Filing Number: 794378
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| Filing Accepted: 11/26/2024 |
| Last/Business Name
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MARTIN
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First Name |
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CYNTHIA DIANNE |
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| Street Address
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4612 WILLOW HAMMOCK DR |
| City, State Zip
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PALMETTO,
FL
34221
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| Email Address
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CYNTHIAMARTIN8238@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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MARTIN |
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First Name |
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CYNTHIA DIANNE |
| Policy # * |
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85673281 |
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Claim #* |
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MSIH-00000670 |
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Attorney is Applicable
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| Last Name* |
ALTMAN
First Name *
ALEXIS
Initial
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| Street Address* |
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925 SOUTH FEDERAL HIGHWAY |
| City, State Zip* |
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BOCA RATON
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FLORIDA
33432
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| Email Address * |
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AALTMAN@KPATTORNEY.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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SPINNAKER INSURANCE COMPANY
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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 24376 |
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| Name of individual responsible for violation (if any):*
SHANE MUELLER
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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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Unfair Trade Practice
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Unsatisfactory Settlement Offer
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Claim Delay
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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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
loss settlement provision
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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.
Spinnaker Insurance Company (“carrier”) has not attempted, in good faith, to settle the insured’s claim when under all the circumstances it could have and should have done so had it acted fairly and honestly toward its insured and with due regard for their interests. In fact, the carrier has intentionally under-valued the scope the insureds’ claim in an effort to maximize its profits, thereby preventing the insured from being able to restore his home to its pre-loss conditions Spinnaker Insurance Company has engaged in these actions, despite the clear and unequivocal burden discussed in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005), wherein the Florida Supreme Court held, “The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insureds.”
This claim arises from Hurricane Milton, which barreled into Florida's on the evening of October 9, 2024. The insureds’ home fell victim to the devastating winds and rains and sustained substantial damage. After sending Shane Mueller to the insured’s property, the carrier sent a letter that the damages were under the insured’s deductible. The estimate included a roof repair and interior work totaling $1,812.85. Upon review of the carrier estimate and settlement letter, it was noted that the claim was improperly scoped, grossly underpaid, and is insufficient to properly indemnify Insured’s loss.
The Carrier and its representative have failed at every step of the process. Spinnaker has failed to adjust and settle the claim in good faith, in accordance with the insurance contract and Florida Statutes. Spinnaker continues to conduct its investigation in a manner prejudicial to the insured, failing to complete a thorough and truthful investigation of the claim. To date, the carrier has failed to fairly pay Insured for the damages they are owed.
Pursuant to Florida Statute §624.155(1)(b)(1), the carrier has failed to settle the claim in good faith when it could and should have done so. The Insured reported the Loss as soon as they were aware of the damage and the Property was presented for inspection. The damage to the Insured’ property was clearly caused by a covered peril under the Policy, but the carrier intentionally turned a blind eye to the damage, low-balled the Claim, and callously delayed the claim process. The carrier has not shown a good faith intention to pay what was owed but rather has underpaid the claim for financial gain and profit.
Pursuant to Florida Statute §626.9541(1)(i)(3)(a), Spinnaker has a duty to adopt and implement standards for the proper investigation of claims. Adjuster Shane Mueller displayed a lack of knowledge, improper training, and/or intent to underpay the claim by signing a letter stating the damages were under the insured’s deductible.
Shane Mueller displayed a further lack of knowledge of (or an intentional choice to ignore) Florida Statute relating to settlement of the claim. She should be aware that the roof is unrepairable and even if repairable, the new shingles would not match the existing roof. Thus, the Insured is entitled to replacement of the roof. Insured believes and asserts that the carrier refuses to implement standards for proper investigation of claims for purely financial reasons.
Florida law mandates that insurers and adjusters do not mislead the Insured by misrepresenting pertinent facts or insurance policy provisions relating to coverages. Florida Insurance companies that fail to follow these Florida laws and regulations, designed to protect consumers, do not only breach their duties under the policy of insurance but do so in bad faith. In violation of Florida Statute §626.9541(1)(i)(3)(b), the carrier intentionally misrepresented the available coverage under the policy.
Further, in violation of Florida Statute §626.9541(1)(i)(3)(d), the carrier improperly denied replacement of the roof without conducting a reasonable investigation based upon available information. The carrier should have requested an ITEL report to determine if a matching shingle was available. Instead, American places the obligation on policyholders to perform the investigation and provide the documentation after claims have been denied, delayed, and/or underpaid.
In Florida, the work of adjusting insurance claims engages the public trust. Spinnaker has breached this trust in the improper adjustment of the Insured’s claim. Though the Insured sustained a loss that, pursuant to the terms of his policy, should be covered by the policy of insurance, Truck Insurance refused to properly indemnify the Insured for his loss in direct contradiction of the terms of the Policy and Florida Statutes. From the very start, Spinnaker did not act in good faith during its adjustment of the Claim as evidenced by the violations noted above.
This notice is provided in order to perfect a right to pursue the civil remedy authorized by Florida Statute §624.155. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must:
1) Pay all amounts due and owing to the insured in the amount of $36,771.86 minus any applicable deductibles, for indemnity benefits;
2) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made.
Should you have any questions please do not hesitate to contact me at 561-892-9988. We appreciate your attention to this matter.
Alexis E. Altman, Esq.
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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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