Civil Remedy Notice of Insurer Violations
Login

Filing Number:     797667
Filing Accepted:  12/19/2024
         Print Filing
Complainant
Last/Business Name *  
CHARLES   First Name   SALIFE AND BERTHA
Street Address * 388 MAGNETA LOOP
City, State Zip * AUBURNDALE, FL 33823
Email Address * INTAKE2@THEKRFIRM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   CHARLES   First Name   SALIFE AND BERTHA
Policy # * 76226-12-12 Claim #* 7007590729-1
Attorney
Attorney is Applicable
Last Name* KADIR First Name * ALI Initial A.
Street Address* 986 DOUGLAS AVE, STE. 102
City, State Zip* ALTAMONTE SPRINGS , FL 32714
Email Address * INTAKE2@THEKRFIRM.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   TRUCK INSURANCE EXCHANGE
NAIC Company Code 21709
 
Name of individual responsible for violation (if any):* JAMIE HART, MICHAEL MITCHELL, AMBER WILLIAMS, GABRIELLE CONLEY, AND ALL TRUCK CLAIMS ADJUSTERS, EMPLOYEES, REPRESENTATIVES, AGENTS, VENDORS, AND/OR ENGINEERS WHO HANDLED THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Misrepresentation
* Statutory provision(s) which the insurer allegedly violated.
 
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 insured and with due regard for her or his interests.
624.155(1)(b)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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)(e) 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.
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)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
626.9541(1)(i)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
* 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 A - Dwelling and Coverage B - Other Structures 1. We insure against accidental direct physical loss or damage to the property described in Coverages A and B, unless the loss is excluded in Section - I Exclusions.”
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Salife and Bertha Charles (“the Charles”) are homeowner insureds with a policy issued by Truck Insurance Exchange (“Truck”). The insured property or home is located at 388 Magneta Loop, Auburndale, Florida 33823. In May of 2024, a hail and windstorm caused extensive damage to the Charles’ home. The Charles timely reported an insurance claim for this damage to Truck and fully cooperated with all requests for inspections. They provided all requested documentation, if any, and complied with all post loss policy conditions. After reporting the claim, Truck retained an unqualified and biased field adjuster who has a financial relationship with Truck. This field adjuster inspected the Charles’ home in an apparent effort to minimize Truck’s losses instead of adjusting the claim in good faith in due regard for the Charles’ interests. Despite Truck finding coverage for their claim, it significantly undervalued the Charles’ claim at only $13,607.28. Due to such, the Charles have not been able to permanently repair their home. Indeed, two (2) tarp mitigation invoices and an estimate for repair of all damages were prepared on behalf of the Charles totaling $124,179.11 and were submitted to Truck; well above the amount from Truck. Based on these facts, it is clear Truck unreasonably denied full coverage for the Charles’ claim in bad faith through its extremely low and unreasonable undervaluation of their claim. Had Truck conducted a reasonable investigation based upon the available information, it would have been evident that affording greater coverage and issuing a substantially higher payment is warranted. Instead, it failed to adopt and implement standards for proper claim investigation as well as misrepresented pertinent policy provisions/facts rather than act fairly and/or honestly with the Charles in due regard for their interests. Truck also delayed the claim and failed to timely respond to communications. This has become a common business practice of Truck. Florida Statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit based on determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. Truck has breached this duty by refusing to properly and timely adjust the loss. As a result, the Charles will have no choice but to retain the undersigned counsel to file a lawsuit against Truck. Truck has more than enough information and is still refusing to accept coverage for this claim. This continued and repeated reckless claim delay and denial of coverage will result in a significant punitive damage award if a bad faith lawsuit is filed. Truck can avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy for this claim and by paying the Charles based on their $124,179.11 estimate and invoices.
Comments
User Id Date Added Comment
cheryl.perez@farmersinsurance.com 02-04-2025 February 4, 2025 Via E-Mail Kuhn Raslavich PA 2110 W Platt St Tampa, FL 33606 Delivered by email to: intake2@thekrfirm.com RE: Salife Charles and Bertha Charles Claim No.: 7007590729-1 Dear Ali Kadir, This correspondence is Truck Insurance Exchange’s (“Truck”) response to the Civil Remedy Notice of Insurer Violation No. 797667 filed on behalf of Complainant Salife and Bertha Charles on December 19, 2024. Complainant alleges that Truck violated various subsections within Sections 624.155 and 626.9541, Florida Statutes, pertaining to Claim No. 7007590729-1 under an insurance policy issued by Truck to Complainant. Truck welcomes the opportunity to respond to the Notice’s allegations. The Notice fails to comply with the specific notice and information requirements set forth in Section 624.155, Florida Statutes, and Form DFS-10-363. Florida law requires strict compliance with the specific notice and information requirements of section 624.155, Florida Statutes. This notice is invalid for the following reasons related to the failure to include information required on Form DFS-10-363: • The notice does not provide the Complainant’s email address. This notice is also invalid due to the failure to include statutorily required information as follows: • The notice does not identify or narrow the person(s) representing the insurer who are most responsible for or who have knowledge of the facts giving rise to the allegations in Complainant's Notice. • The Complainant has failed to provide “specific policy language that is relevant to the violation, if any,” as required by section 624.155, Florida Statutes. Instead, the Complainant has essentially cited all of the language contained within the policy of insurance. Accordingly, Truck is without proper notice as to the specific violations the Complainant alleges were violated. On the merits, Truck avers it handled Complainant’s claim correctly, fairly, in good faith and with due regard for their interests under Complainant’s policy. A review of our records shows the public adjuster, Lifeline Public Adjusters, reported this loss on May 17, 2024, damage to Complainant’s property as a result of windstorm on May 13, 2024. Truck conducted a prompt and thorough investigation into this claim. We immediately made contact to gather information and schedule the inspection. Truck’s claim representative completed the inspection as scheduled on May 20, 2024 in the presence of the insured and public adjuster. We found covered hail damage to the roof, several window screens, pool enclosure, a downspout, mailbox and interior water damage to the living room ceiling. We also found non-covered water damage to the ceiling in the garage. As discussed with our insured, our investigation found that this damage is a result from wear of the caulking from the tub above and not related to the storm. We reviewed the findings with the insured and provided a partial denial letter of explanation along with our estimate for the covered repairs that same date. On July 22, 2024 we received an estimate from Lifeline Public Adjusters for the amount of $116, 696.83. After a careful review of the supplemental request, we issued a payment and provided a detailed explanation of the approved, partially approved, denied line items and those that require additional information. At the request of Lifeline Public Adjusters, we participated in mediation October 3, 2024 which resulted in an impasse. On October 4, 2024 we issued payment for the tarping services provided by Simple Support Solutions. The only facts that Complainant alleges to support their allegations that Truck violated Florida law and handled Complainant’s claim in bad faith is that Truck’s adjustment of the claim did not result in payment of Complainant’s exorbitant demand. Truck’s policy only covers accidental direct physical loss or damage to the property that is not otherwise excluded, which is further limited by the conditions and coverage limits of the policy. In accordance with these terms, Truck properly adjusted this claim. Accordingly, contrary to Complainant’s apparent contention, Truck’s coverage determination was made in good faith. Truck denies any breach of any statutory or contractual duties in the handling of Complainant’s claim. Since we have been advised that a lawsuit has been filed on this claim, our defense counsel will discuss the facts and the perceived issues with you further during the course of the litigation. At this time, our position on coverage and this claim remains unchanged. While this response is meant to be comprehensive, Truck’s response is based on the limited information provided in the Notice filed by Complainant. Also, this letter or any act or failure to act on the part of Truck or any agent or representative of Truck should not be construed as a waiver of any rights or defenses, including but not limited to proper notice and service, available to it by contract or at law as all such right and defenses are hereby specially reserved. We trust that this response addresses the allegations raised in the Notice. Please contact me if you have any questions or should you wish to discuss this matter further. Sincerely, Cheryl Perez, Company Employee Adjuster General Claims Adjuster (913) 274-0230 Truck Insurance Exchange
Acknowledgement
* 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