Filing Number: 801217
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| Filing Accepted: 1/15/2025 |
| Last/Business Name
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WEISBERG
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First Name |
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MICHAEL & ELLEN |
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| Street Address
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28116 GOBY TRAIL |
| City, State Zip
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BONITA SPRINGS,
FL
34135
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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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WEISBERG |
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First Name |
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MICHAEL & ELLEN |
| Policy # * |
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FPH3-000128667 |
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Claim #* |
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01000115065 |
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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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FIRST PROTECTIVE 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 10897 |
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| Name of individual responsible for violation (if any):*
JEFF FRONTCAKAS & RYAN RICHARDSON
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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)(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)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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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.
J. 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 and we have not elected our option to repair.
1. Loss will be payable upon the earlier of the following:
a. 20 days after we receive your proof of loss in compliance with SECTION I – CONDITIONS, C. Duties After Loss, paragraph 9, and reach written agreement with you; or
b. 60 days after we receive your proof of loss in compliance with SECTION I – CONDITIONS, C. Duties After Loss, paragraph 9; 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. If payment is not denied, within 90 days after we receive notice of an initial, reopened or supplemental claim.
However, this provision c. does not apply if factors beyond our control reasonably prevent such payment. Page 41 of 58 FL NCPT HO 03 11 21 Failure to comply with this provision c. does not form the basis of a private cause of action against us.
2. If payment is denied in part, we will pay the undisputed amounts within the same time stated unless we have exercised our option under SECTION I – CONDITIONS, I.
3. Payment of a portion of the claim(s) being asserted in a loss under this policy does not act as a waiver of our right to dispute or deny any unpaid portion of any claim(s) that you may assert arose from a loss.
4. Any payment for expenses of engineering reports, professional services, or other expert opinions, reports, or estimates will not be covered or reimbursed unless we first request or approve the report, service, or other opinion.
5. Payments for all losses are deemed made on the date the payment is mailed to the “insured” or any other person named in the policy or legally entitled to receive payment.
6. The preceding paragraph 5. does not relieve our duty to replace any such payment made by check not yet presented to our bank for payment upon your: a. Notice to us that you or other such intended payee named on the check are not in physical receipt of such payment; and b. Request of its reissuance.
7. In no event will we make duplicate payments for the same element of loss because of the “insured’s” failure to notify us of the existence of or termination of an “assignment agreement.”
T. Notice of Claim
If your policy provides hurricane or windstorm coverage, then a claim, supplemental claim or reopened claim for loss or damage caused by hurricane or other windstorm must be given to us in accordance with the terms of this policy and as follows:
a. A claim or reopened claim must be reported within two years after the hurricane first made landfall or a windstorm other than a Hurricane caused the damage, or,
b. A supplemental claim must be reported within three years after the hurricane first made landfall or a windstorm other than a Hurricane caused the damage, and,
c. Within any other applicable statutorily-required timeframe;
Whichever is less.
This condition concerning time for submission of claim does not affect any limitation for legal action against us as provided in this policy under the Suit Against Us Condition including any amendment to that condition.
SECTION I – PERILS INSURED AGAINST
A. Coverage A – Dwelling And Coverage B – Other Structures
1. We insure against direct physical loss to property described in Coverages A and B.
2. We do not insure, however, for loss:
a. Excluded under Section I – Exclusions;
b. Involving collapse, including any of the following conditions of property or any part of the property:
(1) An abrupt falling down or caving in;
(2) Loss of structural integrity, including separation of parts of the property or property in danger of falling down or caving in; or
(3) Any cracking, bulging, sagging, bending, leaning, settling, shrinkage or expansion as such condition relates to (1) or (2) above;
except as provided in E.8. Collapse under Section I – Property Coverages; or c. Caused by:
(1) Freezing of a plumbing, heating, air conditioning or automatic fire protective sprinkler system or of a household appliance, or by discharge, leakage or overflow from within the system or appliance caused by freezing. This provision does not apply if you have used reasonable care to:
(a) Maintain heat in the building; or
(b) Shut off the water supply and drain all systems and appliances of water. However, if the building is protected by an automatic fire protective sprinkler system, you must use reasonable care to continue the water supply and maintain heat in the building for coverage to apply. For purposes of this provision, a plumbing system or household appliance does not include a sump, sump pump or related equipment or a roof drain, gutter, downspout or similar fixtures or equipment;
(2) Freezing, thawing, pressure or weight of water or ice, whether driven by wind or not, to a:
(a) Fence, pavement, patio or swimming pool;
(b) Footing, foundation, bulkhead, wall, or any other structure or device that supports all or part of a building, or other structure;
(c) Retaining wall or bulkhead that does not support all or part of a building or other structure; or
(d) Pier, wharf or dock;
(3) Theft in or to a dwelling under construction, or of materials and supplies for use in the construction until the dwelling is finished and occupied;
(4) Vandalism and malicious mischief, and any ensuing loss caused by any intentional and wrongful act committed in the course of the vandalism or malicious mischief, if the dwelling has been vacant for more than 60 consecutive days immediately before the loss. A dwelling being constructed is not considered vacant;
(5) Mold, fungus or wet rot. However, we do insure for loss caused by mold, fungus or wet rot that is hidden within the walls or ceilings or beneath the floors or above the ceilings of a structure if such loss results from the accidental discharge or overflow of water or steam from within:
(a) A plumbing, heating, air conditioning or automatic fire protective sprinkler system, or a household appliance, on the "residence premises"; or
(b) A storm drain, or water, steam or sewer pipes, off the "residence premises". For purposes of this provision, a plumbing system or household appliance does not include a sump, sump pump or related equipment or a roof drain, gutter, downspout or similar fixtures or equipment; or
(6) Any of the following:
(a) Wear and tear, marring, deterioration;
(b) Mechanical breakdown, latent defect, inherent vice or any quality in property that causes it to damage or destroy itself;
(c) Smog, rust or other corrosion, or dry rot;
(d) Smoke from agricultural smudging or industrial operations;
(e) Discharge, dispersal, seepage, migration, release or escape of pollutants unless the discharge, dispersal, seepage, migration, release or escape is itself caused by a Peril Insured Against named under Coverage C. Pollutants means any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed;
(f) Settling, shrinking, bulging or expansion, including resultant cracking, of bulkheads, pavements, patios, footings, foundations, walls, floors, roofs or ceilings;
(g) Birds, rodents or insects;
(h) Nesting or infestation, or discharge or release of waste products or secretions, by any animals; or
(i) Animals owned or kept by an "insured"
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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.
January 15, 2025
Sent Via Portal
First Protective Insurance Company d/b/a Frontline Insurance Company
RE: Insureds : Michael Weisberg and Ellen Weisberg
(hereinafter, “Insureds”)
Policy # : FPH3-000128667
Claim # : 01000115065
Property Address : 28116 Goby Trail, Bonita Springs, FL 34135
Persons most knowledgeable of facts giving rise to the Violations: Jeff Frontcakas, Ryan Richardson
Dear First Protective Insurance Company d/b/a Frontline 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 Ian claim on August 1, 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.
In response to the claim, the carrier assigned an undisclosed field adjuster, who was not an engineer, to inspect the loss. Florida Statute 627.70131(3)(e) requires the carrier to provide an estimate within 7 days after the estimate is generated by the insurer’s adjuster. However, Frontline failed to provide any copy of a report and/or generated by its field adjuster. The insurer must send the policyholder a copy of any detailed estimate of the amount of the loss within 7 days after the estimate is generated by an insurer’s adjuster.
On December 20, 2024, the assigned engineer for the carrier, Ryan Richardson from SDII Global, inspected the loss and in his estimation, as engineers from this firm hired by the carrier routinely find, that the damage was not due to wind but due to reasons that may be excluded under the policy. The engineer here additionally based their report on a completely different date of loss, July 12, 2024, instead of the reported actual date of loss of September 28, 2022, for Hurricane Ian. The carrier’s own documents as well as the recorded statement of the insured has established that the date of loss was in fact September 28, 2022, and that the engineer’s inspection based its weather data as other pertinent facts on a completely different date and therefore could not accurately speak to the conditions the roof was under for the correct date of loss.
To date, even though the information has been requested several times from the carrier, the carrier has not stated the frequency at which it hires SDII Global and its engineers to investigate claims. Routinely, as in this claim, only once Frontline sends out an engineer from SDII Global do they deny the roof, finding that the damages are excluded with no explanation whatsoever as to how it was determined which items of damage were caused by covered or excluded perils. 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.
On November 6, 2024, over ninety-seven (97) days after the reporting of the claim the carrier made the unilateral determinations that the damages to the property would be excluded under the policy and therefore be denied. In reaching this conclusion, Frontline failed to adopt and implement standards for the proper investigation of claims. There was no explanation whatsoever as to how Frontline determined which items of damage were caused by excluded perils or how they were caused by excluded perils. 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). Additionally, pursuant to F.S. § 627.70131(7)(a), within 60 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer. Here it took the carrier over ninety-seven (97) days to deny the claim, over thirty-seven (37) days more than the statutorily allotted time, in further violation of F.S. §626.9541(1)(i)(3)(d) and F.S. §626.9541(1)(i)(3)(c).
The insured has been compelled to obtain an independently adjusted estimate totaling in the amount of $88,955.15 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 not articulated nor stated any additional information that would have been necessary for the processing of the claim, nor explained the nature or necessity of said information pursuant to F.S. §626.9541(1)(i)(3)(g) and F.S. §626.9541(1)(i)(3)(h). The carrier has still refused to pay the fully covered amount owed under the policy, instead electing to stand by its unilaterally determined denial of the loss.
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 Frontline 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) = 5,547
§624.155(1)(b)(3) = 3,795
§626.9541(1)(i)(3)(a) = 5,368
§626.9541(1)(i)(3)(c) =3,798
§626.9541(1)(i)(3)(d) = 2,834
§626.9541(1)(i)(3)(g) = 2,001
§626.9541(1)(i)(3)(h) = 1,226
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 and 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 $88,955.15 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. The other provisions are pasted on the pages following the signature block.
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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