Filing Number: 799205
|
| Filing Accepted: 1/4/2025 |
| Last/Business Name
*
|
|
|
BAY AREA PUBLIC ADJUSTER
|
|
First Name |
|
WILLIAM SABIN |
|
| Street Address
*
|
|
PO BOX 55369 |
| City, State Zip
*
|
|
ST. PETERSBURG,
FL
33732
|
| Email Address
*
|
|
SABIN@BAYAREAPA.COM |
| Complainant Type:
*
|
|
Third Party |
|
| Last/Business Name* |
|
JOHNSON |
|
First Name |
|
MATTHEW & CHERYL |
| Policy # * |
|
4423015685 |
|
Claim #* |
|
01000116743 |
|
Attorney is Applicable
|
|
|
|
| Insurer Type
*
|
|
 Authorized Insurer
 Unauthorized Insurer
|
|
|
| Insurer Name |
|
|
| Insurer Name* |
|
FIRST PROTECTIVE INSURANCE COMPANY
|
| Insurer Name* |
|
|
| Street Address* |
|
|
| City, State Zip* |
|
,
|
|
NAIC Company Code 10897 |
|
|
| Name of individual responsible for violation (if any):*
ANY AND ALL ADJUSTERS, SUPERVISORS, MANAGEMENT, ATTORNEYS AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY FIRST PROTECTIVE INSURANCE COMPANY INVOLVED WITH THE HANDLING OF THIS CLAIM INCLUDING JOSH BIGELOW, HOMEOWNER’S PROPERTY CLAIMS ADJUSTER.
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
|
Claim Denial
|
|
|
Unfair Trade Practice
|
|
|
Unsatisfactory Settlement Offer
|
|
|
*
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.
|
|
| 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)(d) |
|
Denying claims without conducting reasonable investigations based upon available information.
|
|
*
Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
SECTION I - PROPERTY COVERAGES
A. Coverage A - Dwelling
1. We cover:
a. The dwelling on the "residence premises"
shown in the Declarations, including structures
attached to the dwelling, and
SECTION I - PERILS INSUREDAGAINST
A. Coverage A - Dwelling And Coverage B -
Other Structures
1. We insure against risk of direct physical loss to
property described in Coverages A and B.
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 60 days after we receive your proof of
loss
In addition, it is believed that the following policy provisions are applicable:
Duties in event of loss policy provision
All terms, conditions and sections of the insurance policy, including, but not limited to:
Section 1 of the insurance policy
Property coverages
Section 1 - perils insured against
Coverage A- dwelling
We insure against risk of direct physical loss to property described in coverages A and B.
FLORIDA ADMINISTRATIVE CODE SECTIONS VIOLATED
In addition to the statutory violations referenced above, the Insured states that First Protective Insurance Company violated the following Florida Administrative Code Sections:
69B-220.201(3)(a) Adjuster shall disclose all financial interests and any direct or indirect aspect of an adjusted transaction.
69B-220.201(3)(b) An adjuster shall treat all claims equally. An adjuster shall not provide favored treatment to any claimant. Adjuster shall adjust all claims strictly in accordance with the insurance contract.
69B-220.201(3)(c) An adjuster shall never approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
69B-220.201(3)(e) An adjuster shall handle every adjustment and settlement with honesty, integrity, and allow fair adjustment or settlement to all parties without any remuneration to himself except to that which he is legally entitled.
69B-220.201(3)(f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition thereof.
69B-220.201(3)(m) An adjuster shall not knowingly fail to advise a claimant of their rights in accordance with the terms and conditions of the contract and applicable laws of the state of Florida.
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
In Florida, the work of adjusting insurance claims engages the public trust. First Protective Insurance Company has breached the public’s trust by its adjustment of Matthew & Cheryl Johnson’s (“Insured”) claim of loss.
First Protective Insurance Company wrongfully denied the insured’s claim for damages from Hurricane Debby. First Protective Insurance Company states, “An Engineer inspected on September 20, 2024. They determined the cracked and displaced tiled on the roof were the result of expansion and contraction and/or foot traffic. The engineer also determined the interior damages to the ceilings and floors were the result of ongoing leaks caused by wear and tear, deterioration, and/or faulty maintenance or construction on the roof.” As per boilerplate letter to the insured dated 12/17/2024. First Protective Insurance Company has tendered $0.00. Our estimate to place the insured back to a pre-loss condition totals $143,366.75 after deductible and recoverable depreciation. First Protective Insurance Company has placed their insured in a vulnerable financial position to force a lesser settlement.
First Protective Insurance Company has failed to create and implement adequate guidelines for the proper investigation and evaluation of claims, claims handling, and for training and supervision of employees resulting in statutory violations as set forth above in paragraph No. 5. First Protective Insurance Company has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim for damages.
Notwithstanding the Insured’s timely notification to First Protective Insurance Company of the insurance claim, First Protective Insurance Company has failed or refused to settle the Insured’s claim in a timely manner and/or adjust the loss with the Insured.
First Protective Insurance Company has failed to promptly settle its Insured’s insurance claim when the obligation to settle the insurance claim had become reasonably clear. To date, notwithstanding the Insured’s pleas otherwise, First Protective Insurance Company has continued to refuse to acknowledge its obligation to conduct a proper investigation, and to tender the insurance monies due and owing its Insured under the policy.
This claim involves the Insured’s property located at 6831 Honeysuckle Trail Lakewood Ranch, FL 34202 which suffered a sudden loss caused by hurricane on or about 8/4/2024. The Insured made application for insurance benefits under the Policy No. 4423015685, under Claim No. 01000116743. First Protective Insurance Company partially accepted coverage for the loss, however, has failed to pay the full amount of benefits due to the Insured.
The insureds utilized the services of a licensed public adjuster who inspected the insureds’ property and
determined that the loss was a covered loss and had caused $143,366.75 in damages after the deductible. The insureds’ public adjuster prepared an estimate for the insureds using XACTIMATE software that incorporated standard industry pricing and accurately reflects the repairs necessary to return the insureds’ property to its pro-loss condition.
The Insured was, and still is, forced to expend out of pocket monies to submit the insurance claim, e.g., retaining legal counsel and other experts to force First Protective Insurance Company to honor its obligations under the insurance policy and to pay all the insurance proceeds due and owing to the Insured.
First Protective Insurance Company adjusted the loss and tendered insurance benefits of $0.00 and has refused and/or failed to tender additional insurance proceeds due and owing to the Insured. First Protective Insurance Company’s refusal and/or failure to settle the insurance claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards its Insured is wrongful conduct. Furthermore, the Insured contends that First Protective Insurance Company’s adjusters and/or representatives financially benefit from such wrongful conduct.
Therefore, to cure the defects outlined in this Civil Remedy Notice, First Protective Insurance Company must:
(1) First Protective Insurance Company must tender to the Insured, $143,366.75, plus any applicable interest.
|
|
*
|
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
|