Filing Number: 801459
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| Filing Accepted: 1/16/2025 |
| Last/Business Name
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| Street Address
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5472 26TH PL SW |
| City, State Zip
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NAPLES,
FL
34116
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| Email Address
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MH@WEKLAW.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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CABRERA |
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First Name |
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PABLO |
| Policy # * |
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SFLH1101054 |
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Claim #* |
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62422 |
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Attorney is Applicable
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| Last Name* |
HENDRIX
First Name *
MERYL
Initial
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| Street Address* |
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800 EAST BROWARD BLVD SUITE 510 |
| City, State Zip* |
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FORT LAUDERDALE
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FLORIDA
33301
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| Email Address * |
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MH@WEKLAW.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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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
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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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Misstatement of policy terms and conditions
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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)(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)(e) |
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Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
AGREEMENT
We will provide the insurance described in this policy in return for the premium and compliance with all applicable provisions of this policy.
SECTION I - PROPERTY COVERAGES
A. Coverage A – Dwelling
1. We cover:
a. The dwelling on the “residence premises” shown in the Declarations, including structures attached to the dwelling; and
PERIL INSURED AGAINST
1. We insure against risk of direct physical loss to property described in Coverages A and B.
C. Loss Settlement
In this Condition C., the terms “cost to repair or replace” and “replacement cost” do not include the increased costs incurred to comply with the enforcement of any ordinance or law, except to the extent that coverage for these increased costs is provided in E.11. Ordinance Or Law under PROPERTY COVERAGES.
I. Loss Payment
We will adjust all losses with you. We will pay you unless some other person is named in the policy or is legally entitled to receive payment. Loss will be payable 60 days after we receive your proof of loss and:
1. Reach written agreement with you;
2. There is an entry of a final judgment; or
3. There is a filing of an appraisal award with us
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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.
Wendy and Pablo Cabrera (“Insureds”) purchased an insurance policy ("Policy") from Safepoint Insurance Company (“Carrier”) with effective coverage on the date of loss, on or about September 28, 2022, and Policy number SFLH1101054 to insure their property located at 5472 26TH Place SW Naples, Florida 34116 ("Property").
On or about September 28, 2022, the Property suffered wind damage to the main roofing system, flat roofing system and exterior as well as subsequent water damage to the interior as a result of Hurricane Ian ("Loss"). Upon becoming aware of the nature of the loss and damage to the Property, the loss was reported to the Carrier within the time afforded by Florida Statute and the policy. The Carrier acknowledged the claim and assigned claim number 62422 ("Claim") to the Loss.
On April 17, 2024, Field Adjuster Ryan Welch, an employee of the Carrier inspected the Insureds Property. Approximately two (2) weeks after the inspection the Insureds claim was denied in its entirety by way of correspondence dated May 1, 2024. The Carrier, through Mr. Welch, denied its Insureds claim for prejudice rather than conducting a meaningful investigation into the claim to try and find coverage for its insureds.
Due to the Insureds lack of familiarity with homeowners’ claims the Insured had retained the services of a Public Adjuster to assist them with the claims process. A representative from Elevate Claim Adjusters, LLC (“Elevate”) inspected the property and provided a detailed estimate of damages to the Carrier totaling $84,343.50.
Since the Insureds became aware of the nature of the loss and damages to the Property, they have mitigated further damage to the Property by making temporary repairs to keep further water from entering the home and have cooperated in all ways possible with every request of the Carrier. The Insureds have fully complied with all applicable Policy provisions requiring cooperation with the investigation; however, the Carrier has unequivocally failed to properly adjust this Claim. Rather than paying the actual damages and/or trying to settle with the Insureds, the Carrier has continued its failures to act in good faith by delaying any prompt resolution of the claim. The Carrier has not attempted, in good faith, to settle this claim when, under the circumstances, it could and should have done so had it acted fairly and honestly toward the policyholders and with due regard to the policyholders' interests. As a result of this incident, the Insureds have suffered damage to the Property.
As a direct consequence of the Carrier’s failure to adjust this Loss in good faith and make any payment, the Insureds continue to be without adequate compensation for the damages sustained at the Insureds' Property.
By stating the above detailed facts, it is clear that the Carrier has violated the following Florida statutes:
• 624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its Insureds and with due regard for their interest;
• The Carrier has no evidence that the roof was leaking prior to Hurricane Ian, however, it continues to refuse to pay for the damages caused by Hurricane Ian.
• 624.155(1)(b)(3) 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;
• 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims;
• 626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
• 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
• 626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
• 626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
• 626.9541(1)(i)(3)(f) 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
• 626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim
To date, the Carrier has acted in bad faith by failing to provide coverage under the Policy to the Insureds. The Insureds’ property continues to be in disarray as the Insureds are without funds to put their property back to its pre-loss condition. As a direct result of the Carrier’s breach of the above Florida Statutes, the Insureds were forced to seek the help of licensed professionals to assist them, including legal counsel. Due to the amount of time that has passed since the information discussed above, there is irrefutable evidence that the Carrier knowingly and intentionally, and in bad faith delays the settlement process in order to further disadvantage the Insureds. The financial detriment caused to the Insureds is a direct result of the Carrier’s reckless treatment of the claims process. The Insureds submitted to every request made by the Carrier in a timely fashion including but not limited to making their property available for inspection, submitting an estimate for repairs and submitting to a recorded statement, which is now being used against them without any reasonable or factual basis. The Carrier failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim.
To deny the Insured the benefit clearly due and owing under the Policy, for which they have time and time again been making premium payments for and after they have satisfied all of their obligations is morally and ethically reprehensible, and reeks of Unfair Claims Practice and Bad Faith. Upon information and belief, the aforementioned actions complained of, among others, were made by the Carrier so often as to constitute a general business practice, evidencing a motive to enhance the Carrier’s profits, and designed to cause a detrimental effect to its policyholders. The above clearly depicts that the Carrier adjusted this claim in bad faith, continue to act in bad faith towards its Insureds, and that the Carrier is in direct violation of Unfair Claims Practices.
This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should the Carrier fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, the Carrier must: (1) Immediately tender $84,344.00 in US dollars to the Insureds which is fairly owed to the Insureds under the insurance policy and would reasonably compensate the Insureds in order to put their Property back to its pre-loss condition; (2) Agree to reimburse the Insureds’ reasonable attorneys’ fees and costs for having to become involved to resolve the claim; (3) Agree to reimburse the Insureds for interest on the amount of benefits that was found to be due and owing to the Insureds, relating back to the date of loss.
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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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