Filing Number: 794480
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| Filing Accepted: 11/27/2024 |
| Last/Business Name
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| Street Address
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6029 61ST CT E |
| City, State Zip
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PALMETTO,
FL
34221
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| Email Address
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DIEGOGCD@HOTMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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GARCIA |
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First Name |
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DIEGO |
| Policy # * |
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4413969153 |
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Claim #* |
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01000075510 |
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Attorney is Applicable
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| Last Name* |
PLATT
First Name *
HOPE
Initial
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| Street Address* |
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800 EAST BROWARD BLVD SUITE 500 |
| City, State Zip* |
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FT. LAUDERDALE
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FL
33301
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| Email Address * |
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HBP@WEKLAW.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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FIRST PROTECTIVE 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 10897 |
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| Name of individual responsible for violation (if any):*
MARK ROBINSON
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Claim Denial
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Claim Delay
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Unsatisfactory Settlement Offer
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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)(2) |
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Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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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)(3)(e) |
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Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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| 626.9541(1)(i)(3)(f) |
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Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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| 626.9541(1)(i)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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| 626.9541(1)(i)(3)(i) |
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Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
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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.
SECTION I – CONDITIONS
C. Duties After Loss is deleted and replaced by
the following:
C. Duties After Loss.
An “assignment agreement” does not change
the obligations to perform the duties required
under this Policy.
In case of a loss to covered property, you must
see that the following are done. These duties
must be performed either by you, an “insured”
seeking coverage, or a representative of
either:
1. Give immediate notice to us or our agent.
Except for Reasonable Emergency
Measures taken under Additional
Coverage 2., there is no coverage for
repairs that begin before the earlier of:
a. 72 hours after we are notified of the
loss;
b. The time of loss inspection by us; or
c. The time of other approval by us.
If you unreasonably deny us access to
inspect the loss during the period in a.
above, coverage for repairs beyond
Reasonable Emergency Measures begins
the earlier of when we are given access to
inspect the loss or when we fail to appear
at a scheduled loss inspection.
2. To the degree reasonably possible, retain
the damaged property and any
photographs of the damaged property;
and
Allow us to inspect, subject to the
paragraph above, all damaged property
prior to its removal from the “residence
5. Protect the property from further damage.
The following must be performed:
a. Take reasonable emergency
measures that are necessary to
protect the covered property from
further damage, as provided under
Additional Coverage 2.
A reasonable emergency measure
under 5.a. above may include a
permanent repair when necessary to
protect the covered property from
further damage or to prevent
unwanted entry to the property. To the
degree reasonably possible, the
damaged property must be retained
for us to inspect.
b. Keep an accurate record of repair
expenses. To the degree reasonably
possible, take pictures prior to repairs
commencing.
6. Cooperate with us in the investigation of a
claim.
This includes speaking to and sharing
information with us or any person
authorized to act on our behalf, and
providing documents which can be
reasonably obtained by you, to facilitate
our investigation of the claim.
You, any “insured” seeking coverage, or a
representative of either of these:
a. Must cooperate with our investigation;
b. Must not act in any manner that
prevents us or any person authorized
to act on our behalf, from investigating
the claim; and
c. May not act in any manner to obstruct
our investigation.
7. 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.
8. As often as we reasonably require:
a. Show us the damaged property and
the cause of loss and the condition it
was in at the time of loss, if possible,
except as to any repairs performed
under SECTION I – PROPERTY
COVERAGES, Additional
Coverages, 2. Reasonable
Emergency Measures;
b. Provide us with records and
documents we request and permit us
to make copies;
10. Produce any updates to the documents
and information described above,
including revised descriptions of loss,
scope of loss, estimates, or other
supporting information:
a. As this information becomes
available, and if additional loss or
damage is discovered or incurred;
and
b. If you are provided with new
estimates or invoices regarding the
losses submitted or not submitted in
the proof of loss.
The duties above apply regardless of whether
you, an “insured” seeking coverage, or a
representative of either retains or is assisted
by a party who provides legal advice,
insurance advice or expert claim advice,
regarding an insurance claim under this
Policy.
The following conditions are added to SECTION I
– CONDITIONS of your policy:
T. Notice of Claim
If your policy provides hurricane or windstorm
coverage, then a claim, supplemental claim or
reopened claim for loss or damage caused by
hurricane or other windstorm must be given to
us in accordance with the terms of this policy
and within three years after the hurricane first
made landfall or a windstorm other than a
hurricane caused the damage. (Supplemental
claim or reopened claim means an additional
claim for recovery from us for losses from the
same hurricane or other windstorm which we
have previously adjusted pursuant to the initial
claim.)
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
(This is Condition S. in form HO 00 04)
SECTION I – PERILS INSURED AGAINST
A. Coverage A – Dwelling And Coverage B –
Other Structures
1. We insure against direct physical loss to
property described in Coverages A and B.
2. We do not insure, however, for loss:
a. Excluded under Section I – Exclusions;
b. Involving collapse, including any of the
following conditions of property or any part
of the property:
(1) An abrupt falling down or caving in;
(2) Loss of structural integrity, including
separation of parts of the property or
property in danger of falling down or
caving in; or
(3) Any cracking, bulging, sagging,
bending, leaning, settling, shrinkage or
expansion as such condition relates to
(1) or (2) above;
except as provided in E.8. Collapse under
Section I – Property Coverages; or
c. Caused by:
(6) Any of the following:
(a) Wear and tear, marring,
deterioration;
(c) Smog, rust or other corrosion, or dry
rot;
SECTION I – EXCLUSIONS
B. We do not insure for loss to property described in
Coverages A and B caused by any of the
following. However, any ensuing loss to property
described in Coverages A and B not precluded by
any other provision in this policy is covered.
1. Weather conditions. However, this exclusion
only applies if weather conditions contribute in
any way with a cause or event excluded in A.
above to produce the loss.
2. Acts or decisions, including the failure to act or
decide, of any person, group, organization or
governmental body.
3. Faulty, inadequate or defective:
a. Planning, zoning, development, surveying,
siting;
b. Design, specifications, workmanship,
repair, construction, renovation,
remodeling, grading, compaction;
c. Materials used in repair, construction,
renovation or remodeling; or
d. Maintenance;
of part or all of any property whether on or off
the "residence premises".
Paragraph A.1. in Form HO 00 03 is deleted and
replaced by the following:
1. We insure for sudden and accidental
direct physical loss to covered property
described in Coverages A and B unless
the loss is otherwise excluded or limited in
this policy. However, loss does not
include, and we will not pay for, any
“diminution in value.”
Paragraph 2.c.(5) is deleted and replaced by the
following:
(5) Repeated seepage or leakage of
water or the presence or
condensation of humidity, moisture,
or vapor, that occurs or develops
over a period of time, whether
hidden or not.
In the event this exclusion applies,
we will not pay for any damages
sustained starting from the first day
and instant the repeated seepage
or leakage of water or steam, or the
presence or condensation of
humidity, moisture, or vapor began.
Paragraph 2.c.(6)(c) is deleted and replaced by
the following:
(c) Smog, rust, decay or other
corrosion;
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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.
Diego Garcia ("Insured") purchased an insurance policy ("Policy") from First Protective Insurance Company d/b/a Frontline Homeowners Insurance (“Frontline”) with effective coverage on the date of loss, on or about September 28, 2022, as a result of Hurricane Ian, and Policy number 4413969153 to insure the property located at 6029 61st Ct E Palmetto, FL 34221 (the "Property").??
On or about September 28, 2022, the Property suffered severe wind and rain damage as a result of Hurricane Ian, which caused ensuing water damage to the Property, including but not limited to the interior ceilings, walls and floors and roof ("Loss"). Upon discovery of the damages from Hurricane Ian, September 28, 2022, the Insured immediately reported the claim to Frontline.
The Insured retained a Florida Adjusters Group, (“FLAG”) to aid with this claim. FLAG inspected the property and determined that it was clear that the loss was a result of Hurricane Ian. Frontline acknowledged the claim and assigned the loss claim number 01000075510.
A field adjuster, Mark Robinson, was assigned to the claim. Mr. Robinson inspected the property on October 20, 2022, less than one month after hurricane Ian made landfall. During his inspection, Mr. Robinson viewed the interior and exterior of the home and the roof. FLAG provided Frontline with photos of the damage, as well as an estimate in the amount of $67,453.81 to place the home in the pre-loss condition.
As the property was damaged severely by Hurricane Ian, the insured did everything he could to protect the home from further damage, as required under the policy. Prior to the Field Adjuster’s inspection, the Insured hired KKA restoration (“KKA”), to perform water dry out at the home. One of the areas that was specifically damaged was the ceiling in the garage. KKA placed air movers and dehumidifiers in the home as well as placed a tarp on the roof. The dry out equipment was in the home from September 29, 2022, through October 3, 2022. KKA submitted their invoice, photos of the home before and after the dry out and tarp on the roof, and their invoice for their services in the amount of $15,153.22, which includes the removal and replacement of the tarp for the Field Adjuster’s inspection. Despite having all of this information, Frontline, refused to pay this invoice.
The insured also hired Delta Mold Services to perform mold testing, as he was concerned that the moisture would lead to mold. The Mold test was performed on March 3, 2023. Mold was found in the garage where there was water damage from the hurricane. Delta Mold charged $1,700 for the testing and lab analysis. Frontline also refused to pay this invoice.
On June 1, 2023, ten months after the date of loss, Frontline issued a coverage determination indicating that they were only opening coverage for minor items related to the roof, including but not limited to one shingle. Frontline states that this damage is below deductible and therefore did not issue a payment. Frontline sent out their own Engineer to inspect the home who determined that the damage to Mr. Garcia’s home was from Hurricane Ian. Despite this, Frontline still has refused to indemnify Mr. Garcia. Frontline further provided a supporting estimate that glossed over the extent and nature of damages.
However, in the same letter, Frontline stated that they did not believe that there was a peril created opening, despite the fact that a Category 5 hurricane had just made landfall and impacted the Insured’s home, photographic evidence. It is clear from the photos of Mr. Garcia’s home, that the majority of his siding on the roof was coming off and was damaged from this storm, this is among many areas of damage that were sustained to the home.
Frontline failed to tender the full amount of monies due and owing under the terms of the policy. To date, notwithstanding the Insureds’ pleas for relief, Frontline has continued to refuse to acknowledge its obligation to tender all monies due and owing to the Insured, and to fully assist the Insured in the mitigation of his damages. The Insured timely notified Frontline of the damages and opened a claim pursuant to the terms and conditions of the insurance policy. In response to their claim for benefits, Frontline sent a representative to investigate and adjust the loss. The adjuster for Frontline confirmed that there were significant damages to the property. Despite recognizing the severity of the damage to the property, Frontline and its representatives attempted to settle the claim for far less than was owed. Frontline misrepresented to the Insureds that it had performed a full and fair investigation and adjustment of the claim at that time and misrepresented that the amounts offered were the full value of the indemnity owed under the provisions of the insurance policy. These misrepresentations were either intentional, or the result of Frontline failing to adequately train and supervise its adjusters and representatives.
The carrier needs to be held accountable for this unilateral and unreasonable delay. Frontline has violated Florida Statute §624.155(1)(b)(1) by continuously not attempting in good faith to settle this claim when it should have done so if it had acted fairly and honestly towards its insured. Frontline has also violated Florida Statute §624.155(1)(b)(3) by failing to promptly settle this covered claim to influence settlement in its favor. Despite being presented all of the indisputable evidence of the amount of damage sustained by this Property. Frontline violated Florida Statutes §626.9541(1)(i)(2) and §626.9541(1)(i)(3)(b) by making material misrepresentations to the Insureds for the purpose and with the intent to settle the claim on less favorable terms than those provided and contemplated by the policy.
Frontline was informed multiple times of the discrepancies and inconsistencies of the below value payment issued to the Insureds. While Frontline was made aware of this information for the purpose of obtaining the money contractually owed to the Insureds under its insurance policy to attempt to return their home to its pre-loss condition in a timely fashion, Frontline has refused to do so and has delayed properly adjusting this claim.
Frontline violated §626.9541(1)(i)(3)(a) when it failed to adopt and implement standards for the proper investigations of claims. Under no circumstances is there an excuse for the lack of a proper investigation in this case. Frontline and their representatives are willfully blind and grossly underqualified to handle a loss such as the one sustained by the Insureds. After being placed on notice as to the blatant underpayment of the Insureds’ claim, Frontline has yet to rectify their actions and do right by the Insured by paying the money they are contractually owed.
Frontline violated §626.9541(1)(i)(3)(g) by failing to promptly notify the Insureds of any additional information necessary for processing the claim. The Insured has more than complied with each and every request and there has still been no action by Frontline. In the event Frontline is in need of additional information, they have failed to promptly notify the Insureds in a timely manner. This pattern of behavior is perpetuated by Frontline and their representatives undeterred by the Ethical Requirements that are imposed by law on all Adjusters. Fla. Admin. Code Ann. R. (3) explicitly states the adjustment of insurance claims engage the trust of the public, and therefore, an adjuster has a duty of fair and honest treatment of the insured throughout the insurance claim process.
Several duties and responsibilities to the Insured were violated in the handling of this claim, which are specifically listed responsibilities of an Adjuster in the Florida Administrative Code. These breached duties and responsibilities include adjusters from Frontline approaching the investigation and settlement in a manner prejudicial to the Insureds, failing to allow a fair settlement with the Insureds, and acting with due diligence in achieving a proper disposition of the claim. In contrast to the legislative intent motivating the enumeration of an Adjuster’s responsibilities outlined in the Administrative Code, the Insureds were not afforded the professional duties entrusted on Frontline by the public.
To date, Frontline has failed to adequately compensate the Insured for the damage that occurred on September 28, 2022, despite having months to pay the Insureds’ claim in full. As a direct result of Frontline’s delay, the Insured was forced to seek the help of legal counsel to assist them. Due to the amount of time that has passed since the date of loss, this acknowledgement is evidence that Frontline knowingly and intentionally are delaying the claims process in order to further disadvantage the Insureds. The financial detriment caused to the Insured and his tenants is a direct result of Frontline’s reckless delay of the claim process.
This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should Frontline 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, Frontline must: (1) Immediately tender the $84,307.03, due and owing to the Insured under the insurance policy that would reasonably place the Insured back to a pre-loss condition; (2) Agree to reimburse the Insured’s reasonable attorneys’ fees and costs for having to become involved to resolve the claim; (3) 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.
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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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