Filing Number: 795628
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| Filing Accepted: 12/6/2024 |
| Last/Business Name
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| Street Address
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9 HIGH POINT CIR UNIT 205 |
| City, State Zip
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NAPLES,
FL
34103
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| Email Address
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SERVICE@PROPERTYPEOPLELAW.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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HERRICK |
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First Name |
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PAUL |
| Policy # * |
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H62-251-0040224-4042 |
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Claim #* |
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057706020 |
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Attorney is Applicable
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| Last Name* |
ILANI
First Name *
DANIEL
Initial
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| Street Address* |
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80 SW 8TH STREET, SUITE 2590 |
| City, State Zip* |
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MIAMI
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FLORIDA
33130
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| Email Address * |
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SERVICE@PROPERTYPEOPLELAW.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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LIBERTY MUTUAL 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 23043 |
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| Name of individual responsible for violation (if any):*
ALL ADJUSTERS, SUPERVISORS, MANAGERS, ATTORNEYS, AND INDIVIDUALS ASSOCIATED WITH AND/OR RETAINED BY LIBERTY MUTUAL INSURANCE COMPANY CONCERNING THE CLAIM AT ISSUES; LIBERTY MUTUAL INSURANCE COMPANY’S DESK ADJUSTER(S); LIBERTY MUTUAL INSURANCE COMPANY
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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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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)(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)(2) |
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A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
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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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| 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.
LIBERTY MUTUAL INSURANCE COMPANY failed to adequately adjust and pay the claim covered under the subject insurance policy. Specifically, but not limited to, LIBERTY MUTUAL INSURANCE COMPANY failed to properly apply the Loss Settlement and Loss Payment provisions of the policy. In addition to the policy sections specifically cited herein, any endorsements or changes to said sections are relevant to the Insured’s claim for civil remedy. There may be additional policy language relevant to this violation that may be discovered.
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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.
LIBERTY MUTUAL INSURANCE COMPANY (hereinafter the “Insurance Company”) issued a homeowners insurance policy to its insured, PAUL & ANN HERRICK (the “Insured”), for the insured property located at 9 High Point Cir Unit 205, Naples, FL 34103. The subject Policy afforded various types of coverages including coverage for damage to dwelling, other structures, personal property, and for loss of use. On or about August 27, 2024, while the subject Policy was in full force and effect, the Insured’s home was damaged as a result of a covered loss. The Insured subsequently notified the Insurance Company of this loss. Thereafter, the Insurance Company acknowledged the loss and assigned claim number 057706020 to the loss. The Insured complied with all policy conditions and cooperated with the Insurance Company’s investigation efforts.
The Insurance Company performed a cursory inspection and failed to retain the unbiased experts necessary to adequately inspect the property to restore the property to its pre-loss condition. Shortly after, the insurance company denied this loss based upon an unqualified evaluation of the damages. Notably, the Insurance Company failed to retain an expert to inspect the property to fully evaluate this claim, relying solely on an inadequate inspection concerning a subject matter and claim their representative is ill-equipped and unqualified to properly evaluate. The Insured and Insured’s representative provided the Insurance Company with all claim-related documents including an estimate to repair covered damages in the amount of $39,517.87 and other supporting documentation and/or information.
Nonetheless, the Insurance Company continues to disregard and ignore the Insured’s claim and request for adequate payment. The Insurance Company has failed to issue proper payment for the claim and has failed to issue sufficient payment to compensate the Insured for damages and repairs covered by the policy and held to be contractually covered by Florida law. The Insured provided the Insurance Company with documentation evaluating the loss, and rather than issuing the proper payment or attempting to reach an agreement with its Insured, the Insurance Company is delaying and denying the claim. Upon information and belief, the Insurance Company performs the subject actions as a business practice, including delaying the claim and/or issuing insufficient payments in an attempt to dissuade its insured from pursuing the claim to the detriment of its insured to increase financial profits.
Based upon self-serving conclusions regarding the cause of loss, the Insurance Company’s conclusions are disconcerting because they are demonstrably incorrect. Further, they directly conflict with the only first-hand accounts of the loss. To be clear, the Insured had personal knowledge of the condition of the property prior to the date of the loss and the amounts owed to make the necessary repairs.
That said, the Insurance Company’s refusal to properly investigate, adjust, and fully compensate the Insured for their claim evidences the Insurance Company’s violation of Section 626.9541(1)(i)(3)(a), Florida Statutes, which requires the Insurance Company to “adopt and implement standards for the proper investigation of claims.” All available information leads to one conclusion—the Insured’s property was damaged by a covered cause of loss for which the Insured is entitled to full and complete compensation. The Insurance Company’s obligation to promptly settle the Insured’s claim is undeniable, and therefore, the Insurance Company has also violated sections 624.155(1)(b)(1), Florida Statutes. The Insurance Company’s conduct is egregious because the Insurance Company purposely ignored relevant facts, even facts from its own experts, that would have confirmed coverage for the Insured’s loss to avoid having to compensate the Insured for damages. To make matters even worse, the Insurance Company has failed to timely respond to the Insured and issue payment for the damages to the property to allow necessary repairs.
The actions taken by the Insurance Company in the handling and adjustment of the Insured’s claim are willful, wanton, and in disregard for the rights of the Insured, and have occurred with such frequency as to indicate a general business practice in violation of the law. The practice includes the Insurance Company’s ongoing inaction of ignoring relevant and accessible information that supports coverage in order to avoid compensating its Insured for covered losses.
To be clear, the recent ruling in Fortune v. First Protective Insurance Company d/b/a Frontline Insurance, out of Florida’s 2nd District Court of Appeal, clears up what this carrier must do the cure this CRN. Similar to here, In Fortune, the Insureds timely filed a claim with their homeowners insurance policy upon suffering damage to their property. The Insurer investigated the claim and denied, contending that the amount of damage did not exceed the Insureds’ deductible. Upon presenting the public adjuster’s estimate and all other materials to the insurance company, the Insurer invoked the appraisal process under the policy.Thereafter, the Insureds filed a Civil Remedy Notice alleging that the insurer made a lowball offer and “flagrantly breached” its duty to attempt in good faith to settle claims, under applicable Florida statutes. Additionally, the Insureds alleged that the Insurer refused to reassess its payment of benefits and the basis for payment and that the Insurer “turn[ed] a blindeye and refuse[d] to properly adjust and settle the claim.”
Noteworthy in Fortune is that although the Homeowners' CRN did not state a specific cure amount, it did state that they had provided their public adjustor's estimate to the Insurer which covered "the full scope of necessary repairs to the direct and ensuing damages." Thus, the Insured had the public adjuster's estimate and knew the amount the Homeowners sought. Neither the statute nor this court's precedent requires the CRN to contain a specific amount sought to cure the alleged bad faith. See § 624.155(3)(b); see Hunt v. State Farm Fla. Ins. Co., 112 So. 3d 547, 549 (Fla. 2d DCA 2013) (recognizing that an appraisal award satisfies the condition precedent of "a determination of liability and extent of damages owed").
In addition to the above statutory violations, the Insurance Company’s adjuster violated the following ethical requirements of Florida Administrative Code 69B-220.201.
(3) Code of Ethics…An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance. The following are standards of conduct that define ethical behavior, and shall constitute a code of ethics that shall be binding on all adjusters:
(b) An adjuster shall treat all claimants equally.
2. An adjuster shall adjust all claims strictly in accordance with the insurance contract.
(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
(d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.
(e) An adjuster shall handle every adjustment and settlement with honesty and integrity, and allow a fair adjustment or settlement to all parties without any remuneration to himself except that to which he is legally entitled.
(f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim.
(o) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise.
In Florida, the work of adjusting insurance claims engages the public trust. During the adjustment of the Insured’s claim, the Insurance Company breached this duty by failing to adhere to and comply with the above referenced obligations. To cure the defects outlined above, the Insurance Company must:
1. Immediately pay the Insured a cure of $39,517.87for losses suffered as a result of the claim;
2. Immediately issue payments for statutory interest for the late payments and owed profit/overhead;
3. Act fairly and honestly towards the Insured and with due regard for their interests;
4. Hire a fair and unbiassed adjuster and experts to properly assess the Insured’s damages;
5. Tender any additional insurance proceeds due and owing to the Insured that would reasonably place the Insured back into a pre-loss condition;
6. Timely adjust the claim with the insured and avoid/limit any additional delay, costs, and prejudice that the Insurance Company’s conduct above has caused and continues to cause the Insured; and
7. Compensate the Insured for the attorneys’ fees and costs accrued as a result of the Insurance Company’s bad faith conduct.
Failure to cure all defects during the 60-day safe harbor period may result in additional extra-contractual damages.
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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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