Filing Number: 800281
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| Filing Accepted: 1/9/2025 |
| Last/Business Name
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PINO
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First Name |
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RODOLFO & ILEANA |
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| Street Address
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3221 NORTHEAST 23RD AVENUE |
| City, State Zip
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LIGHTHOUSE POINT,
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33064
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| Email Address
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RUDRULES@AOL.COM |
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Insured |
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| Last/Business Name* |
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PINO |
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First Name |
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RODOLFO & ILEANA |
| Policy # * |
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HPC-HO3-3327 |
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Claim #* |
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941945 |
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Attorney is Applicable
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| Last Name* |
CHAVIN
First Name *
VALORIE
Initial
S
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| Street Address* |
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12955 BISCAYNE BOULEVARD, SUITE 201 |
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NORTH MIAMI
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FL
33181
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| Email Address * |
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VCHAVIN@CMSLAWGROUP.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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,
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NAIC Company Code 12944 |
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| Name of individual responsible for violation (if any):*
JACK DI GRADO: LISA ROBINSON
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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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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Other
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Violation of Florida Administrative Code 69B-220.201
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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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| 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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Rodolfo and Iliana Pino (the “Insureds”) paid for a policy of insurance with Homeowners Choice Property and Casualty Insurance Company (“the Insurance Company” or “the Carrier”) bearing policy number HPC-HO3-3327, which provides coverage for damages to the Insureds’ property, including significant damage sustained as the result of a failed plumbing component. The Insureds submitted a claim to the Insurance Company when a sudden and accidental escape of water from the plumbing system severely damaged their Property. Sadly, the Insurance Company elevated its own interests over those of its Insureds when it refused to exercise care in the adjustment of the claim by intentionally refusing to acknowledge the full extent of covered damages and the true cost of making repairs. The Insurance Company grossly undervalued the damages, ignored the Insureds’ evidence of the extent of the damage and the costs associated with restoring their Property to its pre-loss condition, and issued a shockingly low payment that will not come close to allowing the Insureds to complete the necessary repairs. Although the Insureds disagreed with the insufficient payment, the Insurance Company denied any additional payment, declined to reinspect the Property and refused to participate in appraisal of the loss, leaving the Insureds without any recourse to address the egregious underpayment. To date, the Insureds are still without the compensation to which they are entitled, and they have been forced to live amongst the damage without access to their kitchen since the Carrier has refused to issue sufficient monies to restore their Property. The Insurance Company has failed and refused to fully, timely and properly compensate its Insureds for the damages suffered as a result of this admittedly covered loss.
The Insureds believe the following Policy language is at issue:
. . .
SECTION I – PROPERTY COVERAGES
COVERAGE A – Dwelling
We cover:
1. The dwelling on the "residence premises" shown in the Declarations, including attached structures and attached wall-to-wall carpeting if damage to the dwelling is caused by a covered loss;
. . .
COVERAGE D – Loss of Use
1. If a loss covered under SECTION I – PROPERTY COVERAGES makes that part of the “residence premises” where you reside not fit to live in, we cover the Additional Living Expense, meaning:
a. Any necessary increase in living expenses incurred by you so that your household can maintain its normal standard of living.
. . .
ADDITIONAL COVERAGES
. . .
2. Reasonable Emergency Measures.
a. We will pay up to the greater of $3,000 or 1% of your Coverage A limit of liability for the
reasonable costs incurred by you for necessary measures taken solely to protect covered property from further damage, when the damage or loss is caused by a Peril Insured Against.
b. We will not pay more than the amount in a. above, unless we provide you approval within
48 hours of your request to us to exceed the limit in a. above. In such circumstance, we will pay only up to the additional amount for the measures we authorize.
If we fail to respond to you within 48 hours of your request to us and the damage or loss is caused by a Peril Insured Against, you may exceed the amount in a. above only up to the cost incurred by you for the reasonable emergency measures necessary to protect the covered property from further damage.
. . .
11. "Fungi", Wet or Dry Rot, Yeast or Bacteria.
a. We will pay up to $10,000 for:
(1) The total of all loss payable under Section I – Property Coverages caused by "fungi", wet or dry rot, yeast or bacteria;
(2) The cost to remove "fungi", wet or dry rot, yeast or bacteria from property covered under Section I – Property Coverages;
(3) The cost to tear out and replace any part of the building or other covered property as needed to gain access to the "fungi", wet or dry rot, yeast or bacteria; and
(4) The cost of testing of air or property to confirm the absence, presence or level of "fungi", wet or dry rot, yeast or bacteria; whether performed prior to, during or after removal, repair, restoration or replacement.
The cost of such testing will be provided only to the extent that there is a reason to believe that there is the presence of "fungi", wet or dry rot, yeast or bacteria.
b. The coverage described in a. only applies:
(1) When such loss or costs are a result of a Peril Insured Against that occurs during the policy period; and
(2) Only if all reasonable means were used to save and preserve the property from further damage at and after the time the Peril Insured Against occurred.
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SECTION I – PERILS INSURED AGAINST
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.
We do not insure, however, for loss:
. . .
2. Caused by:
. . .
e. Accidental discharge or overflow of water or steam; unless loss to property covered under Coverage A or B results from an accidental discharge or overflow of water or steam from
within a plumbing, heating, air conditioning or automatic fire protective sprinkler system or
household appliance on the "residence premises".
Loss to property covered under Coverage A or B that results from an accidental discharge or overflow of water or steam from within a plumbing, heating, air conditioning or automatic fire protective sprinkler system or household appliance on the “residence premises” includes the cost to tear out and repair only that part of a building, or only that part of an other structure, on the "residence premises", necessary to access and repair the system or appliance.
The cost that we will pay for the tear out and repair of the part or portion of the building or other structure covered under Coverage A or B as specified above is limited to only that part or portion of the covered building or other structure which is necessary to provide access to the part or portion of the system or appliance that caused the covered loss, whether the system or appliance, or any part or portion of the system or appliance, is repairable or not.
In no event will we pay for the repair or the replacement of the system or appliance that caused the covered loss.
We do not cover loss:
(1) To the system or appliance from which this water or steam escaped
(2) On the “residence premises” caused by accidental discharge or overflow which occurs off the “residence premises”;
(3) Caused by constant or repeated seepage or leakage of water or steam or the presence or condensation of humidity, moisture or vapor, over a period of weeks, months or years, unless such seepage or leakage of water or the presence or condensation of humidity, moisture or vapor and the resulting damage is unknown to all "insureds" and is hidden within the walls or ceilings or beneath the floors or above the ceilings of a structure;
(4) To a plumbing system, whether above or below the ground, caused by:
(a) Age, collapse, obsolescence, wear, tear;
(b) Fading, oxidization, weathering;
(c) Deterioration, decay, marring, delamination, crumbling, settling, cracking;
(d) Shifting, bulging, racking, sagging, bowing, bending, leaning;
(e) Shrinkage, expansion, contraction, bellying, corrosion;
(f) The unavailability or discontinuation of a part or component of the system;
or
(g) Any other age or maintenance related issue;
(5) To a plumbing system, whether above or below the ground, caused by the impairment, state or condition of the system, which prohibits repair or replacement including access, necessary to connect the adjoining parts of appliances, pipes or system; or
(6) Loss otherwise excluded or limited elsewhere in the policy. For purposes of this provision, a plumbing system or household appliance does not include a sump, sump pump, irrigation system or related equipment or a roof drain, gutter, down spout or similar fixtures or equipment.
. . .
SECTION I – CONDITIONS
. . .
6. Mediation or Appraisal.
. . .
b. Appraisal.
If you and we fail to agree on the amount of loss, either may request an appraisal of the loss. However, both parties must agree to the appraisal. In this event, each party will choose a competent and impartial appraiser within 20 days after receiving a written request from the
other. The two appraisers will choose an umpire. If they cannot agree upon an umpire within 15 days, you or we may request that the choice be made by a judge of a court of record in the state where the “residence premises” is located. The appraisers will separately set the amount of the loss. If the appraisers submit a written report of an agreement to us, the amount agreed upon will be the amount of the loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will set the amount of the loss.
Each party will:
(1) Pay its own appraiser; and
(2) Bear the other expenses of the appraisal and umpire equally.
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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.
The Insureds own property located at 3221 NE 23 Avenue, Pompano Beach, Florida 33064 (the “Property”). On March 19, 2024, after Mr. Pino suffered unexplained physical symptoms, the Insureds investigated and found the symptoms to be a response to mold that developed as the result of water leaking from a pipe hidden within the wall between the kitchen and garage. The Insureds opened the exterior wall to the Property to access and cap the leaking pipe. They immediately retained a plumber to address the leak. The plumber cut through additional outside walls to access and replace the 4-inch cast iron stack in the garage, bathroom and kitchen, as well as the drainpipe to the kitchen sink. The repairs to the plumbing system were completed, but the access holes to the exterior and interior were not repaired.
The Insureds then retained Total Care Restoration to perform reasonable and necessary emergency water mitigation to dry out the saturated Property. Once dry, Total Care issued a Certificate of Completion and generated an invoice totaling $4,627.39 for the work performed at the Property. HiTek Group was engaged to provide an air quality mold test report, and it was determined that elevated levels of mold spores were present in the kitchen lower cabinets and garage. The Insureds retained Restoration Geek Corp. to remediate the mold and address the contaminants that rendered Mr. Pino ill and unable to live in the Property. Until the mold remediation was complete, Mr. Pino was forced to reside outside of the home in a pop-up camper.
The Insureds promptly submitted a claim to the Insurance Company and retained Sharp Adjusting and Consulting Services (the “Public Adjuster”) to assist in navigating the claims adjustment process. The Public Adjuster provided the Carrier with a Letter of Representation on June 13, 2024. To assess the full extent of the damage, the Public Adjuster inspected the Property and prepared an estimate of the reasonable costs to repair all damages resulting from the loss. After a thorough inspection of the Property, the Public Adjuster prepared an estimate that was thereafter revised to address additional damage that was revealed during the mold remediation. The Public Adjuster’s estimate addresses the overwhelming damage to the kitchen, garage, dining room, master bath, master bedroom, master closet, living room, and exterior of the Property. It also allows for payment for the water mitigation and mold remediation performed by Total Care Restoration and Restoration Geeks and allows costs for pack-out of the Insureds’ personal property during the time repairs are completed. The Public Adjuster’s comprehensive estimate was furnished to the Carrier for its consideration, together with a Sworn Statement in Proof of Loss executed by the Insureds attesting to $124,626.21 in damages.
Instead of properly adjusting the Insureds’ loss and timely paying the Insureds for the damage to their Property so they could make the necessary repairs, the Insurance Company began its efforts to avoid its contractual obligations to fully compensate the Insureds for the claim. The Insurance Company assigned the claim to an unqualified, outcome-oriented adjuster, Chip Winborne, who approached the loss with an eye towards underpayment. Mr. Winborne inspected the loss on September 6, 2024. During the inspection, he observed pervasive water damage throughout, including extensive damage to the drywall, baseboards, flooring, kitchen cabinetry and countertop, and exterior walls that were broken through to access and repair the failed plumbing line. Despite witnessing the overwhelming damage to the Property, Mr. Winborne prepared an astoundingly insufficient estimate that contains omissions in scope, undervalues the cost of repairs and cuts corners to deprive the Insureds of full coverage for the loss. For example, although he acknowledged significant damage to the kitchen cabinetry that requires the cabinets to be replaced, he refused to allow for any monies to replace the damaged backsplash and countertop, suggesting instead that the Insureds should detach and reset the old, water-damaged backsplash and countertop over replaced cabinets. After reduction for depreciation and application of the Policy’s deductible, Mr. Winborne determined the entirety of the damage to the Insureds’ Property could be repaired for only $20,305.23. Based on Mr. Winborne’s single inspection, the Insurance Company accepted coverage for the loss and issued payment to the Insureds for only $20,305.23.
Dismayed by the insufficient payment, the Insureds and their Public Adjuster implored the Carrier to reconsider its position and to address the price and scope discrepancies between the two estimates. The Insurance Company failed to respond to the request for reconsideration and similarly failed to take any other meaningful action to properly assess the amount of the loss, neglecting to reinspect the Property or retain an expert qualified and capable of determining the real-world cost of restoring the Property to its pre-loss condition. The Insureds reached out to reputable licensed contractors to obtain repair bids and provided the bids to the Insurance Company to demonstrate that the $20,305.23 payment was woefully insufficient. Finally, the Insureds elected to invoke the appraisal provision of the policy in hopes for an amicable and timely resolution to their claim. The Public Adjuster sent the request for appraisal on September 16, 2024. The Carrier flatly refused the request without providing any reasoning or justification. The Insureds felt abandoned by their Insurance Company. Left without recourse, they had no choice but to retain counsel to protect their rights.
In a good faith effort to resolve the parties’ scope and amount dispute. the Insureds provided the Carrier with bids to repair their home from Cinergy Builders Inc. in the amount of $67,060.28 and Mulhern Group in the amount of $52,800. The Insureds made a pre-suit settlement demand of $45,255.05 on the Insurance Company based on the estimate generated by Cinergy Builders, Inc. in the amount of $67,060.28 because the Insureds did not agree with the scope of the Mulheron Construction Estimate, as it is improperly scoped based on the Insureds’ damages. Despite the Insureds furnishing the Carrier with an estimate from a contractor ready, willing, and able to begin the repairs to the Insureds’ home, the Insurance Company failed and refused to issue payment to its Insureds in line with the real-world costs to restore their home to its pre-loss condition, and instead made a lowball settlement offer that the Insureds could not accept.
Notwithstanding the Insureds’ complete cooperation at every step of the adjustment, the Insurance Company failed to meaningfully adjust the loss and assist the Insureds in restoring their severely damaged Property. After undervaluing the significant damage to the Property in an attempt to pay the Insureds less than the amount due under the terms of the Policy, the Carrier refused any additional payment and maintained the disingenuous position that the Property was only minimally affected by the water loss. The Carrier refused the opportunity to reinspect, failed to retain an expert of its own, and ignored all proof provided by the Insureds, relying only on a single inspection completed by its unqualified adjuster. Moreover, the Carrier refused to participate in appraisal, although the appraisal process was designed to resolve the very type of scope and amount dispute that exists between the parties. Because the Carrier refused to properly adjust the loss and compensate its Insureds, the Insureds have been forced to live amongst the damage and without a working kitchen for months. The Insureds have and will continue to incur and unnecessarily suffer damages, including costs to prosecute this claim, attorney’s fees, and delay damages if the Insurance Company does not retain competent, qualified, and unbiased representatives, participate in good faith adjustment practices, and communicate with the Insureds’ representative(s) to negotiate a fair compromise of the claim within 60 days of the filing of this Civil Remedy Notice.
The Insurance Company’s pattern of failing to adopt and implement standards for the proper investigation of claims constitutes a violation of 626.9541(1)(i)(3)(a). The Carrier’s misrepresentation of pertinent facts and insurance policy provisions relating to coverages at issue constitutes a violation of 626.9541(1)(i)(3)(b). The failure to acknowledge and act promptly upon communications with respect to claims constitutes a violation of 626.9541(1)(i)(3)(c). The failure to promptly notify the Insureds of additional information necessary for the processing of the claim or to clearly explain the nature of requested information and the reasons why such information is necessary is a violation of 626.9541(1)(i)(3)(g)-(h). The Insurance Company’s unreasonable delay and failure to promptly and completely settle the claim establishes violations of sections 626.9541(1)(i)(4), 624.155(1)(b)(1), and 624.155(1)(b)(3). Further, by providing the Insureds an estimate that intentionally and grossly misrepresents the value of the Insureds’ damages, the Insurance Company violated section 626.9541(1)(i)(2), Florida Statutes (“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;”).
The actions taken by the Insurance Company in the handling and adjustment of the claim giving rise to the violations addressed herein, including the established pattern of failing to meaningfully adjust the claim, ignoring clear evidence of covered damages, disregarding the Insureds’ evidence of the true cost to make repairs, failing to retain competent and qualified experts to fully and fairly adjust the claim, issuing a deficient underpayment on the loss and refusing to reassess, declining to submit a simple scope and amount dispute into appraisal, and leaving its Insureds with no alternative but to file suit and attempt to offset the costs of their lawyers fees by serving the Carrier with a Proposal for Settlement that will have to be at least 25% less than what the Insureds will have to ultimately spend to restore their home so the Carrier can avoid paying the full value of claims occur with such frequency as to indicate a general business practice and these acts are willful, wanton, and in gross disregard for the rights of its Insureds.
The Insurance Company’s actions amount to, but are not limited to:
A. “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;” (Fla. Stat. 624.155(1)(b)(1).
B. “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;” (Fla. Stat. sec. 624.155(1)(b)(3))
C. Claim Delay;
D. Claim Denial; and
E. Unfair Trade Practices
The Insurance Company’s actions further amount to unfair claim settlement practices:
1. 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; (Fla. Stat. 626.9541(1)(i)(2)).
2. Committing or performing with such frequency as to indicate a general business practice any of the following:
a. Failing to adopt and implement standards for the proper investigation of claims; (Fla. Stat. 626.9541(1)(i)(3)(a))
b. Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; (Fla. Stat. 626.9541(1)(i)(3)(b))
c. Failing to acknowledge and act promptly upon communications with respect to claims; (Fla. Stat. 626.9541(1)(i)(3)(c))
d. Denying claims without conducting reasonable investigations based upon available information; (Fla. Stat. 626.9541(1)(i)(3)(d))
e. Failing to promptly notify the insured of any additional information necessary for the processing of a claim; (Fla. Stat. 626.9541(1)(i)(3)(g))
f. Failing to clearly explain the nature of the requested information and the reasons why such information is necessary; (Fla. Stat. 626.9541(1)(i)(3)(h)).
3. Failing to pay 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, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by an act of God, prevented by the impossibility of performance, or due to actions by the insured or claimant that constitute fraud, lack of cooperation, or intentional misrepresentation regarding the claim for which benefits are owed. (Fla. Stat. 626.9541(1)(i)(4)).
In addition to the above statutory violations, the Insurance Company’s adjuster violated the following ethical requirements of Florida Administrative Code 69B-220.201:
(3) Code of Ethics . . . An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance. The following are standards of conduct that define ethical behavior, and shall constitute a code of ethics that shall be binding on all adjusters:
(b) An adjuster shall treat all claimants equally.
2. An adjuster shall adjust all claims strictly in accordance with the insurance contract.
(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
(d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.
(e) An adjuster shall handle every adjustment and settlement with honesty and integrity, and allow a fair adjustment or settlement to all parties without any remuneration to himself except that to which he is legally entitled.
(f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim.
(o) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise.
In Florida, the work of adjusting insurance claims engages the public trust. During the adjustment of the Insured’s claim, the Insurance Company breached this duty by failing to adhere to and comply with the above referenced obligations. To cure the defects outlined above, the Insurance Company must:
A. Tender all insurance proceeds due and owing to the Insureds that would reasonably place the Insureds back into a pre-loss condition;
B. Timely communicate with the Insureds’ representative(s) to and participate in good faith negotiations to reach an agreement relating to the parties’ dispute over coverage, scope and amount;
C. Immediately issue payment for statutory interest for any late payments and owed profit/overhead;
D. Act fairly and honestly towards the Insureds and with due regard for their interests;
E. Hire a fair, unbiased, and qualified adjuster(s) and expert(s) to properly assess the Insureds’ damages;
F. Timely and substantively respond to the Insureds’ communications;
G. Timely settle the claim with the Insureds and avoid/limit any additional delay, costs, and prejudice that the Insurance Company’s conduct above has caused and continues to cause its Insureds
This Civil Remedy Notice is given to perfect the right to pursue the civil remedy authorized by this section
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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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