Filing Number: 797736
|
| Filing Accepted: 12/20/2024 |
| Last/Business Name
*
|
|
|
| Street Address
*
|
|
2600 COFFEE POT BLVD NE |
| City, State Zip
*
|
|
SAINT PETERSBURG,
FL
33704
|
| Email Address
*
|
|
WITHHELD |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
LARSON |
|
First Name |
|
BLAKE |
| Policy # * |
|
FPH5557446-00 |
|
Claim #* |
|
FPI250566 |
|
Attorney is Applicable
|
| Last Name* |
MULLINAX
First Name *
MATTHEW
Initial
|
| Street Address* |
|
908 W HORATIO ST |
| City, State Zip* |
|
TAMPA
,
FLORIDA
33606
|
| Email Address * |
|
MATT@MAKRISMULLINAX.COM |
|
|
| Insurer Type
*
|
|
Authorized Insurer
Unauthorized Insurer
|
|
|
| Insurer Name |
|
|
| Insurer Name* |
|
FLORIDA PENINSULA INSURANCE COMPANY
|
| Insurer Name* |
|
|
| Street Address* |
|
|
| City, State Zip* |
|
,
|
|
NAIC Company Code 10132 |
|
|
| Name of individual responsible for violation (if any):*
SHALANAR ROBINSON & GRACE REINHART
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
Claim Denial
|
|
Claim Delay
|
|
Unsatisfactory Settlement Offer
|
|
Unfair Trade Practice
|
|
|
*
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)(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)(2) |
|
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.
|
| 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)(3)(j) |
|
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;
|
|
*
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 PERILS INSURED AGAINST SECTION.
THE LOSS PAYMENT PROVISION.
THE LOSS SETTLEMENT PROVISION.
THE POLICY PROVISIONS CITED IN ANY LETTERS FROM FLORIDA PENINSULA INSURANCE COMPANY (“FPIC”) TO THE INSURED OR THE INSURED’S REPRESENTATIVES.
ANY OTHER PROVISIONS OF THE POLICY WHICH FPIC BELIEVES LIMIT OR PROVIDE COVERAGE FOR THE INSURED’S LOSS.
FLORIDA STATUTES, WHICH ARE INCORPORATED INTO ALL POLICIES IN FLORIDA.
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
THE INSURED PURCHASED, AND FLORIDA PENINSUAL INSURANCE COMPANY (“FPIC”) SOLD, FOR GOOD AND VALUABLE CONSIDERATION OF A POLICY PREMIUM, A HOMEWNERS POLICY OF INSURANCE FOR THE PROPERTY LOCATED AT 2600 COFFEE POT BLVD NE, SAINT PETERSBURG, FLORIDA. FPIC SOLD THE INSURED A POLICY NUMBERED ABOVE, WHICH BECAME EFFECTIVE AUGUST 9, 2024.
WHILE THE POLICY WAS IN FULL FORCE AND EFFECT, ON OR ABOUT OCTOBER 10, 2024, THE INSURED PROPERTY SUFFERED DAMAGE AS A RESULT OF A COVERED PERIL. HURRICANE MILTON STRUCK THE PROPERTY, AND COVERED DAMAGE OCCURRED. THE INSURED TIMELY REPORTED THE CLAIM TO FPIC, AND FPIC ASSIGNED CLAIM NUMBER FPI250566 TO THE LOSS. FPIC ACCEPTED COVERAGE FOR THE LOSS.
WHILE FPIC ACCEPTED COVERAGE FOR THE LOSS, FPIC ALSO DENIED COVERAGE (1) BY NOT INCLUDING NECESSARY REPAIRS IN THE ADJUSTMENT, AND (2) BY NOT DETERMINING THE PROPER AMOUNT NEEDED FOR THE REPAIRS THAT FPIC DID INCLUDE.
FPIC ESTIMATED THE AMOUNT FOR REPAIRS TO BE $1,079.88, AND FOOD LOSS IN THE AMOUNT OF $500.00, FOR A TOTAL CLAIM AMOUNT OF $1,579.88. AFTER THE TWO APPLICABLE DEDUCTIBLES FOR DWELLING AND FOOD LOSS, DEFENDANT ISSUED PAYMENT OF $400.00 TO THE INSURED. THE ADJUSTER SENT TO INSPECT THE PROPERTY, WHO MET WITH THE INSURED’S REPRESENTATIVES AND ESTIMATED THE DAMAGE WAS DREW HARKLAU, LICENSE NUMBER E150857. THIS ESTIMATE WAS NEVER PROVIDED. INSTEAD, FPIC PROVIDED AN ESTIMATE PREPARED BY A GRACE REINHART, LICENSE NUMBER G051833, WHO HAS NOT VISITED THE PROPERTY AND WHOSE IDENTITY IS UNKNOWN. THIS COULD EXPLAIN THE GROSS UNDERVALUE OF THE LOSS BY FPIC, AND AN EXPLANATION SHOULD BE PROVIDED BY FPIC FOR WHY AN ADJUSTER WHO DID NOT INSPECT ESTIMATED THE DAMAGE.
THE INSURED RETAINED HIS OWN PROFESSIONALS, INCLUDING OPINION FROM AN ENGINEER AS TO CAUSATION AND EXTENT OF DAMAGE, QUOTES FOR WINDOW REPAIRS, AND PHOTOGRAPHS AND COMPREHENSIVE ESTIMATE PREPARED BY A LICENSED ADJUSTER RETAINED BY THE INSURED. THE INSURED’S ADJUSTER ESTIMATED THE FULL COST OF RETURNING THE PROPERTY TO ITS PRE-LOSS CONDITION TO BE $749,271.88. THIS ESTIMATE WAS PROVIDED TO FPIC WITH A SWORN STATEMENT IN PROOF OF LOSS BUT TO DATE FPIC HAS REFUSED TO ISSUE PAYMENT IN ACCORDANCE WITH THE ESTIMATE. THE INSURED HAS, AND CONTINUES TO, COMPLY WITH ALL DUTIES AFTER LOSS UNDER HIS POLICY OF INSURANCE.
FPIC HAS DELAYED THE ADJUSTMENT OF THIS CLAIM BY NOT INITIALLY ESTIMATING THE PROPERTY COST OF REPAIRS, BY NOT ACCEPTING AND ISSUEING PAYMENT FOR THE ESTIMATE PREPARED BY THE INSURED’S ADJUSTER, AND FOR NOT ACKNOWLEDGING THE PROPERTY BEING A TOTAL LOSS AS DEFINED BY FLORIDA STATUTE § 627.702, AND THEN ISSUEING THE FULL LIMIT OF THE POLICY AS REQUIRED BY STATUTE.
PINELLAS COUNTY HAS DETERMINED THAT THE DOLLAR AMOUNT LIMIT OF REPAIRS THAT CAN BE MADE TO THIS STRUCTURE IS $537,603.00. REPAIRS COSTING IN EXCESS OF $537,603.00 WILL NOT BE APPROVED AND WILL REQUIRE THE PROPERTY TO BE BROUGHT TO COMPLIANCE WITH CURRENT BUILDING CODE REQUIREMENTS FOR THE LOCATION OF THE PROPERTY AS DICTATED BY THE FLORIDA BUILDING CODE, STATE OF FLORIDA, AND PINELLAS COUNTY. DUE TO IT NOT BEING STRUCTURALLY OR FINANCIALLY FEASIBLE TO BRING THIS PROPERTY TO THE ELEVATION REQUIREMENT FOR WHERE IT IS LOCATED (AMONG OTHER CURRENT REQUIREMENTS THAT ARE NOT POSSIBLE), THIS ESSENTIALLY MAKES THE PROPERTY A TOTAL LOSS. THIS IS COMMONLY REFERRED TO AS THE FEMA 50% RULE, RELATED TO SUBSTANTIAL IMPROVEMENTS AND DAMAGE DETERMINATIONS.
FLORIDA STATUTE § 627.702 STATES IN PART WITHIN SUBSECTION (1)(A):
“IN THE EVENT OF THE TOTAL LOSS OF ANY BUILDING, STRUCTURE, MOBILE HOME AS DEFINED IN S. 320.01(2), OR MANUFACTURED BUILDING AS DEFINED IN S. 553.36(13), LOCATED IN THIS STATE AND INSURED BY ANY INSURER AS TO A COVERED PERIL, IN THE ABSENCE OF ANY CHANGE INCREASING THE RISK WITHOUT THE INSURER’S CONSENT AND IN THE ABSENCE OF FRAUDULENT OR CRIMINAL FAULT ON THE PART OF THE INSURED OR ONE ACTING IN HER OR HIS BEHALF, THE INSURER’S LIABILITY UNDER THE POLICY FOR SUCH TOTAL LOSS, IF CAUSED BY A COVERED PERIL, SHALL BE IN THE AMOUNT OF MONEY FOR WHICH SUCH PROPERTY WAS SO INSURED AS SPECIFIED IN THE POLICY AND FOR WHICH A PREMIUM HAS BEEN CHARGED AND PAID.”
APPLICATION OF FLORIDA STATUTE § 627.702 TO THE FACTS OF THIS CLAIM, SHOW THAT BECAUSE THE ESTIMATED COST OF REPAIRS FROM THIS CLAIM ALONE IS $749,271.88, AND PINELLAS COUNTY WILL NOT APPROVE REPAIRS IN EXCESS OF $537,603.00 BEFORE REQUIRING THE PROPERTY TO BROUGHT TO CURRENT CODE, AND BECAUSE IT IS NOT STRUCTURALLY OR FINANCIALLY FEASIBLE TO BRING THE EXISTING STRUCTURE TO CURRENT CODE, THE INSURED PROPERTY IS A TOTAL LOSS AND FLA. STAT. § 627.702, DICTATES THAT FPIC’S LIABILITY UNDER THE POLICY FOR THE LOSS CAUSED BY A COVERED PERIL IS . ACCORDINGLY, FPIC’S REQUIRED INDEMNIFICATION FOR THIS CLAIM IS THE FULL VALUE OF THE POLICY FOR THIS CLAIM, WHICH IS $1,600,000.00.
THE FOLLOWING IS ALLEGED UPON INFORMATION AND BELIEF. THESE ACTIONS DESCRIBED ABOVE, AND OTHERS THAT OCCURRED IN THIS CLAIM, AMOUNT TO A FAILURE TO ADJUST THE INSURED’S CLAIM IN GOOD FAITH. FPIC’S REFUSAL TO CONDUCT A REASONABLE INVESTIGATION BASED UPON AVAILABLE INFORMATION AND FAILURE TO TIMELY PAY THE INSURED FOR THE DAMAGE AND COVERED LOSS UNDER THE POLICY ISSUED BY FPIC EXHIBITS BAD FAITH. FURTHER, FPIC FAILED TO COMPLY WITH ITS LOSS SETTLEMENT PROVISION. RATHER THAN ISSUING THE PROPER PAYMENT OR ATTEMPTING TO REACH AN AGREEMENT WITH ITS INSURED, FPIC DENIED, UNDERPAID, AND DELAYED THE CLAIM. UPON INFORMATION AND BELIEF, FPIC PERFORMS THE SUBJECT ACTIONS AS A BUSINESS PRACTICE, INCLUDING DELAYING THE CLAIM AND PARTIALLY DENYING THE CLAIM IN AN ATTEMPT TO DISSUADE ITS INSURED FROM PURSUING THE CLAIM TO THE DETRIMENT OF ITS INSURED AND TO INCREASE FINANCIAL PROFITS.
THE INSURED IS CONSIDERING ALL AVAILABLE OPTIONS FOR REPAIRS AND RESTORING THE PROPERTY TO ITS PRE-LOSS CONDITION AS A RESULT OF THE DAMAGE FROM THIS CLAIM. ONE OF THESE OPTIONS INCLUDES DEMOLITION OF SOME OR ALL OF THE INSURED STRUCTURE. THIS NOTIFICATION IS BEING PROVIDED TO FPIC SO THAT FPIC MAY CONDUCT ANY ADDITIONAL INSPECTIONS IT FEELS ARE NEEDED FOR ANY REASON RELATED TO THE POLICY OR PENDING CLAIMS, AND TO PREVENT ANY SPOLIATION ARGUMENT BY FPIC AT ANY POINT IN THE FUTURE. AN EXACT TIMEFRAME FOR WHEN THIS DECISION OR POTENTIAL DEMOLITION MAY OCCUR CANNOT BE GIVEN, AS THE SITUATION IS FLUID, HAPPENING IN REAL TIME, AND DICTATED BY THE REQUIREMENTS OF THE COUNTY, FLORIDA LAW, AND THE FINANCIAL IMPLICATIONS CREATED BY THIS LOSS. ACCORDINGLY, SHOULD FPIC WISH TO INSPECT THE DWELLING IT SHOULD NOTIFY BOTH THE INSURED’S PUBLIC ADJUSTER AND THE FILER OF THIS NOTICE IN WRITING (EMAIL IS SUFFICIENT) WITHIN THIRTY (30) CALENDAR DAYS. DURING THAT TIME INSPECTION REMAINS POSSIBLE BUT AFTER THAT TIME, THERE CAN BE NO GUARANTEE THE HOME WILL BE AVAILABLE TO INSPECT. IN NOTIFYING FPIC OF THIS, THE INSURED IS COMPLYING WITH ANY DUTIES AFTER LOSS UNDER THE POLICY OF INSURANCE.
IN THE EVENT FPIC BELIEVES THIS CIVIL REMEDY NOTICE LACKS INFORMATION NECESSARY FOR FPIC TO CURE THE DEFECTS OUTLINED IN THIS NOTICE, OR THAT IT LACKS REQUIRED SPECIFICS IN ANY WAY, FPIC SHOULD CONTACT THE FILER OF THIS NOTICE DIRECTLY AND ALERT THEM TO THAT AS SOON AS POSSIBLE, PRIOR TO ANY FORMAL RESPONSE.
THIS NOTICE IS FILED AND GIVEN TO FPIC TO PERFECT THE RIGHT TO PURSUE THE CIVIL REMEDY THAT SECTION 624.155 AUTHORIZES.
TO CURE THE DEFECTS OUTLINED IN THIS CIVIL REMEDY NOTICE, FPIC MUST:
(1). ADMIT FULL COVERAGE FOR THE INSURED’S LOSS;
(2). INITIALLY AND IMMEDIATELY THE FULL VALUE OF THE PUBLIC ADJUSTER’S ESTIMATE, $749,271.88, LESS ANY APPLICABLE DEDUCTIBLE.
(3). DEEM THE PROPERTY A TOTAL LOSS UNDER FLORIDA STATUTE § 627.702, AND ISSUE THE REMAINING COVERAGE A LIMIT, FOR A TOTAL CLAIM PAYMENT OF $1,600,000.00, LESS ANY APPLICABLE DEDUCTIBLE.
(3). PAY STATUTORY INTEREST ON THE AMOUNT OF UNPAID CONTRACT DAMAGES FROM THE DATE OF THE LOSS TO THE PRESENT TIME PURSUANT TO F.S. §627.70131.
A COPY OF THIS FORM SUBMITTED TO THE FDFS HAS BEEN PROVIDED TO THE FOLLOWING PARTIES PROVIDING THEM NOTICE OF THE FILING OF THE CIVIL REMEDY NOTICE:
FLORIDA PENINSULA INSURANCE COMPANY
VIA EMAIL TO: CLAIMS@FLORIDA PENINSULA.COM
|
|
*
|
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
|