Filing Number: 794348
|
| Filing Accepted: 11/26/2024 |
| Last/Business Name
*
|
|
|
HART
|
|
First Name |
|
CHRISTOPHER |
|
| Street Address
*
|
|
4301 WEST KENSINGTON AVENUE |
| City, State Zip
*
|
|
TAMPA,
FL
33629
|
| Email Address
*
|
|
CHART@BUSHROSS.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
HART |
|
First Name |
|
CHRISTOPHER |
| Policy # * |
|
3218765715 |
|
Claim #* |
|
01000125381 |
|
Attorney is Applicable
|
|
|
|
| Insurer Type
*
|
|
 Authorized Insurer
 Unauthorized Insurer
|
|
|
| Insurer Name |
|
|
| Insurer Name* |
|
FRONTLINE INSURANCE UNLIMITED COMPANY
|
| Insurer Name* |
|
|
| Street Address* |
|
|
| City, State Zip* |
|
,
|
|
NAIC Company Code 10074 |
|
|
| Name of individual responsible for violation (if any):*
ERIKA WINKFIELD
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
|
Claim Denial
|
|
|
Claim Delay
|
|
|
Unsatisfactory Settlement Offer
|
|
|
Unfair Trade Practice
|
|
|
*
Statutory provision(s) which the insurer allegedly violated.
|
|
|
|
| 624.155(1)(b)(1) |
|
Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
|
|
| 624.155(1)(b)(3) |
|
Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
|
|
| 626.9541(1)(i)(3)(a) |
|
Failing to adopt and implement standards for the proper investigation of claims.
|
|
| 626.9541(1)(i)(3)(b) |
|
Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
|
|
| 626.9541(1)(i)(3)(d) |
|
Denying claims without conducting reasonable investigations based upon available information.
|
|
| 626.9541(1)(i)(4) |
|
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).
|
|
*
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 POLICY LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE POLICY
COVERAGES, VALUATION PROVISIONS, AND OTHER TERMS AND CONDITIONS OF THE POLICY.
VARIOUS LANGUAGE THROUGHOUT THE POLICY, INCLUDING BUT NOT LIMITED TO PROVISIONS
GOVERNING COVERAGE FOR HURRICANE LOSS, ROOF DAMAGE, WATER DAMAGE, WINDSTORM
DAMAGE, THE LOSS PAYMENT PROVISION(S), THE PROVISIONS GOVERNING THE DUTIES AND
OBLIGATIONS OF THE INSURER; AND COVERAGE A – DWELLING; COVERAGE B – OTHER STRUCTURES;
COVERAGE C – PERSONAL PROPERTY; AND COVERAGE D – LOSS OF USE. ALSO REFER TO: ALL
ADDITIONAL COVERAGES PROVISIONS, ALL COVERAGES PROVIDED BY ENDORSEMENT OR RIDER,
THE DECLARATIONS PAGE, LOSS PAYMENT OR SETTLEMENT PROVISION(S), DUTIES IN EVENT OF
LOSS POLICY PROVISION. ALL TERMS AND CONDITIONS OF THE INSURANCE POLICY, THE INSURANCE
POLICY DEFINITIONS SECTION, THE INSURANCE POLICY’S EXCLUSION OF COVERAGE PROVISIONS,
ALL INSURANCE POLICY PROVISIONS THAT PROVIDE COVERAGE TO THE INSURED PROPERTY, AND
ALL OTHER POLICY PROVISIONS.
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
The facts of this case are clear and undisputed. I have a policy with Frontline Insurance with an effective date of 5/28/24 running through 5/28/25. Included within that policy is hurricane coverage with a hurricane deductible equivalent to $16,000.00. Hurricane Milton made landfall on October 9, 2024 just south of Tampa Bay, with the heaviest winds and rain located on the northern eyewall over Tampa. My family and I were evacuated under mandatory orders. Once the mandatory evacuation orders were lifted, we returned home to assess the damage. There was damage to the roof, a tree fell through the pool cage, the fence, gutters and soffits, landscaping, the gazebo and the flooring in the kitchen, dining and living room areas. We filed a claim with Frontline on October 14, 2024. Frontline sent out a field adjuster, who had traveled from Michigan, to assess the damage. Thereafter, we dealt with our desk adjuster, Erika Winkfield. The remaining issues on this claim are the floors and fence.
A. Floors:
Our communications with Erika were confusing and frustrating to say the least. Initially, she advised that the flooring was not going to be covered due to “seepage.” After explaining that our home did not flood, and offering a possible explanation that the water under the flooring was a result of fridge defrosting and/or leaking after losing power for 6 days, Erika advised the flooring damage would be covered, but that I may need to pay an additional deductible because it would be considered an “other peril” and not under the hurricane coverage. This was going to be an additional $5,000 in deductible. I questioned how this could be when it was damaged during a hurricane that I was already paying a $16,000 deductible for. She then told me she would ask her leader then call me back. She called back within the hour and advised the floors would be covered under the hurricane deductible. The very next day I received a call from Erika advising that “she had gotten a second opinion to make sure she was right” and Frontline was now denying coverage for the flooring altogether. When pushed for a reason, she stated that “power loss” was an exclusion. She had no explanation for why she admitted it was covered at first. She referred me to Seun, her leader, who I also spoke with and was told the power loss exclusion was “what we are going with.”
I decided to get a quote for the fence as I questioned the validity of Frontline’s damage estimate. The fence company I received an estimate from advised me that if I tried to repair the 5-6 sections of damaged fence, it would not match and the fence would be different colors. I sent in the fence quote, along with pictures showing the fence leaning over, which specifically states that just repairing sections will cause the fence not to match. I received a call from LaDonna from Frontline advising me that my fence quote was “too much more” than their $491.00 estimate. She told me that I should get a “handyman” over to try and fix it. I advised her the fence company told me doing repairs will make the fence not match and she said it was just “too much” and that I need to get someone else to come out.
As the claim stands now, the disagreements with Frontline are as follows: coverage for flooring damage and amount for fence repair. Additionally, we initially raised damages to the landscaping, and we were not going to push the issue and just buy new trees ourselves, but since we have had to go through this process, we also are asking for coverage for the landscaping.
Applicable Policy Language:
The power loss exclusion merely states that Frontline will not pay for loss of power. However, that exclusion specifically states "But if the failure results in a loss, from a peril insured against on the residence premises, we will pay for the loss caused by that peril."
Perils insured Against include damage caused by leaking appliances, as well as every other possible cause of the water damaged flooring (wind-blown rain, leaking roof, etc). It should be noted that the Field Adjusters report specifcally noted that the cause of the water damaged flooring could not be determined, and yet, Frontline has tried to not pay for it under "seepage" first and now "power loss."
Additionally, the policy provides coverage for replacing undamaged property due to mismatch, which would apply to both the fence and the flooring.
In short, the policy language provides coverage for damage caused by accidental discharge of water (and any other potential cause other than flood, which has been excluded as a possible cause since we did not flood). The exclusion for power outage merely states that Frontline will not compensate a policyholder for losing power; however, it specifically states that damage caused by a power loss IS covered. Further, the policy states that Frontline will repair or replace undamaged property due to mismatch, which would apply to the floors and the fence. This is all straight from the policy, which makes Frontline’s refusal to adhere to their policy terms needlessly frustrating.
|
|
*
|
The submitter hereby states that this notice is given in order to perfect the rights of the
person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.
Before submitting a Notice using this system, please verify that all text has been entered
correctly and completely. Once the Notice has been submitted, the text cannot be changed
or deleted.
|
DFS-10-363
Rev. 10/14/2008
|