Filing Number: 794366
|
| Filing Accepted: 11/26/2024 |
| Last/Business Name
*
|
|
|
EMERY AUTO & DIESEL REPAIR INC.
|
|
First Name |
|
|
|
| Street Address
*
|
|
6436 SAN CASA DR. |
| City, State Zip
*
|
|
ENGLEWOOD,
FL
34224
|
| Email Address
*
|
|
EMERYAUTOPAY@YAHOO.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
EMERY AUTO & DIESEL REPAIR INC. |
|
First Name |
|
|
| Policy # * |
|
0509548612 |
|
Claim #* |
|
05000001144 |
|
Attorney is Applicable
|
| Last Name* |
PLATT
First Name *
HOPE
Initial
|
| Street Address* |
|
800 EAST BROWARD BLVD SUITE 500 |
| City, State Zip* |
|
FT. LAUDERDALE
,
FL
33301
|
| Email Address * |
|
HBP@WEKLAW.COM |
|
|
| 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):*
PETRINA MOTEN
|
| Type of Insurance
*
Commercial Property & Casualty
|
|
|
| Reason for Notice
*
|
|
|
Claim Delay
|
|
|
Unsatisfactory Settlement Offer
|
|
|
*
Statutory provision(s) which the insurer allegedly violated.
|
|
|
|
| 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.
|
|
| 624.401(4)(b)(1) |
|
However, any person acting as an insurer without a valid certificate of authority who violates this section commits insurance fraud, punishable as provided in this paragraph. If the amount of any insurance premium collected with respect to any violation of this section is less than $20,000, the offender commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084, and the offender shall be sentenced to a minimum term of imprisonment of 1 year.
|
|
| 626.9541(1)(i)(3)(a) |
|
Failing to adopt and implement standards for the proper investigation of claims.
|
|
| 626.9541(1)(i)(3)(d) |
|
Denying claims without conducting reasonable investigations based upon available information.
|
|
| 626.9541(1)(i)(3)(f) |
|
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.
|
|
| 626.9541(1)(i)(3)(i) |
|
Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
|
|
*
Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
A. Coverage
1. Business Income
Business Income means the:
a. Net Income (Net Profit or Loss before income
taxes) that would have been earned
or incurred; and
b. Continuing normal operating expenses
incurred, including payroll.
…
We will pay for the actual loss of Business Income
you sustain due to the necessary "suspension"
of your "operations" during the "period
of restoration". The "suspension" must be
caused by direct physical loss of or damage to
property at premises which are described in
the Declarations and for which a Business Income
Limit of Insurance is shown in the Declarations.
The loss or damage must be caused
by or result from a Covered Cause of Loss.
With respect to loss of or damage to personal
property in the open or personal property in a
vehicle, the described premises include the
area within 100 feet of the site at which the described
premises are located.
E. Loss Conditions
The following conditions apply in addition to the
Common Policy Conditions and the Commercial
Property Conditions.
2. Appraisal
If we and you disagree on the value of the
property or the amount of loss, either may
make written demand for an appraisal of the
loss. In this event, each party will select a competent
and impartial appraiser. The two appraisers
will select an umpire. If they cannot
agree, either may request that selection be
made by a judge of a court having jurisdiction.
The appraisers will state separately the value
of the property and amount of loss. If they fail
to agree, they will submit their differences to
the umpire. A decision agreed to by any two
will be binding. Each party will:
a. Pay its chosen appraiser; and
b. Bear the other expenses of the appraisal
and umpire equally.
If there is an appraisal, we will still retain our
right to deny the claim.
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.
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.
We will give notice of our intentions within
30 days after we receive the sworn proof of
loss.
, We will not pay you more than your financial
interest in the Covered Property.
. 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.
We may elect to defend you against suits
arising from claims of owners of property.
We will do this at our expense.
We will pay for covered loss or damage
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.
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Emery Auto & Diesel Repair Inc. ("Insured") purchased an insurance policy ("Policy") from Frontline Insurance Unlimited d/b/a Frontline Insurance ("Frontline" or “Carrier”) with effective coverage on the date of loss, on or about September 28, 2022, and Policy number 0509548612 to insure their property located at 6436 San Casa Dr., Englewood, FL 34224 (the "Property").??With effective dates from October 30, 2021, to October 30, 2022.
On or about September 28, 2022, the Property suffered roof and interior damage from a category 5 Hurricane Ian which caused damage to the Property, including but not limited to the roof and exterior of the business which caused an opening in the structure to allow for interior water entry and damage to the interior of the business. ("Loss"). Additionally, the Insured suffered an interruption in the business as it was closed as a result of the storm and the damages that were caused to the business prevented it from opening and serving customers.
Coverage was opened for the damages and the claim went through the appraisal process. However, $40,942.34 was withheld in recoverable depreciation. The insured provided the appropriate documents to the carrier showing that he met the requirements for the depreciation to be released, however, the carrier refuses to do so to date.
Additionally, the insured made a claim for business interruption. The carrier issued two separate payments which total $30,706.
Currently, the insured wants to be made whole and be properly compensated for the damages that he sustained and the loss of business that he is entitled to which is approximately $91,000.
After being provided plenty of evidence (including photos, estimates, and access to the property, showing that the Hurricane caused damage at the property, The Carrier continues to refuse to provide additional money. The Carrier is trying to avoid finding any further information that would increase the amount of coverage available on this claim despite being aware that additional costs were incurred by the Insured to repair their property.
The Insureds have fully complied with all applicable Policy provisions requiring cooperation with the?investigation;?however, the Carrier has unequivocally failed to properly adjust this Claim, as further elaborated above. Rather than paying the actual damages and/or trying to settle with the Insured, the Carrier has continued its pre-suit failures to act in good faith into litigation by delaying the prompt resolution of the claim. The Carrier has not attempted, in good faith, to settle this claim when, under the circumstances, it could and should have done so had it acted fairly and honestly toward the policyholder and with due regard to the policyholder's interests.? Rather, The Carrier has acted with only its own profit and shareholders in mind.
As a direct consequence of the Carrier’s failure to adjust this Loss in good faith and make any supplemental payment, the Insured continues to be without adequate compensation for the damages sustained at the Insured's Property more than two and a half years ago.
By stating the above detailed?facts,?it is clear that the Carrier has violated the following Florida statutes:?
• 624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its Insureds and with due regard for their interest.
• 624.155(1)(b)(3) Except as to liability coverages, failing to promptly settle claims, when the obligation to?settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
• 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the?proper investigation of?claims;
• 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims;
• 626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
• 626.9541(1)(i)(3)(f) 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
• 626.9541(1)(i)(3)(i) Unfair claim settlement practices
To date, The Carrier has in bad faith failed to provide sufficient coverage under the Policy to the Insured. The Insured is without the funds to replace their damaged roof and bring it back to its pre-loss condition.
As a direct result of The Carrier’s failure to pay the Claim and breach of the Florida Statutes, the Insured was forced to seek the?help of licensed professionals to assist them, including legal counsel.?Due to the amount of time that has passed since the date of loss and the information discussed above, there is irrefutable evidence that The Carrier knowingly and intentionally, and in bad faith delayed the settlement process in order to further disadvantage the Insured. The financial detriment caused to the Insured is a direct result of The Carrier’s reckless treatment of the claims process. The Insured submitted all documents requested in a timely fashion, made their property available for inspection immediately after the discovery of the loss, submitted an estimate, and satisfied all requests. However, The Carrier failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim.?
Upon information and belief, the aforementioned actions complained of, among others, were made by The Carrier so often?as to constitute a general business practice, evidencing a motive to enhance The Carrier’s profits, and designed to cause a detrimental effect to its policyholders. The above clearly depicts that The Carrier adjusted this claim in bad faith, continue to act in bad faith towards its Insured, and that The Carrier is in direct violation of Unfair Claims Practices.??
This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should The Carrier fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, The Carrier must: (1) Immediately tender all proceeds due and owing to the Insured that are fairly owed to the Insured under the insurance policy that would reasonably compensate the Insured in order to put the loss property back to its pre-loss condition in the amount of $91,000; (2) Immediately afford coverage for the repairs to the subject property necessary to put the property back into its pre-loss condition (3) Agree to reimburse the Insured's reasonable attorneys’ fees and costs for having to become involved to resolve the claim; and (4) Agree to reimburse the Insured for interest on the amount of benefits that was found to be?due and owing to the Insured, relating back to the date of loss.
|
|
|
*
|
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
|