Filing Number: 798659
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| Filing Accepted: 12/30/2024 |
| Last/Business Name
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LEDESMA-PEREZ
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First Name |
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MARIO |
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| Street Address
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1871 17TH STREET SOUTHWEST |
| City, State Zip
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NAPLES,
FL
34117
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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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LEDESMA-PEREZ |
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First Name |
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MARIO |
| Policy # * |
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HCPC-HO3-521013-3 |
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Claim #* |
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932259 |
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Attorney is Applicable
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| Last Name* |
SIGEL
First Name *
MELANIE
Initial
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| Street Address* |
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800 E. BROWARD BLVD. STE. 510 |
| City, State Zip* |
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FORT LAUDERDALE
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FL
33301
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| Email Address * |
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MDS@WEKLAW.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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HOMEOWNERS CHOICE PROPERTY & CASUALTY INSURANCE COMPANY, INC.
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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 12944 |
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| Name of individual responsible for violation (if any):*
SUSAN HORN, JUAN RAMIREZ, DEFENDANT
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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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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)(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)(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)(4) |
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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).
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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.
COVERAGE A – DWELLING and COVERAGE B –
OTHER STRUCTURES
We insure against risk of direct loss to property
described in Coverages A and B only if that loss is a
physical loss to property.
***
3. Loss Settlement.
Covered property losses are settled as follows:
a. Property of the following types:
(1) Personal property;
(2) Awnings, carpeting, household
appliances, outdoor antennas and
outdoor equipment, whether or not
attached to buildings; and
(3) Structures that are not buildings;
at actual cash value at the time of loss but not
more than the amount required to repair or
replace. b. Buildings under Coverage A or B at
replacement cost without deduction for
depreciation, subject to the following:
(1) If, at the time of loss, the amount of
insurance in this policy on the damaged
building is 80% or more of the full
replacement cost of the building
immediately before the loss, we will
initially pay the actual cash value of the
loss, less any applicable deductible. We
will then pay any remaining amounts
necessary to perform such repairs or
replacement as work is performed and
expenses are incurred, but not more than
the least of the following amounts:
(a) The limit of liability under this policy
that applies to the building;
(b) The replacement cost of that part of
the building damaged for like
construction and use on the same
premises; or
(c) The necessary amount to repair or
replace the damaged building.
In the event of a total loss to the dwelling
we will pay the replacement cost without
reservation or holdback of any
depreciation in value. Subject to the limits
of your policy.
***
10. Loss Payment.
We will adjust all losses with you.
We will pay you unless some other person is
named in the policy or is legally entitled to receive
payment.
Loss will be payable:
a. 20 days after we receive your proof of loss and
reach written agreement with you; or
b. 60 days after we receive your proof of loss;
and
(1) There is an entry of a final judgment; or
(2) There is a filing of an appraisal award or a
mediation settlement with us.
c. Within 90 days after we receive the notice of a
property insurance initial, reopened or supplemental claim from you, where we shall
pay or deny such claim or portion of such
claim, unless there are circumstances beyond
our control which reasonably prevent such
payment.
However, our failure to comply with this
subsection shall not form the sole basis for a
private cause of action against us.
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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.
Mario Ledesma-Perez (the "Insured") purchased an insurance policy ("Policy") from Homeowners Choice Property & Casualty Insurance Company ("HCPCI"), with effective coverage on the date of the loss, on or about September 28th, 2022, and policy number 932259 to insure the property located at 1871 17th Street Southwest, Naples, FL 34117 (the "Property").
On or about September 28th, 2022, the Property suffered severe damage as the result of the sudden and devastating Hurricane Ian which caused ensuing damages to the Property, including but not limited to the roof and exterior of the Property (the "Loss"). HCPCI was notified of the Loss. HCPCI acknowledged the claim and assigned claim number 932259 ("Claim") to the Loss.
From the onset, it was clear to the Insured that HCPCI had one goal - to reduce or eliminate its liability in the claim. HCPCI delivered a coverage determination that misrepresented the material facts of the claim and relied on a faulty and disingenuous expert report. HCPCI thus denied the Insured the full benefits they are rightfully entitled to without properly evaluating the documentation and proof provided by the insured.
Frustrated with HCPCI’s denial and confused as to their rights under the policy, the Insured was forced to retain the services of a public adjuster, Nationwide Public Adjuster, LLC. (“NATIONWIDE”), and legal counsel. NATIONWIDE inspected the damage to the property and generated a true and accurate estimate of the damages in the amount of $61,769.00. Despite multiple requests from the Insured pleading that HCPCI reconsider their position, HCPCI refused to provide the Insured with the funds needed to return the property to its pre-loss condition.?
The Insured has fully complied with all applicable policy provisions requiring cooperation with the investigation, however HCPCI is unjustifiably and unreasonably denying payment to the Insured. Rather than paying the actual damages and/or trying to settle with the Insured, HCPCI is delaying a prompt resolution of the claim. Additionally, HCPCI has not attempted, in good faith, to settle this claim when, under the circumstances, it could and should have done so had it acted fairly and honestly toward the policyholder and with due regard to the policyholder’s interests.
As a direct consequence of HCPCI’s failure to adjust this loss in good faith and make any supplemental payment, the Insured continues to be without adequate compensation for the damages sustained at their Property.
By stating the above detailed facts it is clear that HCPCI has violated the following Florida Statutes:
• 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 Insureds and with due regard for their interest; when HCPCI denied coverage on the Insureds’ claim.
• 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, by failing to respond to the Insureds’ public adjuster, and Insureds’ counsel with respect to supplemental requests for payments;
• 626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
• 626.9541(1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the Insureds and/or their public adjuster of the basis in the insurance policy, in relation to the facts or applicable law, for the offer of a compromise settlement;
• 626.9541(1)(i)(4) Failing to pay any undisputed amounts of partial or full benefits owed under first-party property insurance policies within 90 days after an insurer receives notice of a residential property insurance claim, determine the amounts of partial or full benefits, and agree to coverage; when HCPCI failed to release any undisputed amount of the claim to the Insureds.
To date, HCPCI has in bad faith failed to provide a sufficient coverage determination to the Insured. The Insured’s property continues to be in disarray as the Insured is without funds to put their property into its pre-loss condition. As a direct result of HCPCI’s denial of coverage and breach of Florida Statutes, the Insured was forced to seek the help of licensed professionals to assist them, including a public adjuster and legal counsel. Due to the amount of time that has passed since the date of loss, the information discussed above, it is irrefutable evidence that HCPCI knowingly and intentionally, and in bad faith delays the claims process in order to further disadvantage the Insured. The financial detriment caused to the Insured is a direct result of HCPCI’s reckless treatment of the claims process. The Insured submitted all documents requested in a timely fashion, made her property available for inspection, submitted supplemental invoices, estimates and requests. However, HCPCI failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim.
To deny the Insured the benefit clearly due and owing under the Policy, for which they have time and time again been making premium payments for and after they have satisfied all of her obligations is morally and ethically reprehensible, and reeks of Unfair Claims Practice and Bad Faith. Upon information and belief, the aforementioned actions complained of, among others, were made by HCPCI so often as to constitute a general business practice, evidencing a motive to enhance HCPCI’s profits, and designed to cause a detrimental effect to its policyholders. The above clearly depicts that HCPCI adjusted this claim in bad faith and that HCPCI is in direct violation of Unfair Claims Practices.
This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should HCPCI fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, HCPCI must: (1) Immediately tender all proceeds due and owing to the Insured that are fairly owed to the Insured under the insurance policy that would reasonably compensate the Insured in order to put the loss property back to its pre-loss condition; (2) Agree to reimburse the Insured’s reasonable attorneys’ fees and costs for having to become involved to resolve the claim; (3) Agree to reimburse the Insured for interest on the amount of benefits that was found to be due and owing to the Insured, relating back to the date of loss.
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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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