Filing Number: 795601
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| Filing Accepted: 12/5/2024 |
| Last/Business Name
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| Street Address
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3404 W EL PRADO BLVD |
| City, State Zip
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TAMPA,
FL
33629
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| Email Address
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WITHHELD |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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CENTI |
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First Name |
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MATTHEW |
| Policy # * |
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FPH5558501-01 |
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Claim #* |
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FPI250421 |
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Attorney is Applicable
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| Last Name* |
WALLACE
First Name *
BLAKE
Initial
M
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| Street Address* |
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8635 W. HILLSBOROUGH AVENUE, SUITE 401 |
| City, State Zip* |
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TAMPA
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FLORIDA
33615
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| Email Address * |
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BLAKE@KLINGLAW.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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FLORIDA PENINSULA 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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NAIC Company Code 10132 |
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| Name of individual responsible for violation (if any):*
SELBY HATCHER, DAVID WILLIAMS, AND ERICA PILGROM
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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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Unsatisfactory Settlement Offer
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Claim Delay
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Unfair Trade Practice
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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)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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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)(j) |
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Altering or amending an insurance adjuster’s report without:
(I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and
(II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or
(III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
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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.
THE INSUREDS DO NOT HAVE A FULL CERTIFIED COPY OF THE POLICY. HOWEVER, THE PERTINENT POLICY PROVISIONS ARE THE LOSS PAYMENT AND LOSS SETTLEMENT PROVISIONS AS WELL AS THE PROVISIONS DESCRIBING OVERAGES AT ISSUE.
A. Loss By Windstorm During A Hurricane
With respect to Paragraphs C. and D., coverage for loss caused by the peril of windstorm during a hurricane
which occurs anywhere in the state of Florida, includes loss to:
1. The inside of a building; or
2. The property contained in a building caused by:
a. Rain;
b. Snow;
c. Sleet;
d. Hail;
e. Sand; or
f. Dust;
If the direct force of the windstorm damages the building, causing an opening in a roof or wall and the rain,
snow, sleet, hail, sand or dust enters through this opening.
B. Hurricane Described
A. A hurricane means a storm system that has been declared to be a hurricane by the National Hurricane
Center of the National Weather Service.
B. A hurricane occurrence:
a. Begins at the time a hurricane warning is issued for any part of Florida by the National Hurricane
Center of the National Weather Service; and
b. Ends 72 hours following the termination of the last hurricane warning issued for any part of Florida by
the National Hurricane Center of the National Weather Service.
C. Calendar Year Hurricane Deductible Described
A hurricane deductible issued by us or another insurer in our insurer group or under a policy assumed from
Citizens Property Insurance Corporation under a Takeout Agreement:
1. Can be exhausted only once during each calendar year; and
2. Applies to loss to Covered Property caused by one or more hurricanes during each calendar year.
The dollar amount of the calendar year hurricane deductible is shown on your Declarations.
A minimum deductible of $500 applies.
D. Application of Calendar Year Hurricane Deductible
1. In the event of the first windstorm loss caused by a single hurricane occurrence during a calendar year, we
will pay only that part of the total of all loss payable under COVERAGES that exceeds the calendar year
hurricane deductible stated in your Declarations.
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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.
December 5, 2024
Sent Via Email
FLORIDA PENINSULA INSURANCE COMPANY
csclaims@floridapeninsula.com
RE: Insured : MATTHEW CENTI (hereinafter, “Insured”)
Policy # : FPH5558501-01
Claim # : FPI250421
Property Address : 3404 W El Prado Blvd, Tampa, FL 33629
Persons most knowledgeable of facts giving rise to the Violations: Selby Hatcher, David Williams, and Erica Pilgrom
Dear FLORIDA PENINSULA INSURANCE COMPANY:
Please find enclosed the civil remedy notice filed for the above referenced claim. This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statute §624.155 As discussed in greater detail in the notice, the carrier has not attempted in good faith to settle the claimant’s claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its claimant and with due regard for its interests. The carrier has done everything possible to delay the claim and refuses to provide any sort of status of the claim. Furthermore, the carrier is required to properly investigate and adjust claims and cannot place that burden upon the insured. This was made clear by the appellate court and the Florida Supreme Court in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005) (“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 insured…”).
The carrier was put on notice of the insured’s Hurricane Milton claim on October 19, 2024. Since the commencement of the claim the carrier has failed to timely communicate with the insured. It is obvious that the carrier is not attempting to pay for the clearly covered damages owed under the policy.
The carrier assigned David Williams, who is not an engineer, to inspect the loss. On November 21, 2024, the carrier made the unilateral determinations that A) the damages to the property, including the interior would be excluded under the policy and therefore be denied and that B) the damages that were covered failed to exceed the deductible on the policy and that the insured would be entitled to $0 after the application of the deductible. It was clear that the damages exceeded the deductible.
Moreover, in reaching those conclusions, Florida Peninsula failed to adopt and implement standards for the proper investigation of claims. There was no explanation whatsoever as to how Florida Peninsula determined which items of damage were caused by covered or excluded perils. Furthermore, the carrier’s failure to assign a qualified and experienced engineer further violates F.S. §626.9541(1)(i)(3)(a). Moreover, as the carrier denied coverage without conducting a reasonable investigation based upon available information, the carrier violated F.S. §626.9541(1)(i)(3)(d).
Additionally, the carrier failed to describe how it arrived at the amount it withheld for depreciation. The policy does not explain how depreciation or actual cash value is calculated, and the carrier did not explain the facts or applicable law in relation to the payment made. This is a violation of F.S. §626.9541(1)(i)(3)(f).
Florida Statute 627.70131(3)(e) requires the carrier to provide an estimate within 7 days after the estimate is generated by the insurer’s adjuster. However, it is clear that Florida Peninsula altered the original estimate and failed to provide the unaltered copy. The insurer must send the policyholder a copy of any detailed estimate of the amount of the loss within 7 days after the estimate is generated by an insurer’s adjuster. The carrier also violated F.S. §626.9541(1)(i)(3)(j) by failing to provide a detailed explanation of as why the changes had the effect of reducing the estimate of the loss made and by failing to include on the report or as an addendum to the report a detailed list of all changes made to the report.
The insured has been compelled to obtain an independently adjusted estimate totaling in the amount of $237,227.74 that would be needed to repair the property back to its pre-loss condition. The insured has complied with all the carrier’s requests to date. The carrier has still refused to pay the fully covered amount owed under the policy, instead electing to stand by its unilaterally determined deficient valuation of the loss while denying the rest of the loss.
It is clear that the carrier is not treating the claimant with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the claimant; failing to implement proper standards for the adjustment and investigation of claims and placing the company’s interests before the claimant’s interests; not training, supervising or managing adjusters properly so that prompt and full payments are made; refusing to pay the full amount owed to the insured despite the fact that the damages are covered under the policy; looking for ways to delay full recovery or any recovery to the insured; and refusing to provide coverage for the claimant’s loss in a timely manner. The Carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(d), 627.4137(1), and Fla. Stat. §627.70131.
The actions taken by Florida Peninsula in the handling/adjustment of the insured’s claim were willful, wanton, malicious, and in reckless disregard for the rights of any insureds and occur with such frequency as to indicate a general business practice, and further are in violation of Florida Statutes §624.155 and F.S. §626.954. Indeed, when performing a search on the Florida Department of Financial Services website’s Civil Remedy Notice of Insurer Violation page the results of searches of violations of the statutes referenced herein by the carrier returned the following results thereby indicating that the number of times they occur rise to the level of a general business practice, and warrant punitive damages:
§624.155(1)(b)(1) = 3,767
§624.155(1)(b)(3) = 2,750
§626.9541(1)(i)(3)(a) = 3,609
§626.9541(1)(i)(3)(b) = 2,952
§626.9541(1)(i)(3)(d) = 2,296
§626.9541(1)(i)(3)(f) = 2,290
§626.9541(1)(i)(3)(j) = 17
Based upon the above-referenced acts and omissions, the carrier has breached the insurance contract by failing to pay the amount due to the insured, by denying coverage which existed under the insurance contract with the insured in the instant dispute, by failing to adjust the loss with the insureds, and by failing to perform and adequate investigation. These are violations and breaches of the policy language cited above.
Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1) Pay the complete covered loss in the amount of $237,227.74 less any applicable policy deductible; and 2) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been emailed to the carrier.
The specific policy provisions the carrier violated are the loss payment provision, the loss settlement provision, and the coverage provisions. Specifically, the loss payment provision states “we will adjust all losses with you.” Yet, the carrier did not consult the homeowner in deciding who would investigate the cause or amount of damages, and what the ultimate payment should be. The other provisions are pasted on the pages following the signature block.
If you have any questions or concerns, please send all correspondence via email to Blake@klinglaw.com and Jorlyn@KlingLaw.com to ensure a prompt response. We ask that all correspondence be done via email rather than regular mail. Should you need to send something regular mail, please advise us prior to sending same via the emails above.
Sincerely,
Kling Law, P.A.
Blake M Wallace, Esq.
Blake M. Wallace, Esquire
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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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