Filing Number: 799502
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| Filing Accepted: 1/6/2025 |
| Last/Business Name
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WARD
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First Name |
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HARRY & DOROTHY |
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| Street Address
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820 WHOOPING CRANE CT., |
| City, State Zip
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BRADENTON,
FL
34212
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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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WARD |
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First Name |
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HARRY & DOROTHY |
| Policy # * |
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SIC3124442 |
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Claim #* |
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202410015605 |
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Attorney is Applicable
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| Last Name* |
WALLACE
First Name *
BLAKE
Initial
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| Street Address* |
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8635 W. HILLSBOROUGH AVE., STE. 401 |
| City, State Zip* |
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TAMPA
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FLORIDA
33615
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| Email Address * |
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BLAKE@KLINGLAW.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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SLIDE 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 17227 |
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| Name of individual responsible for violation (if any):*
CLAUDIA SHENESEY
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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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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)(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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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 specific policy provisions the carrier violated are the loss payment provision, the loss settlement provision, and the coverage provisions. Specifically, the loss payment provision states “we will adjust all losses with you.” Yet, the carrier did not consult the homeowner in deciding who would investigate the cause or amount of damages, and what the ultimate payment should be. On December 19, 2024, a certified copy of the policy as well as other claim documentation was requested by counsel of the insured. To date of the filing of this civil remedy notice the policy has not been provided by the carrier. This is in violation of F.S. §626.9541(1)(i)(3)(c) as the carrier has failed to acknowledge and act promptly upon communications with respect to claims. F.S. §627.70131(1)(a) provides that upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 7 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer.
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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.
Sent Via Email
SLIDE INSURANCE COMPANY
slideclaims@seibels.com
RE: Insured : HARRY WARD AND DOROTHY WARD
(hereinafter, “Insured/Claimant”)
Policy # : SIC3124442
Claim # : 202410015605
Property Address : 820 Whooping Crane Ct., Bradenton, FL 34212
Persons most knowledgeable of facts giving rise to the Violations: Claudia Shenesey
Dear SLIDE INSURANCE COMPANY:
Please find enclosed the civil remedy notice filed for the above referenced claim. This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statute §624.155 As discussed in greater detail in the notice, the carrier has not attempted in good faith to settle the claimant’s claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its claimant and with due regard for its interests. The carrier has done everything possible to delay the claim and refuses to provide any sort of status of the claim. Furthermore, the carrier is required to properly investigate and adjust claims and cannot place that burden upon the insured. This was made clear by the appellate court and the Florida Supreme Court in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005) (“The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insured…”).
The carrier was put on notice of the insured’s Hurricane Milton claim on October 24, 2024. Since the commencement of the claim the carrier has failed to timely communicate with the insured. It is obvious that the carrier is not attempting to pay for the clearly covered damages owed under the policy.
The carrier assigned an unnamed field adjuster from Precision Roof Consulting, LLC, who is not an engineer, to inspect the loss. On November 18, 2024, the carrier made the unilateral determinations that A) the damages to the property, including the interior would be excluded under the policy and therefore be denied and that B) the damages that were covered failed to exceed the deductible on the policy and that the insured would be entitled to $0 after the application of the deductible. It was clear that the damages exceeded the deductible. There was no explanation whatsoever as to how the field adjuster, determined which items of damage were caused by covered or excluded perils. Instead, the carrier generally averred to what it had determined to be the cause of loss without any showing of pertinent fact or evidence of how such conclusions were reached to support said facts. This is in violation of F.S. §626.9541(1)(i)(3)(f) as the carrier failed 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 the claim.
Moreover, in reaching those conclusions, Slide failed to adopt and implement standards for the proper investigation of claims. There was no explanation whatsoever as to how Slide determined which items of damage were caused by covered or excluded perils. Furthermore, the carrier’s failure to assign a qualified and experienced engineer further violates F.S. §626.9541(1)(i)(3)(a). Moreover, as the carrier denied coverage without conducting a reasonable investigation based upon available information, the carrier violated F.S. §626.9541(1)(i)(3)(d).
The insured has been compelled to obtain an independently adjusted estimate totaling in the amount of $ 125,737.00 that would be needed to repair the property back to its pre-loss condition. The insured has complied with all the carrier’s requests to date. The carrier has still refused to pay the fully covered amount owed under the policy, instead electing to stand by its unilaterally determined deficient valuation of the loss while denying the rest of the loss. This is in violation of F.S. 624.155(1)(b)(1) and 624.155(1)(b)(3) as the carrier is clearly placing the company’s interests before the claimant’s interests and not attempting in good faith to settle claims.
It is clear that the carrier is not treating the claimant with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the claimant; failing to implement proper standards for the adjustment and investigation of claims and placing the company’s interests before the claimant’s interests; not training, supervising or managing adjusters properly so that prompt and full payments are made; refusing to pay the full amount owed to the insured despite the fact that the damages are covered under the policy; looking for ways to delay full recovery or any recovery to the insured; and refusing to provide coverage for the claimant’s loss in a timely manner. The Carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(d), 627.4137(1), and Fla. Stat. §627.70131.
The actions taken by Slide in the handling/adjustment of the insured’s claim were willful, wanton, malicious, and in reckless disregard for the rights of any insureds and occur with such frequency as to indicate a general business practice, and further are in violation of Florida Statutes §624.155 and F.S. §626.954. Indeed, when performing a search on the Florida Department of Financial Services website’s Civil Remedy Notice of Insurer Violation page the results of searches of violations of the statutes referenced herein by the carrier returned the following results thereby indicating that the number of times they occur rise to the level of a general business practice, and warrant punitive damages:
§624.155(1)(b)(1) = 1,272
§624.155(1)(b)(3) = 812
§626.9541(1)(i)(3)(a) = 1,210
§626.9541(1)(i)(3)(c) = 830
§626.9541(1)(i)(3)(d) = 565
§626.9541(1)(i)(3)(f) = 668
Based upon the above-referenced acts and omissions, the carrier has breached the insurance contract by failing to pay the amount due to the insured, by denying coverage which existed under the insurance contract with the insured in the instant dispute, by failing to adjust the loss with the insureds, and by failing to perform an adequate investigation. These are violations and breaches of the policy language cited above.
Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1) Pay the complete covered loss in the amount of $125,737.00 less any applicable policy deductible; and 2) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been emailed to the carrier.
The specific policy provisions the carrier violated are the loss payment provision, the loss settlement provision, and the coverage provisions. Specifically, the loss payment provision states “we will adjust all losses with you.” Yet, the carrier did not consult the homeowner in deciding who would investigate the cause or amount of damages, and what the ultimate payment should be. On December 19, 2024, a certified copy of the policy as well as other claim documentation was requested by counsel of the insured. To date of the filing of this civil remedy notice the policy has not been provided by the carrier. This is in violation of F.S. §626.9541(1)(i)(3)(c) as the carrier has failed to acknowledge and act promptly upon communications with respect to claims. F.S. §627.70131(1)(a) provides that upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 7 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer.
If you have any questions or concerns, please send all correspondence via email to Blake@klinglaw.com and Jorlyn@KlingLaw.com to ensure a prompt response. We ask that all correspondence be done via email rather than regular mail. Should you need to send something regular mail, please advise us prior to sending same via the emails above.
Sincerely,
Blake M. Wallace, Esq.
Blake M. Wallace
Attorney at Law
Enclosed: Civil Remedy Filing
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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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