Filing Number: 798172
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| Filing Accepted: 12/24/2024 |
| Last/Business Name
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| Street Address
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15891 CAPTIVA DRIVE |
| City, State Zip
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CAPTIVA,
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33924
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| Email Address
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TJR964@AOL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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RIEU |
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First Name |
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TIMOTHY |
| Policy # * |
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OICF0008192-02 |
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Claim #* |
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22FLDFV0008606 |
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Attorney is Applicable
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| Last Name* |
KELLAM
First Name *
CHRISTOPHER
Initial
W
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| Street Address* |
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759 PARKWAY STREET, SUITE 202 |
| City, State Zip* |
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JUPITER
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FLORIDA
33477
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| Email Address * |
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CKELLAM@KELLERSWAN.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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OLYMPUS 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 12954 |
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| Name of individual responsible for violation (if any):*
OCTAVIO BERMUDEZ
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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 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)(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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
114. The specific policy language is found in policy number OICF0008192-02, DP 00 03 07 88 Dwelling Property 3 - Special Form as amended by OIC DP 09 SP 06 18 Special Provisions – Florida, Conditions subsection 12 within the “Our Option” provision (cited in Insurer’s 11.10.2022 letter, incorporated herein)
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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.
* This notice is given in order to perfect the right to pursue the civil remedy authorized by section 624.155, Florida Statutes.
*This Civil Remedy Notice is intended to comply with all requirements of section 624.155, Florida Statutes and Florida law interpreting same. If Insurer takes the position that it cannot respond to this Notice because information is missing, Complainant requests that Insurer advise Complainant immediately so that reasonable, substantive issues can be addressed.
1. Complainant Name: Timothy Rieu
2. Complainant Street Address: 15891 Captiva Drive
3. Complainant City, State, Zip: Captiva, Florida 33924
4. Complainant Email Address: tjr964@aol.com
5. Complainant Type: Insured
6. Insured Name: Timothy Rieu
7. Insured Policy #: OICF0008192-02
8. Insured Claim #: 22FLDFV0008606
9. Attorney Name: Christopher Kellam
10. Attorney Street Address: 759 Parkway Street, suite 202
11. Attorney City, State, Zip: Jupiter, Florida 33477
12. Attorney Email Address: ckellam@kellerswan.com
13. Violation Insurer Type: Authorized Insurer
14. Violation Insurer Name: Olympus Insurance Company
15. Violation Type of Insurance: Residential Property & Casualty
16. Violation Insurer Street Address: P.O. Box 33117
17. Violation Insurer City, State, Zip: Palm Beach Gardens, Florida 33420
18. Person representing insurer: Octavio Bermudez
19. Reasons for Notice: Claim Delay, Unfair Trade Practice
Facts and Circumstances giving rise to the insurer’s violation:
A. SPECIAL RELATIONSHIP.
1. Insurer and Insured.
2. Insured paid Insurer annual premium to insure the covered property, which includes a dwelling.
3. Premium pays for, among other coverages, Coverage A – Dwelling.
4. Premium includes inspecting the dwelling for any claim.
5. Insurer has a duty to determine extent of all loss, damage, and coverage – under each type of coverage applicable to a claim.
6. Insurer has duty to provide complete information with regard to any claim.
7. Insurer cannot injure, defraud, or deceive Insured with regard to any claim.
8. Insurer has a duty to act in good faith at all times.
B. INSURER’S CLAIMS EXPERIENCE.
9. Insurer has been insuring dwellings for years.
10. Insurer has had hundreds of hurricane claims in the past.
11. Insurer has a team of consulting experts to help it determine extent of loss and damage with regard to any claim; e.g., roofers, engineers, contractors, etc.
12. Insurer knows dwellings located near the coastline are at risk of damage in Florida due to hurricanes.
13. Insurer knows that dwellings located near the coastline are often used as rental properties.
14. Insurer knows that, when a dwelling is damaged by hurricane, the structural integrity of the dwelling (roof, windows, doors) is compromised.
15. Insurer knows that subsequent weather events, even those not as severe as the loss event, can cause damage because of the compromised roof.
16. Insurer knows this will continue until dwelling is repaired.
17. Insurer knows that a roof cannot be repaired when a loss causes sufficient damage to compromise the entire system; the roof must be replaced.
18. Insurer knows that water leaking to the interior, when sitting over time, causes continuous damage including mold.
19. Insurer knows that a dwelling cannot be used as a rental property when damaged by a hurricane.
C. INSURED’S HOMEOWNER’S INSURANCE POLICY.
20. Insurer issued to Insured a Dwelling Property 3 policy.
21. All loss is covered unless expressly excluded.
22. There is coverage for this loss.
D. INSURED DWELLING.
23. Insurer knew the following information in this section D when issuing the policy, at each renewal, and prior to the loss.
24. Roofing system consisted of primary insulation, cover board, underlayment (underlying primary moisture barrier), and surfacing.
25. Dwelling had an uncompromised roofing system with aluminum surface material.
26. Roofing system was and is required to comply with applicable Florida building and safety codes.
27. Uncompromised roofing system protected Insured’s dwelling from all weather.
28. When wind and rain events occurred, the uncompromised roofing system was waterproof because of the layered construction.
29. When roofing system was compromised by the subject loss event and failed, the roof ceased to function as designed and required.
30. The covered property was used by Insured as a rental property.
31. Insured regularly maintained the coverage property because of its continued use as a rental property.
32. Insurer has no evidence of roof, window, door, or interior water damage existing prior to the subject loss.
E. INSURER’S NOTICE.
33. Insurer knows year home was built.
34. Insurer knows when policy is issued the age of the dwelling.
35. Insurer knows when policy is issued the condition of the dwelling.
36. Insurer was aware of all relevant underwriting materials.
37. Insurer knows a weather event, namely Hurricane Ian, occurred while the subject policy was in force and effect.
38. Insurer knows that, subsequent to Hurricane Ian, Insured’ roof, windows, doors, and dwelling interior were damaged and suffered a loss.
F. TYPICAL HURRICANE CLAIM.
39. Insurer knows that hurricane-force winds can and do damage Florida dwellings.
40. Insurer knows the damaged roof will leak causing further damage, and will continue to deteriorate until repaired or replaced.
41. Symptoms may include, among others: (a) damaged roof materials; (b) water damage; (c) leaking water to interior; (d) bad smell; (e) roaches, flies or rodents; or (f) other water leak problems (“symptoms”).
42. Symptoms will continue until the dwelling is repaired.
43. Insurer knows that, until repaired, a rental property is not livable until repairs are completed.
44. Insurer knows that hurricanes cause such extensive damage that Insured are unable to complete repairs without policy benefits.
45. Insured must make emergency mitigation efforts.
46. However, Insurer relies on a lengthy, complicate insurance policy that Insured may not fully understand.
47. Insurer delays investigation and resolution of the claim so that insureds feel that they must accept lower policy benefits payments just to move forward.
48. Insured is forced to threaten the filing of a lawsuit by submitting Notice of Intent to Initiate Litigation.
G. INSURED’S CLAIM.
49. Insured notified Insurer that he had dwelling damage caused by Hurricane Ian.
50. Insured submitted to Insurer photographs, documentation, and information acquired soon after the storm passed.
51. Insured’s photographs included those showing damage to the roof and to the interior of the dwelling.
52. Insurer knows that the claimed damage did not exist prior to the hurricane striking Insured’s dwelling.
53. Insurer knows that the dwelling is not livable until hurricane-related damage is repaired.
54. Insurer was required to determine the extent of all loss, damage, and coverage.
55. Insurer had a duty to pay or deny the claim within 90 days.
56. Insurer knew the symptoms of damage caused by a hurricane.
57. Insurer has had every opportunity to diagnose the cause of the symptoms.
58. In the meantime, Insured’s dwelling remained uninhabitable.
59. Insurer has known that Insured were not able to rent the covered property following Hurricane Ian.
H. INSURER’S INSPECTION.
60. Insurer inspected the dwelling.
61. Purpose of inspection was to determine extent of loss, damage, and coverage.
62. Insurer had a team of consulting experts available for the inspection.
63. Insurer was not limited to one inspection.
64. Insurer knew that a failed roof and window system would trigger coverage or indemnity payments under policy for the following: (a) tear-out; (b) roof replacement; (c) post tear out repairs; (d) rental; and (e) moving and storage during any repairs (“indemnity payments”).
I. INSURER’S RESPONSE TO INSURED’S CLAIM.
65. On 11.10.2022, Insurer selected the Option to repair or replace Insured’s roof.
66. Insurer selected contractor “Baldwin” to replace the roof.
67. However, Insurer’s contractor would not replace all the gutters, soffit, and fascia.
68. Insurer’s original roof cover material selection was a different material than covered the roof at the time of Hurricane Ian.
69. Insurer’s original roof cover material selection was not designed for use in proximity to bodies of salt water, as with Insured’s dwelling.
70. Insurer’s original roof cover material selection was not of like kind and quality to the material covering the roof at the time of the loss.
71. Insurer then changed contractors to Neumann Construction & Roofing LLC.
72. Insurer’s again approved roof cover material selection that was a different material than covered the roof at the time of Hurricane Ian.
73. Insurer than approved a like kind and quality aluminum roof cover material.
74. Insured met with Insurer’s contractor to complete the paperwork necessary to start the re-roof process.
75. Insured then did not hear from Insurer’s contractor for a number of weeks.
76. Insured then learned form Insurer’s contractor, without any notice from Insurer, that the re-roof Option would not move forward.
77. To date, Insurer knows that Insured cannot complete the remaining repairs until the roof is replaced.
78. To date, Insured continues to lose rental money because the dwelling is not rentable.
79. Insurer has yet to correct this failure.
80. Insurer failed to provide complete information regarding the extent of the loss; e.g., partial disclosure of material information is misleading.
81. Insurer’s intent was to injure, defraud, or deceive Insured.
82. Insurer failed to act in Insured’ best interest.
83. Insurer refused to acknowledge the complete extent of loss and damage.
84. Insurer’s response to Insured’s claim and its actions are made in bad faith.
85. Insured submitted a Notice of Intent to Initiate Litigation, Notice Number 170974.
86. Insurer failed to complete the Option selection.
87. On 11.18.2024, Insurer deposed Insured.
88. Insurer has thus far provided no explanation for its failure to follow through on its Option selection.
89. To help Insurer evaluate this civil remedy notice of insurer violation, please review the allegations under insured’s Complaint, written discovery responses, and deposition testimony which are adopted herein.
J. INSURER’S GENERAL BUSINESS PRACTICE & BAD FAITH.
90. An insurer’s general business practice includes pre-suit, litigation, mediation, or appraisal.
91. This case is an example of Insurer’s general business practice.
92. Insurer demands to utilize a contractor of its choosing to replace its insureds’ roofs within 90 days. 627.70131(5)(a), F.S.
93. Insurer selects this Option to save money.
94. Insurer then fails to complete the Option.
95. Insurer fails to write the policy clearly for insured to understand; e.g., when reading the policy, endorsements, amendments or changes you have to be a lawyer that specializes in reading insurance policies to understand what it says and even then sometimes the lawyers disagree.
96. Insurer fails to provide complete and accurate information to its insured.
97. Insurer ignores, denies, and fails to identify, all loss, damage and coverage.
98. Insurer’s intent is to injure, defraud, or deceive insured. 817.234(7)(b), F.S.
99. Insured retain an attorney to procure complete payment of the loss covered under the policy.
100. Insured submit a Notice of Intent to Initiate Litigation.
101. Insurer responds to the Notice with a demand to continue the claim negotiation process without clear indication of what will be covered and paid.
102. Insured serves Insurer with a lawsuit from breach of the homeowner’s insurance contract.
103. Insurer takes this course of action as a general business practice.
104. When an insured is forced to file suit for breach of the policy, Insurer denies allegations in response to the complaint that should be admitted, it asserts affirmative defenses without a factual or legal basis, it objects and fails to answer discovery during the litigation and otherwise obstructs the process to force the insured to settle for less than their loss and damages.
105. Insurer’s actions are unfair, deceptive, intentional, and otherwise in made bad faith and violate all applicable statutes which include, but are not limited to, the statutory provisions cited under this civil remedy notice.
106. These practices are designed to obstruct the claim process and force the insured to settle for less than their loss and damages.
107. This general business practice significantly decreases Insurer’s loss payments.
K. STATUTORY PROVISIONS WHICH THE INSURER ALLEGEDLY VIOLATED
108. Insurer violated section 624.155(1)(b)(1), Florida Statutes: 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.
109. Brief summary of section 624.155(1)(b)(1) violation – Insurer acknowledged coverage under this claim and initially invoked its option to repair or replace. Insurer and Insured moved forward with the process as regards replacing the roof by utilizing Olympus Elite Repair Program and Neumann Construction & Roofing LLC. Insurer initially chose a different vendor with whom Insured met to complete the roof replacement process. Insured then changed vendors to Neumann. Insured cooperated with Insurer’s vendor and signed all paperwork necessary to complete the re-roof work. Insurer recently, without notice to Insured, stopped the replacement process.
110. Insurer violated section 624.155(1)(b)(3), Florida Statutes: 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.
111. Brief summary of section 624.155(1)(b)(3) violation – Insurer acknowledged coverage under this claim and initially invoked its option to repair or replace. Insurer and Insured moved forward with the process as regards replacing the roof by utilizing Olympus Elite Repair Program and Neumann Construction & Roofing LLC. Insurer initially chose a different vendor with whom Insured met to complete the roof replacement process. Insured then changed vendors to Neumann. Insured cooperated with Insurer’s vendor and signed all paperwork necessary to complete the re-roof work. Insurer recently, without notice to Insured, stopped the replacement process.
112. Insurer violated section 626.9541(1)(i)(3)(f), Florida Statutes: 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.
113. Brief summary of section 626.9541(1)(i)(3)(f) violation – In addition to the above, Insurer failed to explain its reason for not completing the re-roof process through the Olympus Elite Repair Program.
L. REFERENCE TO SPECIFIC POLICY LANGUAGE
114. The specific policy language is found in policy number OICF0008192-02, DP 00 03 07 88 Dwelling Property 3 - Special Form as amended by OIC DP 09 SP 06 18 Special Provisions – Florida, Conditions subsection 12 within the “Our Option” provision (cited in Insurer’s 11.10.2022 letter, incorporated herein).
M. MEASURE OF CURE
115. Insurer can cure its violations and avoid a bad faith action with respect to Coverage A, as regards the Option to repair or replace the Insured’s roof.
116. Please timely complete replacement of the roof pursuant to the conditions already agreed.
117. To be clear, Complainant is aware that Insurer agreed to utilize Neumann Construction & Roofing LLC to replace the damaged roof with like-kind-and-quality (aluminum roof with warranty) pursuant to the Olympus Elite Repair Program.
118. Note that this Civil Remedy Notice specifically relates only those damages under Coverage A of the subject Policy specifically addressed by Insurer’s previously invoked Option to repair or replace the Insured’s roof; Complainant reserves his right to pursue remaining damages under Coverage A as well as damages under Coverage C and Coverage D.
119. Second, Insurer must admit Complainant’s entitlement to reasonable attorneys’ fees and costs in an amount to be determined by settlement or by a determination of the Court in which Complainant’s action is pending.
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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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