Filing Number: 799332
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| Filing Accepted: 1/6/2025 |
| Last/Business Name
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EARL J. HALE, JR., INDIVIDUALLY AND AS TRUSTEE OF THE EARL J. HALE JR. TRUST DATED 1/10/1996
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First Name |
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| Street Address
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2038 MORNING SUNE LANE |
| City, State Zip
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NAPLES,
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34119
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| Email Address
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TODOCHILDS@AOL.COM |
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Insured |
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| Last/Business Name* |
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EARL J. HALE, JR., INDIVIDUALLY AND AS TRUSTEE OF THE EARL J. HALE JR. TRUST DATED 1/10/1996 |
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First Name |
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| Policy # * |
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SFLD3015134-02 |
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Claim #* |
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57461 |
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Attorney is Applicable
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| Last Name* |
PETTINATO
First Name *
DAVID
Initial
J
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| Street Address* |
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1000 W. CASS STREET |
| City, State Zip* |
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TAMPA
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FLORIDA
33606
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| Email Address * |
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DPETTINATO@OLDERLUNDYLAW.COM, DJP-PARALEGALS@OLDER |
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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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SAFEPOINT 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 15341 |
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| Name of individual responsible for violation (if any):*
RYAN WELCH, JOSE A. HERNANDEZ, AND ALL OTHER ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY SAFEPOINT INSURANCE COMPANY INVOLVED IN THE CLAIM.
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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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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Other
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Failure to properly investigate claim and with due regard to Insured’s interest
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Other
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Failure to acknowledge and act promptly to communications regarding claim
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Other
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Elderly Insured
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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)(2) |
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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.
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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)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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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.
ADD’L STATUTES VIOLATED
§627.70131(7)(a)
POLICY LANGUAGE
The Insured may not be in possession of a complete copy the applicable policy of insurance, however, the specific policy language relevant to the violations outlined below is contained within SafePoint Insurance Company’s Homeowners policy, Policy No. SFLD3015134-02, issued to the Insured including, but is not limited to, the following:
Coverage A-Dwelling provisions (SIC DP3 SP 01 22 / DP 00 03 12 02)
Coverage B-Other Structures provisions (SIC DP3 SP 01 22 / DP 00 03 12 02)
Coverage C-Personal Property provisions (SIC DP3 SP 01 22 / DP 00 03 12 02)
Coverage D-Fair Rental Value provisions (SIC DP3 SP 01 22 / DP 00 03 12 02)
Additional Coverages provisions (SIC DP3 SP 01 22 / DP 00 03 12 02)
- Reasonable Emergency Measures
- Other Structures
- Debris Removal
- Rental Value and Addtl. Living Expenses
- Trees, Shrubs And Other Plants
- Glass or Safety Glazing Material
- “Fungi,” Mold, Wet Or Dry Rot, Or Bacteria
Emergency Water Removal Services endorsement (SIC DP3 EWR 05 21)
Calendar Yr. Hurricane Deductible w. Suppl. Reporting Req. – FL. endorsement (DP 03 51 05 05)
Limited Fungi, Wet or Dry Rot, or Bacteria Coverage endorsement (SIC DLV 24 71 10 15)
Hurricane-Limited Screened Enclosure & Carport Coverage endorsement (SIC DP LSE 10 15)
The Declarations Page (SIC DWDEC2 01 22)
Loss Payment or Loss Settlement provisions (SIC DP3 SP 01 22 / DP 00 03 12 02)
Duties in Event of Loss Policy provisions (SIC DP3 SP 01 22 / DP 00 03 12 02)
The insurance policy's definition sections (SIC DP3 SP 01 22 / DP 00 03 12 02)
The insurance policy's exclusion of coverage provisions (SIC DP3 SP 01 22 / DP 00 03 12 02)
Please advise if there are other applicable policy provisions that are not cited above but would provide coverage to the Insured for the September 28, 2022, Hurricane Ian and/or hurricane-force winds loss.
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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.
In Florida, the work of adjusting insurance claims engages the Public Trust. SAFEPOINT INSURANCE COMPANY (“SAFEPOINT”) has breached this duty by its failure or refusal to acknowledge its Insured’s claim of loss.
SAFEPOINT has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees resulting in statutory violations as set forth above. SAFEPOINT has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim for damages.
To date, notwithstanding the Insured’s pleas, SAFEPOINT has continued to refuse to acknowledge its obligation to acknowledge and pay the full amount of its Insured’s claim.
This complaint is made on behalf of the Insured, Earl J. Hale, Jr., individually and as Trustee of the Earl J. Hale Jr. Trust dated 1/10/1996 (“MR. HALE”). Further, this complaint is a statement that notice is hereby given in order to perfect the right to pursue the civil remedy authorized and pursuant to Florida Statute §624.155.
In consideration of the premium paid to it by MR. HALE, SAFEPOINT issued an Homeowners policy, Policy No. SFLD3015134-02 (hereinafter referred to as “the Policy”), to MR. HALE wherein the insurance policy provided coverage for all losses, including Hurricane Ian and/or hurricane-force winds, except those losses which were expressly excluded.
The policy was in full force and effect at the time the damage occurred as a result of Hurricane Ian and/or hurricane-force winds, and the ensuing damages as a direct result thereof, to the insured premises located at 2038 Morning Sune Lane, Naples, FL 34119, on or about September 28, 2022.
On or about September 28, 2022, Hurricane Ian, a large and destructive Category 5 storm, struck the state of Florida, becoming the deadliest hurricane to strike the state of Florida in over 80 years. Hurricane Ian was the third-costliest weather disaster on record, causing complete destruction or extensive property damage to the structures, homes, businesses, and roadways in its path. Millions of people were left without power, while many others were entrapped or forced to seek refuge elsewhere. As a result of the extreme damage and loss of life, the name Ian will never be used again for an Atlantic hurricane.
MR. HALE was a victim of Hurricane Ian’s destruction when his insured home suffered exterior and interior damages due to hurricane-force winds, and ensuing damages, including, but not limited to, extensive wind damage to the roof system.
MR. HALE’S insured property sustained damages to the gutters and roof of the home, including but not limited to, the roof tiles, water barrier, flashing, drip edge, flashing, caps, ridge, etc.
MR. HALE timely notified SAFEPOINT of the damages and opened a claim pursuant to the terms and conditions of the Policy.
In response, SAFEPOINT assigned the claim to its representative to adjust and investigate the loss, as well as a field adjuster to inspect the damages. SAFEPOINT’S representative visited the insured property and performed a cursory and inadequate investigation of the damaged property.
In contrast to SAFEPOINT’S inspection, MR. HALE’S inspection estimate from Utopia Public Adjusting (Utopia), totaled $89,406.61 RCV in Dwelling damages (Coverage – A). Utopia’s estimate was more inclusive of the full extent of damages sustained to MR. HALE’S insured property, as detailed above.
SAFEPOINT retained experts from its preferred vendor list, instead of retaining objective experts, AKG Roofing and Specialty Services, Inc. (AKG), to provide it with thorough and completely objective opinions and conclusions. SAFEPOINT retained “hired gun” experts to provide it with an outcome-oriented investigation and opinions to deny the claim, and/or reduce the amount of the claim pay out. This is unfair claims handling practices.
On or about June 23, 2023, SAFEPOINT submitted a Denial Letter to MR. HALE, stating that his roof system “did not suffer from the date of loss/event as presented” and that evidence shows “an ongoing issue that was present well prior to 09/28/22”.
With regards to MR. HALE’S claims determination process, SAFEPOINT has misrepresented the full extent of damages sustained to his property and has failed to reinspect. As such, MR. HALE’S ability to restore his property to pre-loss condition has been delayed.
To date, MR. HALE has not received any owed insurance benefits from SAFEPOINT.
To date, MR. HALE has not received any reinspection requests from SAFEPOINT.
To date, MR. HALE has not received any settlement offers from SAFEPOINT.
To date, SAFEPOINT has failed to tender any supplemental insurance benefits. SAFEPOINT has admitted that MR. HALE sustained covered damages as a result of the Hurricane Ian and/or hurricane-force winds loss that occurred on or about September 28, 2022 but has denied tendering all owed insurance benefits to MR. HALE. Pursuant to Florida Statute §626.9541(1)(i)(4), SAFEPOINT is required to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 90 days after SAFEPOINT received notice of the residential property insurance claim, determine the amounts of partial or full benefits, and agree 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). As SAFEPOINT has failed to do so, SAFEPOINT has wrongfully denied coverage.
Since the beginning of the claim, SAFEPOINT has engaged in a pattern of delay, denial, and reckless disregard for MR. HALE’S rights. The actions of SAFEPOINT listed herein have been continuing in nature and given the totality of the circumstances, which includes SAFEPOINT’S adjustment, actions and/or omissions post the filing of this CRN. MR. HALE contends that given the past experience in this matter with SAFEPOINT, it is reasonably foreseeable that SAFEPOINT’S current actions will extend to its entire conduct in the handing of his claim, including the acts or omissions of SAFEPOINT and/or its representatives, until the final resolution of his claim. As such, MR. HALE contends adequate notice has been given should SAFEPOINT’S actions and violations listed herein continue after the expiration of this notice.
SAFEPOINT has failed and/or refused to settle the claim when it could and should have done so had it acted fairly and honestly towards MR. HALE, and has failed to take into account the information and evidence provided that contradict its decisions.
Even upon receipt of additional and supporting evidence to the contrary, SAFEPOINT has continued to stand by its claim denials. As such, MR. HALE does not anticipate SAFEPOINT will rescind its denial of his claim.
SAFEPOINT’S conduct has been reckless and unfair to MR. HALE, and has caused and continues to cause additional damages throughout the property. This is evidenced by the delay in paying the claim and the failure of SAFEPOINT to evaluate the claim in total.
To date, SAFEPOINT has failed and/or refused to provide MR. HALE with all the insurance benefits due and owing and has not tendered the full amount needed to repair the Property despite knowing that MR. HALE has sustained covered damages to his insured property.
As SAFEPOINT must admit, it is implied within every insurance policy a duty of good faith and fair dealings. In an insurance contract, each party is prevented from interfering with the other’s right to benefit from the contract. The obligations of good faith and fair dealings encompass qualities of decency and humanity inherent in its responsibilities as a fiduciary. SAFEPOINT is bound to conduct itself with the utmost good faith for the benefit of MR. HALE. However, SAFEPOINT has failed to comply with the obligations in connection with this claim and has never looked at the claim or the contract for insurance with good faith and fair dealing. Instead, SAFEPOINT has looked for ways not to pay the claim in full, or at all, and these actions have been to the detriment of MR. HALE.
The adjusters assigned to this claim have a duty to adjust and treat all claims equally. Since the beginning of this claim the representatives on behalf of SAFEPOINT have approached this investigation in a manner prejudicial to MR. HALE. SAFEPOINT is using either untrained or improperly trained adjusters in connection with this claim. SAFEPOINT should have been adjusting the loss with MR. HALE but instead, it was looking for ways not to pay the claim at all, or pay the claim in full. If SAFEPOINT handles all the claims in the manner in which MR. HALE’S claim was adjusted, then it is improperly handling all claims.
SAFEPOINT has refused and/or failed to comply with The Policy’s cooperation and/or “Loss Payment” provision. Under The Policy, SAFEPOINT was to timely tender undisputed insurance benefits to MR. HALE. SAFEPOINT has failed and/or refused to timely tender owed insurance benefits, undisputed or otherwise. This is a breach of The Policy.
SAFEPOINT has refused and/or failed to cooperate and/or “Adjust the Loss” by cooperating with MR. HALE during the claims adjustment process in compliance with The Policy’s “Loss Payment” provision. This is a breach of The Policy.
The concept of insurance is that insurance is the insurer’s granting of timely and prompt indemnity or security against a contingent loss. Florida Statute §624.02 defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that MR. HALE may mitigate his damages and to put him back into the position he was in prior to the loss as quickly as possible. SAFEPOINT has breached this duty.
SAFEPOINT has refused and/or failed to tender all insurance proceeds to MR. HALE upon demand. SAFEPOINT’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 MR. HALE is wrongful conduct. Furthermore, MR. HALE contends that SAFEPOINT’S adjusters and/or representatives financially benefit by such wrongful conduct.
It is clear that SAFEPOINT’S adjusters have also failed to adhere to insurance industry rules and guidelines when adjusting a first party claim. It is also evident that SAFEPOINT violated the Florida unfair claims practices, the adjuster’s ethical code of conduct, and acted irresponsibly in the handling of its insured’s claims. In this case, MR. HALE paid a hefty premium for a service, the service is called claims adjusting (I encourage you to read the book titled, “The Claims Environment” written by James J. Markham, Kevin M. Quinley, and Layne S. Thompson-this book is taught in every first year AIC course).
The claim professional must dispense his or her knowledge and skill for the benefit of society. The general public expects claims representatives to pay all legitimate claims promptly and fairly. The claim professional must harness all of his or her knowledge and expertise to accomplish the objectives of the claim function. He or she must also adhere to the highest degree of ethical conduct. In addition to interacting with other insurance personnel and service providers in a professional manner, the claims professional must deal with public’s and regulator’s expectations. Insurance Companies provide such a vital and necessary service to society that the selling and servicing of insurance is imbued with a public trust. James J. Markham, Kevin M. Quinley, Layne S. Thompson, “The Claims Environment”, Insurance Institute of America, 1st ed., 1993.
Accordingly, SAFEPOINT has a contractual and statutory obligation to investigate all possible bases which might support MR. HALE’S claim and cannot deny a claim without thoroughly investigating the foundation for its denial or basis for withholding insurance benefits. SAFEPOINT violated its obligations here.
- SAFEPOINT has a contractual and statutory obligation to make a perfunctory investigation, not ignoring evidence that would support MR. HALE’S claim. SAFEPOINT violated its obligations here.
- SAFEPOINT has a contractual and statutory obligation not to look the other way when confronted with facts revealing the possibility of coverage and resisting reasonable interpretations of its policy. SAFEPOINT violated its obligations here.
- SAFEPOINT has a contractual and statutory obligation not to deny the claim based on standards known to be impermissible or on an interpretation contrary to established law. SAFEPOINT violated its obligations here.
These actions and violations were either done intentionally or as the result of SAFEPOINT’S failure to adopt and implement the proper standards of the investigation and adjustment of claims.
Overall, SAFEPOINT’S investigation of the claim was inadequate and contrary to its obligations under the insurance policy and Florida law.
MR. HALE has done everything legally requested by SAFEPOINT to date. To cure the violations set forth in this Civil Remedy Notice, SAFEPOINT must now agree to acknowledge its duties and obligations under the law in adjusting its insured’s claim, and tender rightfully owed insurance benefits to return MR. HALE to his pre-loss condition.
Further, to cure the violations set forth in this Civil Remedy Notice, MR. HALE hereby requests that SAFEPOINT tender at this time, or prior to the expiration of the statutory cure period, the amount of MR. HALE’S damage estimate and demand which accurately reflects the true nature and extent of MR. HALE’S damages. Therefore, SAFEPOINT should tender $90,016.61 (less any prior payments, depreciation, excess policy limits, and/or deductible) in insurance benefits at this time.
Although MR. HALE has made a demand for payment in the amount of $90,016.61 (less any prior payments, depreciation, excess policy limits, and/or deductible) and has provided SAFEPOINT with all the necessary documentation in support thereof, he is still willing to consider and to potentially accept any reasonable counter-offer made by SAFEPOINT. Therefore, if SAFEPOINT is not in agreement with MR. HALE’S reasonable demand for payment of his rightfully owed insurance benefits being submitted at this time, MR. HALE hereby requests that SAFEPOINT now make a reasonable counter-offer before the expiration of the cure period. MR. HALE still hopes that his claim can be resolved amicably.
The concept of insurance is that insurance is the insurer’s granting of timely and prompt indemnity or security against a contingent loss. Florida Statute §624.02 defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that MR. HALE may mitigate his damages and to put him back into the position he was in prior to loss as quickly as possible. SAFEPOINT breached this duty.
This notice is given in order to perfect the right to pursue the civil remedy authorized and pursuant to Florida Statute §624.155, including any and all bad faith/extra contractual, should SAFEPOINT fail to cure the violations set forth in this Civil Remedy Notice within the given cure period.
While no specific “cure amount” is required for this Civil Remedy Notice to be valid, MR. HALE will consider the allegations contained herein “cured” if SAFEPOINT, without any requirement for a release:
(1) Immediately tenders the amount of MR. HALE damage estimate in the amount of $89,406.661 (less any prior payments, depreciation, excess policy limits, and/or deductible), which accurately reflects the true nature and extent of the damages to the Dwelling / Other Structures;
(2) Immediately tenders the amount of statutory interest due and owing to MR. HALE pursuant to Florida Statute §627.70131(5)(a).
(3) Immediately provides MR. HALE with the documentation SAFEPOINT has used and/or continues to contend, supports the claim determination made by SAFEPOINT in the adjustment of MR. HALE’S claim. Specifically, SAFEPOINT must provide MR. HALE with its claim estimate(s), supporting photographs and/or videos, as well as any and all reports of any expert(s) or other individuals retained on behalf of SAFEPOINT upon which SAFEPOINT has relied on in reaching and/or further supporting its coverage determination in MR. HALE’S claim.
MR. HALE continues to remain open to a fair and reasonable settlement offer from SAFEPOINT in an effort to avoid additional delay, costs and expenses, and hereby request the same prior to the expiration of the statutory “cure” period. MR. HALE has provided SAFEPOINT with all necessary estimates, documentation, etc. in support of the claim. SAFEPOINT must act fairly and honestly in its response to MR. HALE’S request for a prompt, fair and reasonable settlement offer and resolution of the claim.
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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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