Filing Number: 801674
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| Filing Accepted: 1/16/2025 |
| Last/Business Name
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2600 ISLAND BOULEVARD CONDOMINIUM ASSOCIATION, INC.
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First Name |
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| Street Address
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2600 ISLAND BLVD |
| City, State Zip
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AVENTURE,
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33160
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| Email Address
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GENERALMANAGER@RESIDENCEDUCAP.COM |
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Insured |
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| Last/Business Name* |
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2600 ISLAND BOULEVARD CONDOMINIUM ASSOCIATION, INC. |
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First Name |
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| Policy # * |
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41-LX-062798244-1 |
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Claim #* |
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CH 197951 |
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Attorney is Applicable
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| Last Name* |
CRUTCHFIELD
First Name *
TIMOTHY
Initial
H
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| Street Address* |
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1700 SAN SOUCI BLVD |
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NORTH MIAMI
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FL
33181
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| Email Address * |
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TIM@MINTZTRUPPMAN.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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LEXINGTON INSURANCE COMPANY
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| Insurer Name* |
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| Street Address* |
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,
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NAIC Company Code 19437 |
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| Name of individual responsible for violation (if any):*
CARLOS ARANGO, MARCUS WASHINGTON, JAMIE PETITO
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| Type of Insurance
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Commercial 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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| 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)(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.
POLICY PROVISIONS
A. Covered Causes of Loss
When Special is shown in the Declarations,
Covered Causes of Loss means direct physical
loss unless the loss is excluded or limited in this
policy.
E. Exclusions
1. We will not pay for loss or damage caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence with the loss.
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g. Water
(1) Flood, surface water, waves (including tidal wave and tsunami), tides, tidal water, overflow of any body of water, or spray from any of these, all whether or not driven by wind (including storm surge)
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(4) Water under the ground surface pressing on, or flowing or seeping through:
(a) Foundations, walls floors or paved surfaces;
(b) Basements, whether paved or not; or
(c) Doors, windows or other openings;
3. We will not pay for loss or damage caused by or resulting from any of the following, 3.a. through 3.c. But if an excluded cause of loss that is listed in 3.a. through 3.c. results in a Covered Cause of Loss, we will pay for the loss or damage caused by that Covered Cause of Loss.
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b. Acts or decisions, including the failure to act or decide, of any person, group, organization or governmental body.
c. Faulty, inadequate or defective:
(1) Planning, zoning, development, surveying, siting;
(2) Design, specifications, workmanship, repair, construction, renovation,
remodeling, grading, compaction;
(3) Materials used in repair, construction, renovation or remodeling; or
(4) Maintenance;
II. Wind Driven Precipitation
Subparagraph 1.c. of section C. Limitations is deleted in its entirety and replaced by the following:
c. The interior of any building or structure, or to personal property in the building or structure, caused
by or resulting from rain, snow, sleet, ice, sand or dust, whether driven by wind or not, unless:
(1) The building or structure first sustains damage by a Covered Cause of Loss to its roof or walls
through which the rain, snow, sleet, ice, sand or dust enters; or
(2) The loss or damage is caused by or results from thawing of snow, sleet or ice on the building
or structure.
However, we will pay for direct physical loss or damage to the interior of any building or structure, or to
personal property in the building or structure caused by or resulting from wind driven precipitation
being rain, snow, sleet or ice, when driven by wind absent any damage to the building or structure.
The most we will pay for loss or damage by wind driven precipitation in any one occurrence is
$1,000,000 unless a higher limit is shown on the Declarations or by endorsement hereto.
The policy deductible applicable to windstorm or hail will apply to all loss or damage caused by or
resulting from wind driven precipitation.
All other terms and conditions remain the same.
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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.
FACTS
On December 23, 2019, the Insured suffered a loss when water gained ingress to the property and caused damage to the interior of the property. At the time of the loss, the pool deck of the property was undergoing renovation. During the night, a heavy rain storm moved through the area resulting in water ponding on the pool deck where it did not adequately drain with the drain system hampered by construction debris. The ponding water caused damage to the doors to the property allowing a substantial flow of water into the property and causing extensive interior damage.
Insurance Company rather than acting in good faith and helping their Insureds at their time of need they violated FS 624.155 & 626.9541 relative to all aspects of their handling of the subject claim.
The Insureds promptly reported the water loss and fully cooperated with Insurance Company. The Insureds relied upon the Insurance Company’s adjusters to act in good faith relative to all aspects of adjusting and paying the subject claim. The Insurance Company assigned claim number CH 197951 relative to the subject loss The Insurance Company retained Athens Administrators to act as their agent to properly adjust the subject claim on the Insurance Company’s behalf in accordance with the policy terms and Florida Statutes 624.155 & 626.9541. Carlos Arango of McClarens was assigned to act as the filed adjuster and Kush Daruwalla was retained as an engineer to evaluate the cause of the loss.
The Insurance Company failed to attempt in good faith to settle the claim when,
under all the circumstances, it could have and should have done so, had it acted fairly
and honestly toward its insured and with due regard for the Insureds’ interests. The Insurance Company has failed to place their Insureds in their pre-loss condition.
The Insurance Company has failed to adopt and implement standards for the proper investigation of the subject claim and misrepresented pertinent facts and insurance policy provisions relating to coverages with regards to that issue. The Insurance company misrepresented
The Insurance Company intentionally made numerous misrepresentations and /or omissions placing the Insurance Company’s interests before the policy holders’ interests in the reservation of rights letter, the denial letter and its answer to the complaint. The Insurance Company misrepresented that the exclusion for surface water applied to the loss when under Florida law water that accumulates on a structure is not excluded as surface water. The water that caused the damage accumulated above the third floor of a parking garage, well above ground level. The Insurance Company misrepresented that an exclusion for damage caused by “water under the ground surface” applied even though the water was rainwater that accumulated on a pool deck above a three-story garage structure. The Insurance Company raised affirmative defenses that do not apply to the loss. The Insurance Company misrepresented that the exclusion under the Policy for acts or decisions of persons, groups, organizations or governments applied and indicated that the basis for this exclusion was in the denial letter. There were no such facts in the denial letter and the Insurance Company has been unable to provide any factual support for this defense. The Insurance Company misrepresented that the exclusion for inadequate maintenance applied to the loss and indicated that the factual basis for such defense was found in the denial letter. There were no such facts in the denial letter and the Insurance Company has been unable to provide any factual support for this defense. The Insurance Company misrepresented that the exclusion for failure to take reasonable steps to protect the property after a loss applied to the loss and indicated that the factual basis for such defense was found in the denial letter. That is, the Insurance Company accused the insured of neglect. There were no such facts in the denial letter and the Insurance Company has been unable to provide any factual support for this defense. The Insurance Company misrepresented that the exclusion for inadequate maintenance applied to the loss and indicated that the factual basis for such defense was found in the denial letter. There were no such facts in the denial letter and the Insurance Company has been unable to provide any factual support for this defense. The Insurance Company misrepresented that the limitation on water damage to the interior of the property unless the water gains entrance to the property through an opening created by a covered cause of loss applied to the loss and indicated that the factual basis for such defense was found in the denial letter. There were no such facts in the denial letter and the Insurance Company has been unable to provide any factual support for this defense when the volume of water caused deflection of the doors to the property allowing ingress to the property as a result of a covered cause of loss. As such, the Insurance Company raised exclusions that clearly did not apply to the facts of this loss.
The insured sustained direct physical loss during the effective dates of coverage and none of the exclusions within the policy apply to the subject water loss
The Insurance Company intentionally failed to disclose pertinent insurance policy provisions relating to coverage. In particular, the Insurance Company failed to disclose that there is coverage for damage cause by wind driven rain regardless of whether there is an opening caused by a covered cause of loss for a reduced amount of coverage and failed to show that the opening was not created by a rain event allowing water to enter and damage the common areas of the building.
The Insurance company failed to acknowledge and act promptly upon communications with respect to the claim and failed to promptly respond to their Insureds. The Insurance Company has denied coverage and/or failed to pay the full amount of the claim or portions of the claim without conducting reasonable investigations based upon available information when it was clear that there was coverage for the loss.
The Insurance Company 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 portions of the claim or for the offer of a compromised settlement in an attempt to place their Insureds in their pre-loss condition.
The Insurance Company failed to promptly notify the insured of any additional information necessary for the processing of a claim and/or failed to clearly explain the nature of the requested information and the reasons why such information is necessary in order to attempt to place their Insureds in their pre-loss condition.
The Insurance Company’s wrongful conduct and omissions includes, but are not limited to: 1) improperly denying the claim 2) not conducting full, prompt and proper investigation 3) not treating the insureds with good faith claims conduct; 4) looking for ways to deny full recovery to the insureds ; 5) looking for ways to delay full recovery to the insured; 6) Not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and complete indemnity to the insureds ; 7) failing to implement proper standards for the adjustment and investigation of claims; and 9) not training, supervising or managing adjusters properly so that prompt and full resolution of the claim is made in accordance with Florida law and the policy provisions , but rather placing the Insurance company’s interests before the policy holders’ interests.
All of the actions of the Insurance Company are of a general business practice and are willful, wanton and with reckless disregard for the rights of their Insureds.
Insurance Company can rectify these violations by acting fairly and honestly towards their Insureds with due regard for their interests and making full payment of all amounts due and owing under the Policy relative to the damages sustained as a result of the subject loss and paying all costs and attorney’s fees unnecessarily incurred by the Insureds including prejudgment interest from the date of loss as a result of the Insurance Company’s violations of Florida Statutes 624.155 and 626.9541.
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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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