The insurer shall provide a reasonable explanation in writing to the policyholder of the basis in the insurance policy, in relation to the facts or applicable law, for the payment, denial, or partial denial of a claim. If the insurer’s claim payment is less than specified in any insurer’s detailed estimate of the amount of the loss, the insurer must provide a reasonable explanation in writing of the difference to the policyholder. Any payment of an initial or supplemental claim or portion of such claim made 60 days after the insurer receives notice of the claim, or made after the expiration of any additional timeframe provided to pay or deny a claim or a portion of a claim made pursuant to an order of the office finding factors beyond the control of the insurer, whichever is later, bears interest at the rate set forth in s. 55.03. Interest begins to accrue from the date the insurer receives notice of the claim. The provisions of this subsection may not be waived, voided, or nullified by the terms of the insurance policy. If there is a right to prejudgment interest, the insured must select whether to receive prejudgment interest or interest under this subsection. Interest is payable when the claim or portion of the claim is paid. Failure to comply with this subsection constitutes a violation of this code. However, failure to comply with this subsection does not form the sole basis for a private cause of action.
SPECIFIC POLICY LANGUAGE
The Insured(s) may not be in possession of a complete copy the applicable policy of insurance, however, the specific policy language relevant to the violations outlined below is contained within People's Trust Insurance Company’s policy, Policy No. PFL410181-04 (“Policy”), issued to the Insured including, but is not limited to, the following:
Dwelling Coverage provisions
SECTION I - PROPERTY COVERAGES (PTIC P003 0323)
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".
***
B. Coverage B - Other Structures
1. We cover other structures, when premium for Coverage B is shown on the Declarations
page, 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.
***
C. Coverage C - Personal Property
1. Covered Property
We cover personal property, when premium for Coverage C is shown on the Declarations
page, owned or used by an "insured" while it is anywhere in the world. After a loss and at
your request, we will cover personal property owned by:
a. Others while the property is on the part of the "residence premises" occupied by an
"insured"; or
b. A guest or a "residence employee", while the property is in any residence occupied
by an "insured".
***
D. Coverage D - Loss Of Use
The limit of liability for Coverage D is the total limit for the coverages in 1. Additional Living
Expense, 2. Fair Rental Value and 3. Civil Authority Prohibits Use below.
1. Additional Living Expense
If a loss covered under Section I makes that part of the "residence premises" where you
reside not fit to live in, we cover any necessary increase in living expenses incurred by
you so that your household can maintain its normal standard of living.
***
3. Civil Authority Prohibits Use
If a civil authority prohibits you from use of the "residence premises" as a result of direct
damage to neighboring premises by a Peril Insured Against, we cover the loss as provided
in 1. Additional Living Expense and 2. Fair Rental Value above for no more than two (2)
weeks.
***
E. Additional Coverages
1. Debris Removal
a. We will pay your reasonable expense for the removal of:
(1) Debris of covered property if a Peril Insured Against that applies to the damaged
property causes the loss; or
(2) Ash, dust or particles from a volcanic eruption that has caused direct loss to a
building or property contained in a building.
This expense is included in the limit of liability that applies to the damaged property.
If the amount to be paid for the actual damage to the property plus the debris removal
expense is more than the limit of liability for the damaged property, an additional five
percent (5%) of that limit is available for such expense.
b. With regard to damage to covered structures, we will also pay your reasonable
expense, up to $1,000, for the removal from the "residence premises" of:
(1) Your trees felled by the peril of Windstorm or Hail;
(2) Your trees felled by the peril of Weight of Ice, Snow or Sleet; or
(3) A neighbor's tree(s) felled by a Peril Insured Against under Coverage C;
provided the trees damage a covered structure. The $1,000 limit is the most we will
pay in any one loss, regardless of the number of fallen trees. No more than $500 of
this limit will be paid for the removal of any one tree. This coverage is additional
insurance.
2. Reasonable Repairs
a. We will pay the reasonable cost incurred by you for the necessary measures taken
solely to protect covered property that is damaged by a Peril Insured Against from
further damage.
b. If the measures taken involve repair to other damaged property, we will only pay if
that property is covered under this policy and the damage is caused by a Peril Insured
Against. This coverage does not:
(1) Increase the limit of liability that applies to the covered property; or
(2) Relieve you of your duties, in case of a loss to covered property, described in C.4
(1) under Section I - Conditions.
***
11. "Fungi", Wet Or Dry Rot, Or Bacteria
a. We will pay up to $10,000 for:
(1) The total of all loss payable under Section I - Property Coverages caused by
"fungi", wet or dry rot, or bacteria;
(2) The cost to remove "fungi", wet or dry rot, or bacteria from property covered
under Section I - Property Coverages;
(3) The cost to tear out and replace any part of the building or other covered
property as needed to gain access to the "fungi", wet or dry rot, or bacteria;
(4) The cost of testing of air or property to confirm the absence, presence or level
of "fungi", wet or dry rot, or bacteria, whether performed prior to, during or after
removal, repair, restoration or replacement; the cost of such testing will be
provided only to the extent that there is a reason to believe that there is the
presence of "fungi", wet or dry rot, or bacteria.
b. The coverage described in a. only applies when such loss or costs are a result of a
Peril Insured Against that occurs during the policy period and only if all reasonable
means were used to save and preserve the property from further damage at and after
the time the Peril Insured Against occurred.
c. $10,000 is the most we will pay for the total of all loss or costs payable, including Loss
of Use under this Additional Coverage regardless of the:
(1) Number of locations insured; or
(2) Number of claims made.
d. If there is covered loss or damage to covered property not caused, in whole or in part,
by "fungi", wet or dry rot, or bacteria, loss payment will not be limited by the terms
of this Additional Coverage, except to the extent that "fungi", wet or dry rot, or bacteria
cause an increase in the loss or any Loss of Use. Any such increase in the loss or
Loss of Use will be subject to the terms of this Additional Coverage.
This coverage does not increase the limit of liability applying to the damaged covered
property.
12. Ordinance Or Law
a. You may use up to twenty-five percent (25%) of the limit of liability that applies to
Coverage A for the increased costs you incur due to the enforcement of any ordinance
or law which requires or regulates:
(1) The construction, demolition, remodeling, renovation or repair of that part of a
covered building or other structure damaged by a Peril Insured Against;
(2) The demolition or reconstruction of the undamaged part of a covered building or
other structure, when that building or other structure must be totally demolished
because of damage by a Peril Insured Against to another part of that covered
building or other structure; or
(3) The remodeling, removal or replacement of the portion of the undamaged part of
a covered building or other structure necessary to complete the remodeling, repair
or replacement of that part of the covered building or other structure damaged by
a Peril Insured Against.
b. You may use all or part of this ordinance or law coverage to pay for the increased
costs you incur to remove debris resulting from the construction, demolition,
remodeling, renovation, repair or replacement of property as stated in a. above.
c. We do not cover:
(1) The loss in value to any covered building or other structure due to the
requirements of any ordinance or law; or
(2) The cost to comply with any ordinance or law which requires any "insured" to test
for, monitor, clean up, remove, contain, treat, detoxify, or neutralize, or any way
respond to or assess the effects of pollutants in or on any covered buildings or
other structures.
Pollutants means any solid, liquid, gaseous or thermal irritant or contaminant,
including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste
includes materials to be recycled, reconditioned or reclaimed.
This coverage is additional insurance.
***
SECTION I - PERILS INSURED AGAINST (PTIC P003 0323)
A. Coverage A - Dwelling And Coverage B - Other Structures
1. We insure against direct physical loss to property described in Coverages A and B.
***
B. Coverage C - Personal Property
We insure for direct physical loss to the property described in Coverage C caused by any
of the following perils unless the loss is excluded in Section I - Exclusions.
***
2. Windstorm Or Hail
This peril includes loss to watercraft of all types and their trailers, furnishings, equipment,
and outboard engines or motors, only while inside a fully enclosed building.
This peril does not include loss to the property contained in a building caused by rain,
snow, sleet, sand or dust unless the direct force of wind or hail damages the building
causing an opening in a roof or wall and the rain, snow, sleet, sand or dust enters through
this opening.
***
SECTION I - CONDITIONS
B. Deductible
Unless otherwise noted in this policy, the following deductible provision applies:
With respect to any one loss:
1. Subject to the applicable limit of liability, we will pay only that part of the total of all loss
payable that exceeds the deductible amount shown in the Declarations.
2. If two or more deductibles under this policy apply to the loss, only the highest deductible
amount will apply.
C. Duties After Loss
In case of a loss to covered property, we have no duty to provide coverage under this policy
if you fail to comply with the following duties. These duties must be performed either by you,
an "insured" seeking coverage, or a representative of either:
1. Give prompt notice to us or our agent;
2. Notify the police in case of loss by theft, vandalism or malicious mischief;
3. Notify the credit card or electronic fund transfer card or access device company in case
of loss as provided for in 6. Credit Card, Electronic Fund Transfer Card Or Access Device,
Forgery And Counterfeit Money under Section I - Additional Coverages;
4. Protect the property from further damage. If repairs to the property are required, you must:
a. Make reasonable and necessary repairs to protect the property; and
b. Keep an accurate record of repairs to the extent reasonably possible, including
documentation showing the condition of the dwelling before you commenced repairs,
and further provide repair expenses.
5. Cooperate with us in the investigation of a claim;
6. Prepare an inventory of damaged personal property showing the quantity, description,
actual cash value and amount of loss. Attach all bills, receipts and related documents that
justify the figures in the inventory;
7. As often as we reasonably require:
a. Show us the damaged property to the extent reasonably possible;
b. Provide us with records and documents we request and permit us to make copies;
c. You and any "insured" must submit to recorded statements when requested by us;
d. In the County where the "residence premises" is located, you, your agents, your
representatives and any and all insureds must submit to examinations under oath and
sign the same when requested by us;
At your request, the examinations will be conducted separately and not in the presence
of any other persons except legal representation;
e. Permit us to take samples of damaged and undamaged property for inspection,
testing, and analysis; and
f. Any and all insureds must execute all authorizations for the release of information
when requested by us.
8. Send to us, within sixty (60) days after our request, your signed, sworn proof of loss which
sets forth, to the best of your knowledge and belief:
a. The time and cause of loss;
b. The interests of all "insureds" and all others in the property involved and all liens on
the property;
c. Other insurance which may cover the loss;
d. Changes in title or occupancy of the property during the term of the policy;
e. Specifications of damaged buildings and detailed repair estimates;
f. The inventory of damaged personal property described in C.6. above;
g. Receipts for additional living expenses incurred and records that support the fair rental
value loss; and
h. Evidence or affidavit that supports a claim under 6. Credit Card, Electronic Fund
Transfer Card Or Access Device, Forgery And Counterfeit Money under Section I -
Additional Coverages, stating the amount and cause of loss.
D. Loss Settlement
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; and
c. Structures that are not buildings;
at actual cash value at the time of loss but not more than the amount required to repair
or replace.
***
K. 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 on the earliest of the
following:
1. Twenty (20) days after we receive your proof of loss and we reach written agreement
with you;
2. Sixty (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"; or
3. If payment is not denied, within sixty (60) days after we receive notice of an initial claim,
"reopened claim", or "supplemental claim". However, this provision (K 3.) does not apply
if factors beyond our control reasonably prevents such payment.
Our failure to comply with this paragraph shall not form the sole basis for an action against us
for breach of contract under this policy or for benefits under this policy.
***
S. Notice of Claims
Any claim or "reopened claim", but not a "supplemental claim", under an insurance policy that
provides property insurance for loss or damage caused by any peril is barred unless notice of
the claim is given to us in accordance with the terms of this policy and within one year after
the date of loss. A "supplemental claim" is barred unless notice of the "supplemental claim"
was given to us in accordance with the terms of this policy and within eighteen months after
the date of loss.
For claims resulting from hurricanes, tornadoes, windstorms, severe rain, or other weatherrelated
events, the date of loss is the date that the hurricane made landfall or the tornado,
windstorm, severe rain, or other weather-related event is verified by the National Oceanic and
Atmospheric Administration (NOAA).
This condition concerning time for submission of claim does not affect any limitation for legal
action against us as provided in this policy under the Suit Against Us Condition including any
amendment to that condition.
The Notice of Claims time for submission sets the cutoff deadline for providing Notice of Claim
and does not affect your obligations under the terms of the policy, including but not limited to
compliance with the policy's Duties After Loss provision by providing prompt notice of the
claim.
NOTICE OF CHANGE IN POLICY TERMS (PTIC NOCPT 0323)
SECTION I - PROPERTY COVERAGES
The part of your policy that describes SECTION I - PROPERTY COVERAGE has been
revised. Please review your policy language carefully.
Coverage A - Dwelling
A.2. has been revised to add that we do not cover "solar panel(s)", "solar roof(s)", or "solar
water heating system(s)" or any of their components such as, but not limited to, pipes supplying
and returning water to "solar panel(s)", inverters, batteries, mounting poles, mounting brackets,
or interconnecting wiring associated with "solar panel(s)", "solar roof(s)", and/or "solar water
heating system(s)", all whether attached to the dwelling or not, including the cost to remove,
reset and/or replace "solar panel(s)", "solar roof(s)", and/or "solar water heating system(s)",
whether affecting repairs to covered property to which it is attached or not.
Coverage B - Other Structures
B.2. has been revised to add that we do not cover "solar panel(s)", "solar roof(s)", or "solar
water heating system(s)" or any of their components such as, but not limited to, pipes supplying
and returning water to "solar panel(s)", inverters, batteries, mounting poles, mounting brackets,
or interconnecting wiring associated with "solar panel(s)", "solar roof(s)", and/or "solar water
heating system(s)", all whether attached to the dwelling or not, including the cost to remove,
reset and/or replace "solar panel(s)", "solar roof(s)", and/or "solar water heating system(s)",
whether affecting repairs to covered property to which it is attached or not.
***
SECTION I - CONDITIONS
The part of your policy that describes SECTION I - CONDITIONS has been revised.
Please review your policy language carefully.
Duties After Loss has been revised to clarify that in the case of a loss to covered property, we
have no duty to provide coverage under this policy if you fail to comply with the duties listed
within the provision.
A new provision has been added to Loss Settlement which provides that the policy does not
provide coverage for and expressly excludes any payment for expenses of engineering reports,
professional services, or other expert opinions, reports, or estimates to establish and/or
determine the cause of loss or the amount of loss rendered by professionals including, but not
limited to appraisers, inspectors, contractors, plumbers, consultants, estimators, roofers, or
engineers paid for or ordered by your or any "insured" or any representative acting on your or
any insured's behalf, unless we first request or approve the report, service, or other opinion.
Item 3. of Loss Payment has been revised to provide that loss will be payable within sixty (60)
days after we receive notice of an initial claim, "reopened claim", or "supplemental claim" if
payment is not denied. However, this provision (K 3.) does not apply if factors beyond our
control reasonably prevents such payment.
Notice of Claims has been revised to provide that any claim or "reopened claim" under an
insurance policy that provides property insurance for loss or damage caused by any peril is
barred unless notice of the claim is given to us in accordance with the terms of this policy and
within one year after the date of loss. A "supplemental claim" is barred unless notice of the
"supplemental claim" was given to us in accordance with the terms of this policy and within
eighteen months after the date of loss.
***
CHANGES TO ENDORSEMENTS
The Endorsements described below have changed. Please review your policy Endorsements
carefully.
PREFERRED CONTRACTOR ENDORSEMENT (PTIC E023)
The Preferred Contractor Endorsement allows "us" at our option to select Rapid Response Team,
LLC ® to perform emergency or other mitigation services or to make covered repairs to your
dwelling or other structures. "You" agree that in the event of a covered loss to your dwelling or
other structures on the "residence premises," other than a sinkhole loss, "we" at our option may
select Rapid Response Team, LLC ® to repair your damaged property as provided by the policy
and its endorsements. This endorsement does not reduce the applicable deductible(s) under the
policy. "You" will be responsible for paying the amount of the deductible(s) to Rapid Response
Team, LLC ® prior to the start of repairs. No repairs shall proceed prior to "you" paying the
applicable deductible(s).
This endorsement changes the "Reasonable Repair'' provision in Section I - Property
Coverages, Additional Coverages E. The endorsement also revises the following Section I -Conditions:
Duties After Loss, Loss Settlement, Suit Against Us, and Our Option. The
endorsement adds provisions relating to Loss Payment, Appraisal, and Our Duties After Loss.
All of the provisions of your policy that are not affected by this endorsement remain unchanged.
Please review your Preferred Contractor Endorsement carefully.
***
PREFERRED CONTRACTOR ENDORSEMENT (PTIC E023 0422)
THIS ENDORSEMENT CHANGES YOUR POLICY. PLEASE READ IT CAREFULLY.
THIS ENDORSEMENT DOES NOT APPLY TO SINKHOLE CLAIMS.
In consideration of the premium credit shown on "your" Declarations Page, "you" agree to the following:
THIS ENDORSEMENT ALLOWS US AT OUR OPTION TO SELECT RAPID RESPONSE TEAM, LLC™
TO MAKE COVERED REPAIRS TO YOUR DWELLING OR OTHER STRUCTURES.
"You" agree that in the event of a covered loss to "your" dwelling or other structures on the "residence
premises", other than a sinkhole loss, "we" at our option may select Rapid Response Team, LLC™ to
repair "your'' damaged property as provided by the policy and its endorsements.
This endorsement does not reduce the applicable deductible under the policy. "You" will be responsible
for paying the amount of the deductible to Rapid Response Team, LLC™.
In addition, the following provisions of the policy and its endorsements where applicable, are changed:
DEFINITIONS
The following definitions are added:
"Tropical Storm Occurrence" A "tropical storm occurrence":
a. Begins at the time a tropical storm watch or warning is issued for any part of Florida by the
National Hurricane Center of the National Weather Service;
b. Continues for the time period during which the tropical storm conditions exist anywhere in
Florida; and
c. Ends seventy-two (72) hours following the termination of the last tropical storm watch or tropical
storm warning issued for any part of Florida by the National Hurricane Center of the National
Weather Service.
"PCS Event" A "PCS event" means a weather event that is assigned a catastrophe number by the
Insurance Services Office, Inc. Property Claims Services.
"Weather Event" A "weather event" is a "hurricane occurrence", "tropical storm occurrence" or "PCS
event".
SECTION I - PROPERTY COVERAGES
E. Additional Coverages
2. Reasonable Repairs is deleted and replaced by the following for losses other than sinkhole:
a. If a peril causing a loss and related damage are covered ( other than sinkhole loss) and
emergency or other mitigation services are necessary to protect covered property
from further damage, "you" must notify "us" before authorizing or commencing such
services so that "we", at our option, may select Rapid Response Team, LLC™ to
perform the emergency or other mitigation services.
b. If "you" do not notify "us" and allow "us", at our option, to select Rapid Response Team,
LLC™ to perform the emergency or other mitigation services, "our" obligation
arising from the rendition of such services performed to protect the covered
property from further damage is limited to the lesser of the following:
(1) The reasonable cost "you" incur and for which "you" are contractually obligated to
any third parties for necessary services rendered solely to protect the property from
further damage; or
(2) The amount "we" would have paid to Rapid Response Team, LLC™ for necessary
services rendered solely to protect the covered property from further damage.
This coverage does not increase the limit of liability that applies to the covered property. In no event
does this endorsement obligate "us" to pay any amounts to "you" or ''your" own contractor for repairs and
restoration of the insured dwelling or property under SECTION I - PROPERTY COVERAGES A
Coverage A - Dwelling and B. Coverage B - Other Structures other than as set forth above.
SECTION I - CONDITIONS
C. Duties After Loss
4. a. and b. are deleted and replaced by the following for losses other than sinkhole:
4. Protect the property from further damage. If repairs to the property are required, or if the services of
a contractor are required to protect the property from further damage, "you" must:
a. Notify "us" before authorizing or commencing the repairs or the services so "we", at our
option, may select Rapid Response Team, LLC™ to make covered repairs or perform the
services; and
b. Keep an accurate record of repair expenses;
If "you" do not notify "us" prior to authorizing or commencing the Reasonable Repairs as described
in SECTION I - PROPERTY COVERAGE E. Additional Coverages and allow "us" at our option to
select Rapid Response Team, LLC™ for such Reasonable Repairs, "our'' obligation for the
Reasonable Repairs is limited to the lesser of the following:
a. The reasonable cost "you" incur for necessary Reasonable Repairs; or
b. The amount "we" would have paid to Rapid Response Team, LLC™ selected
by "us" for necessary Reasonable Repairs.
D. Loss Settlement, 2. d. the following is revised:
d. If "we" do not elect to repair, "we" will initially pay at least the actual cash value of
the insured loss less any applicable deductible. "We" will then pay the necessary
amounts actually spent to repair or replace the damaged building as work is performed
and expenses are incurred. If a total loss of the covered dwelling occurs, if "we" do not
elect to repair, "we" shall pay the replacement cost coverage without reservation of any
depreciation in value, subject to policy limits.
I. Suit Against Us is deleted and replaced with the following:
If you and we fail to agree on a settlement, the amount of loss, or scope of repairs, you must notify
us of your disagreement in writing at least 10 business days prior to filing suit. You must also
provide the Department of Financial Services with written notice of your intent to initiate litigation at
least 10 business days before filing suit under the policy, in accordance with Section 627. 70152,
Florida Statutes.
No action can be brought against us unless there has been full compliance with all of the terms
under this policy and the action is started within five (5) years after the date of loss.
J. Our Option is deleted and replaced with the following:
At our option:
1. For losses settled on an actual cash value basis, we may repair or replace any part of the
damaged property with material or property of like kind and quality.
2. For losses covered under Coverage A - Dwelling, insured for Replacement Cost Loss
Settlement as outlined in SECTION I - CONDITIONS, Loss Settlement, we may repair the
damaged property with material of like kind and quality without deduction for depreciation.
3. We will send written notice to you no later than thirty (30) days after our inspection of the
reported loss, unless factors beyond our control reasonably prevent "us" from doing so.
However, following a "hurricane occurrence" or multiple "weather events" within a sixty (60)
day period, we will send written notice to you no later than sixty (60) days after our inspection
of the reported loss, unless factors beyond our control reasonably prevent "us" from doing so.
4. You must comply with the duties described in SECTION I - CONDITIONS, C. 6 and 7.
5. You must provide access to the property and execute any necessary municipal, county or
other governmental documentation or permits for repairs to be undertaken.
6. You must execute all work authorizations to allow our preferred contractors and any
subcontractors and related parties entry to the property. The signed form must specify the
insured's identification of the estimated scope of repair for purposes of restoring the insured
dwelling.
7. You must otherwise cooperate with repairs to the property. If non-covered damage(s) to the
dwelling are your responsibility and the covered damage is resulting from the non-covered
damage(s), including but not limited to roof repairs, such damage shall be repaired in
compliance with local and state governmental regulations and in a workmanlike manner prior
to commencement of covered repairs. Any dispute as to the amount of loss, including scope of
covered repairs shall be resolved as provided by the policy and its endorsements.
8. You are responsible for payment of the deductible(s) stated in your Declarations page directly
to our preferred contractor. With respect to repairs made under Coverage A or B, the
deductible(s) must be paid prior to repairs commencing. No repairs shall proceed prior to you
paying the applicable deductible(s).
9. Our right to repair or replace, and our decision to do so, is a material part of this contract and
under no circumstances relieves you or us of our mutual duties and obligations under this
contract. Our acceptance of your estimated scope of repair shall be binding upon the parties for
purposes of restoring the insured dwelling.
1 0. You and we must cooperate with alternate scope dispute resolution as to loss to property
arising under Coverage A or B, including but not limited to Department of Financial Services
mediation, demand for appraisal and all related duties, or either party's acceptance of a
dwelling estimate or scope of proposed repair(s) furnished by either party to the other for
consideration and acceptance.
11. Any "action" or assertion of a claim for loss as a result of a "construction defect" arising from
the repairs or restoration services performed by our preferred contractor, its subcontractors,
suppliers, or design professionals under this endorsement is subject to certain notice and cure
requirements as set forth in this Preferred Contractor Endorsement.
There are important requirements that must be complied with before an "action" asserting a
claim of loss caused by an alleged "construction defect" can be filed:
a. At least sixty (60) days before filing an "action", "you" must serve our preferred
contractor with a written notice of claim that describes in reasonable detail the nature of
each alleged "construction defect" and the damage or loss resulting from the defect.
b. Within thirty (30) days of receipt of the notice of claim, our preferred contractor is entitled
reasonable access to inspect the property to determine the nature and cause of the
alleged "construction defects", and the nature and extent of any repairs or replacements
necessary to remedy the defects.
c. Within forty-five (45) days after service of the notice of claim, our preferred contractor
must serve a written response to the notice. The written response must provide:
(1) an offer to remedy the alleged "construction defect" at no cost to the claimant, a
detailed description of the proposed repairs necessary to remedy the defect, and
a timetable for the completion of such repairs;
(2) an offer to compromise and settle the claim by monetary payment and a
timetable for making payment;
(3) an offer to compromise and settle the claim by a combination of repairs and
monetary payment that includes a detailed description of the proposed repairs
and a timetable for the completion of such repairs and making payment; or
(4) a statement that our preferred contractor disputes the claim and will not remedy
the defect or compromise and settle the claim.
The response shall be served to the attention of the person who signed the notice of
claim, unless otherwise designated in the notice of claim.
d. Within forty-five (45) days of receiving the offer, "you" must serve written notice of
acceptance or rejection of the written offer. "You" are not obligated to accept the written
offer. The deadlines and procedures described in this Preferred Contractor Endorsement
must be followed to protect "your" rights as a property owner.
For purposes of 11. including a. through d. above, the term:
"Action" means any civil action or arbitration proceeding for damages or indemnity asserting a
claim for damage to or loss of real or personal property caused by an alleged "construction
defect", but does not include any administrative action or any civil action or arbitration
proceeding asserting a claim for alleged personal injuries arising out of an alleged "construction
defect".
"Construction defect" means a deficiency in, or a deficiency arising out of, the design,
specifications, surveying, planning, supervision, observation of construction, or construction,
repair, alteration, or remodeling of the real property resulting from:
(a) Defective material, products, or components used in the construction or remodeling;
(b) A violation of the applicable codes in effect at the time of construction or remodeling
which gives rise to a cause of action pursuant to Section 553.84, Florida Statutes;
(c) A failure of the design of real property to meet applicable professional standards of care
at the time of the governmental approval; or
(d) A failure to construct or remodel the real property in accordance with accepted trade
standards for good and workmanlike construction at the time of construction.
K. Loss Payment, the following is added:
4. When "we" have exercised our option to repair "your'' damaged property pursuant to this Preferred
Contractor Endorsement, "we" will repair the damaged property with material of like kind and
quality without deduction for depreciation. Such repair is in lieu of issuing any loss payment that
would otherwise be due under the policy.
S. Appraisal, the following is added to the policy:
Where "we" elect to repair:
1. If "you" and "we" fail to agree on the amount of loss, which includes the scope of repairs, either may
demand an appraisal as to the amount of loss and the scope of repairs. In this event, each party will
choose a competent appraiser within 20 days after receiving a written request from the other. The
two appraisers will choose an umpire. If they cannot agree upon an umpire within 15 days, "you" or
"we" may request that the choice be made by a judge of a court of record in the state where the
"residence premises" is located. The appraisers will separately set the amount of loss and scope of
repairs. If the appraisers submit a written report of an agreement to "us", the amount of loss and
scope of repairs agreed upon will be the amount of loss and scope of repairs. If they fail to agree,
they will submit their differences to the umpire. A decision agreed to by any two will set the amount
of loss and the scope of repairs. Each party will pay its own appraiser, and bear the other expenses
of the appraisal and umpire equally.
2. The scope of repairs shall establish the work to be performed and completed by Rapid Response
Team, LLC™. Such repair is in lieu of issuing any loss payment to "you" that otherwise would be
due under the policy. The amount of loss shall establish only the initial amount paid to Rapid
Response Team, LLC™ by "us", and any additional amounts required to complete repairs shall be
"our'' responsibility and will be paid to Rapid Response Team, LLC™ without regard to policy limits
or the amount of initial payments.
3. If "we" demanded mediation under Condition G. Mediation of Section I - Conditions and either party
rejects the mediation results, "you" are not required to submit to, or participate in, any appraisal of
the loss as a precondition to an action against us.
T. Our Duties After Loss, the following section is added to the policy:
Our duties after loss pertaining to commencement and performance of repairs are as follows:
1. Upon establishment of final scope of repair, "we" will instruct Rapid Response Team, LLC™
to furnish "you" with written documentation of current licensure as required by any applicable
local, municipal, county, state, federal or governmental authority's ordinances, statutes or
regulations.
2. Upon establishment of final scope of repair, "we" will instruct Rapid Response Team, LLCTM to
furnish "you" with written documentation of current workers' compensation insurance and
commercial general liability coverage with policy limits of no less than $1,000,000, or in a greater
amount as may be required by any applicable municipal, county, state or federal ordinances,
statutes or regulations.
'We" may, at our option, assist Rapid Response Team, LLC™ by providing the documentation.
All of the provisions of your policy that are not affected by this endorsement remain unchanged.
***
Perils Insured Against
Loss Payment
Loss Settlement
Please advise if there are other applicable policy provisions that are not cited above but would provide coverage to the Insured for the October 9, 2024, windstorm loss.
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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. People's Trust Insurance Company (“PTIC”) has breached the public’s trust by its adjustment of Ted Power and Leslie Power (“MR. AND MRS. POWER”) claim of loss. People's Trust Insurance Company’s mailing address is 18 People's Trust Way, Deerfield Beach, FL 33441.
PTIC 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. PTIC has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the MR. AND MRS. POWER’S insurance claim for damages.
PTIC has failed to promptly settle MR. AND MRS. POWER’S insurance claim when the obligation to settle the insurance claim had become reasonably clear. To date, notwithstanding MR. AND MRS. POWER’S pleas otherwise, PTIC has continued to refuse to acknowledge its obligation to conduct a proper investigation, and to tender the full amount of insurance monies due and owing its MR. AND MRS. POWER under the policy.
This claim involves MR. AND MRS. POWER’S property located at 1165 Tahiti Parkway, Sarasota, FL 34236 which sustained significant damage from wind and ensuing damages as a result of Hurricane Milton on or about October 9, 2024.
On or about October 9, 2024, Hurricane Milton struck the state of Florida, and made landfall as a Category 3 on the barrier island of Siesta Key in Sarasota County, Florida. MR. AND MRS. POWER were victims of Hurricane Milton’s destruction and subsequently incurred wind damage and ensuing losses to their home located in Sarasota County as a result of Hurricane Milton. MR. AND MRS. POWER’S home suffered extensive wind damage to the metal roof system. This allowed water intrusion into the home, causing interior damage throughout the home. MR. AND MRS. POWER timely notified INSURER of the damages and opened a claim pursuant to the terms and conditions of the Policy.
To date, notwithstanding MR. AND MRS. POWER’s pleas, PTIC has continued to refuse to acknowledge its obligation to acknowledge and pay the full amount of its MR. AND MRS. POWER’s claim.
This complaint is made on behalf of MR. AND MRS. POWER, Ted Power and Leslie Power (“MR. AND MRS. POWER”). Further, this complaint is a statement that notice is hereby given in order to perfect the right to pursue the civil remedy authorized and pursuant to Florida Statute §624.155.
In consideration of the premium paid to it by MR. AND MRS. POWER, People’s Trust Insurance Company issued an Homeowners policy, Policy No. PFL410181-04 (hereinafter referred to as “the Policy”), to MR. AND MRS. POWER wherein the insurance policy provided coverage for all losses, including wind, except those losses which were expressly excluded.
The policy was in full force and effect at the time the damage occurred as a result of wind, and the ensuing damages as a direct result thereof, to the insured premises located at 1165 Tahiti Parkway, Sarasota, FL 34236, on or about October 9, 2024.
On or about October 9, 2024, MR. AND MRS. POWER’S property sustained interior and exterior damages as a result of wind and ensuing damages as a result of Hurricane Milton.
On October 10, 2024, MR. AND MRS. POWER timely notified PTIC of the loss and known damages and opened a claim pursuant to the Policy. In response, PTIC assigned the claim to its representative MARCUS ELLS FL License #G040080 to adjust and investigate the loss, as well as a field adjuster to inspect the damages.
Under Form E023 04/22, PTIC invoked the preferred contractor endorsement of the policy to provide emergency services and tarping to MR. AND MRS. POWER insured property.
PTIC’S representative visited the insured property and performed a cursory and inadequate investigation of the damaged property.
On October 16, 2024, PTIC provided MR. AND MRS. POWER with an estimate of damages to their insured property which totaled $14,288.49 (RCV)/$14,002.82 (ACV). See attached, Carrier Estimate 10.16.24, and advised MR. AND MRS. POWER payment in the amount of $2,100.82 would be issued.
On October 16, 2024, MR. AND MRS. POWER contacted a roofing professional, Kingdom Roofing, to visit the property and assess the storm-related damage. During their visit, the roofing company determined that the roof required a full replacement.
Concerned PTIC has no intention of fairly and honestly adjusting their loss, MR. AND MRS. POWER retained the services of the undersigned to assist in adjusting their loss directly with PTIC.
On November 4, 2024, MR. AND MRS. POWER’s counsel advised PTIC MR. AND MRS. POWERS home was in need of emergency mitigation services and MR. AND MRS. POWER had not received a response from PTIC’S preferred vendor program, Rapid Response Team. In correspondence dated November 4, 2024, PTIC issued its coverage determination letter which stated payment in the amount of $2,100.82 would be issued based on the October 16, 2024, estimate. The estimate opened coverage to MR. AND MRS POWER’S exterior, fence, roof, gutters, downspouts, soffit, and fascia; and interior drywall, finishing, insulation, to the master bedroom and master bathroom.
The same day, at approximately 4:57 pm ET, PTIC forwarded MR. AND MRS. POWER’S counsel an estimate dated October 24, 2024, Variation Report, notice of right to mediate, and a mediation brochure. See attached, Coverage Determination 11.05.24.
On November 5, 2024, PTIC provided an estimate dated October 24, 2024, Variation Report, notice of right to mediate, and a mediation brochure, and its coverage determination letter dated November 4, 2024, which stated:
“Enclosed, please find our itemized estimate describing the work needed to return your covered damages to pre-loss condition prepared by the field adjuster who inspected your property. Per that estimate, the amount of covered damages totals $14,002.82 measured at Actual Cash Value. Your policy carries an applicable deductible of $11,902.00. Applying that deductible to the estimate leaves your net compensable damages at $2,100.82. Should you submit documentation sufficiently showing you incurred costs to repair your covered damages, we will issue additional payment for withheld depreciation, bringing the payment to Replacement Cost Value. Please find the following enclosed loss payment(s) for your Claim:
Property Coverage Amount
Coverage A – Dwelling (Actual Cash Value) $14,002.82
Less your applicable deductible amount – $11,902.00
TOTAL PAYMENT $2,100.82
Our underwriting department may contact you later for proof your covered repairs were properly completed. Please keep accurate records of all expenses, including paid invoices, cancelled checks, receipts, photographs, and other documentation establishing completion of repairs related to this Claim.
IN CLOSING
If you discover any additional damages not previously reported or considered in our evaluation of your Claim, please contact us immediately and provide any supporting information and documentation for our review. Should you have any questions or need further assistance, please contact me at (561) 593-3508 x 3315 or at Mellis@pti.insure.”
In response, on November 14, 2024, MR. AND MRS. POWER provided PTIC with their executed sworn statement in proof of loss, an estimate of damages totaling $93,626.63 which included photos and proposal for the roof replacement.
On November 17, 2024, PTIC stood by its correspondence dated November 4, 2024, coverage determination and estimated damages from the estimated dated October 24, 2024, and issued a valuation of MR. AND MRS. POWER’S damages which totaled $14,288.49 (RCV)/$14,002.82 (ACV).
In correspondece dated November 18, 2024, PTIC issued written correspondence that made a blanket disagreement with the estimate provided and scope of damages but did not specify what portions were specifically disagreed with.
“ Based on the nature and extent of damages observed during our investigation of the loss, PTI must respectfully reject the estimate without limitation, as claiming damages, which based upon our inspection, have determined to fall outside the covered scope of this loss.”
See attached, SPOL Rejection 11.18.24
To date, PTIC has failed to tender all insurance benefits. PTIC has admitted that MR. AND MRS. POWER sustained covered damages as a result of hurricane force winds loss that occurred on or about October 9, 2024, but has denied tendering all owed insurance benefits to MR. AND MRS. POWER.
Pursuant to Florida Statute §626.9541(1)(i)(4), PTIC is required to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after PTIC received notice of the residential property insurance claim, determine the amounts of partial or full benefits, and agree to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5). As PTIC has failed to do so, PTIC has wrongfully denied coverage.
Since the beginning of the claim, PTIC has engaged in a pattern of delay, denial, and reckless disregard for MR. AND MRS. POWER’S rights. The actions of PTIC listed herein have been continuing in nature and given the totality of the circumstances, which includes PTIC’S adjustment, actions and/or omissions post the filing of this CRN. MR. AND MRS. POWER contend that given the past experience in this matter with PTIC, it is reasonably foreseeable that PTIC’S current actions will extend to its entire conduct in the handing of their claim, including the acts or omissions of PTIC and/or its representatives, until the final resolution of their claim. As such, MR. AND MRS. POWER contend adequate notice has been given should PTIC’S actions and violations listed herein continue after the expiration of this notice.
PTIC has failed and/or refused to settle the claim when it could and should have done so had it acted fairly and honestly towards MR. AND MRS. POWER and has failed to take into account the information and evidence provided that contradict its decisions.
PTIC’S conduct has been reckless and unfair to MR. AND MRS. POWER and has caused and continues to cause additional damage throughout the property. This is evidenced by the delay in paying the claim and the failure of PTIC to evaluate the claim in total.
To date, PTIC has failed and/or refused to provide MR. AND MRS. POWER with all the necessary insurance benefits due and owing and has not tendered the full amount needed to repair the Property despite knowing that MR. AND MRS. POWER have sustained covered damages to their insured property.
As the PTIC must admit, it is implied within every insurance policy a duty of good faith and fair dealings. In an insurance contract, each party is prevented from interfering with the other’s right to benefit from the contract. The obligations of good faith and fair dealings encompass qualities of decency and humanity inherent in its responsibilities as a fiduciary. PTIC is bound to conduct itself with the utmost good faith for the benefit of MR. AND MRS. POWER. However, PTIC has failed to comply with the obligations in connection with this claim and has never looked at the claim or the contract for insurance with good faith and fair dealing. Instead, PTIC has looked for ways not to pay the claim in full, or pay the claim at all, and these actions have been to the detriment of MR. AND MRS. POWER.
The adjusters assigned to this claim have a duty to adjust and treat all claims equally. Since the beginning of this claim the representatives on behalf of PTIC have approached this investigation in a manner prejudicial to MR. AND MRS. POWER. PTIC is using either untrained or improperly trained adjusters in connection with this claim. PTIC should have been adjusting the loss with MR. AND MRS. POWER but instead, it was looking for ways not to pay the claim at all or pay the claim in full. If the PTIC handles all the claims in the way MR. AND MRS. POWER’S claim was adjusted, then it is improperly handling all claims.
Therefore, demand is hereby made as follows:
Estimate $93,626.63
Less Prior Payments $2,100.82
Less Deductible $11,902.00
TOTAL $79,623.81
The concept of insurance is that the insurer will investigate and grant timely and prompt indemnity or security against a contingent loss. Florida Statute §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 in that definition is the fact that payment must be made timely and promptly so that MR. AND MRS. POWER may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. PTIC has breached this duty.
MR. AND MRS. POWER was, and still is, forced to expend out of pocket monies to submit her insurance claim, e.g., retaining an attorney and other experts to force PTIC to honor its obligations under the insurance policy and to pay all the insurance proceeds due and owing to them.
PTIC has refused and/or failed to tender all the insurance proceeds due and owing to MR. AND MRS. POWER. PTIC’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 MR. AND MRS. POWER is wrongful conduct. Furthermore, MR. AND MRS. POWER contends that PTIC’s adjusters and/or representatives financially benefit from such wrongful conduct.
PTIC has refused and/or failed to comply with The Policy’s cooperation and/or “Loss Payment” provision. Under The Policy, PTIC was to timely tender undisputed insurance benefits to MR. AND MRS. POWER. PTIC has failed and/or refused to timely tender owed insurance benefits, undisputed or otherwise. This is a breach of The Policy.
PTIC has refused and/or failed to cooperate and/or “Adjust the Loss” by cooperating with MR. AND MRS. POWER during the claims adjustment process in compliance with The Policy’s “Loss Payment” provision. This is a breach of The Policy.
This notice is given in order to perfect the right to pursue the civil remedy authorized by Fla. Stat. §624.155.
Therefore, to cure the defects outlined in this Civil Remedy Notice, PTIC must:
(1) Create and implement adequate guidelines for the proper investigation and evaluation of claims and for the training and supervision of employees, which will avoid future statutory violations as set forth above, and prevent this from occurring in the future;
(2) PTIC must create and implement adequate guidelines for the proper investigation and evaluation of these types of claims and for the training and supervision of employees with regard to these claims to ensure that the claims handling procedure with regard to these types of losses are adequate to prevent other Insureds from being treated unfairly and wrongfully;
(3) PTIC must tender to MR. AND MRS. POWER $79,623.81 as set forth above; and,
(4) PTIC must act fairly and honestly towards its MR. AND MRS. POWER and with due regard for her interests in attempting to settle its MR. AND MRS. POWER’S claim.
Or, in the alternative, should PTIC not be in agreement with MR. AND MRS. POWER’S reasonable demand for payment of their rightfully owed insurance benefits being submitted at this time, MR. AND MRS. POWER may still be willing to consider and potentially accept a reasonable counter-offer made by PTIC. As such, MR. AND MRS. POWER hereby request that PTIC now make a reasonable counter-offer before the expiration of the cure period. MR. AND MRS. POWER still hope that their claim can be resolved amicably.
Attachments:
1. Carrier Estimate 10.16.24.
2. Coverage Determination 11.05.24
3. Response to Request for SPOL 11.14.24
4. SPOL Rejection 11.18.24
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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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