Filing Number: 803964
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| Filing Accepted: 1/28/2025 |
| Last/Business Name
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GILLEN
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First Name |
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EILEEN AND BRIAN |
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| Street Address
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1110 93RD ST NW |
| City, State Zip
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BRADENTON,
FL
34209
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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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GILLEN |
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First Name |
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EILEEN AND BRIAN |
| Policy # * |
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SJ31153919 |
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Claim #* |
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202410012129 |
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Attorney is Applicable
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| Last Name* |
DANIELS
First Name *
MONICA
Initial
E
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| Street Address* |
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560 VILLAGE BOULEVARD, SUITE 110 |
| City, State Zip* |
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WEST PALM BEACH
,
FLORIDA
33409
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| Email Address * |
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MDANIELS@THEDANIELS-LAWGROUP.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):*
ANDREA POPE, KRISTY BASSA, ROBERT FAZIO, AND ANY AND ALL ADJUSTERS, MANAGERS, SUPERVISORS, AND INDIVIDUALS ASSOCIATED WITH THE CLAIM.
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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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Unfair Trade Practice
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Unsatisfactory Settlement Offer
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Claim Delay
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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)(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.
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.
SECTION I – PERILS INSURED AGAINST
A. Coverage A – Dwelling And Coverage B – Other Structures
1. We insure against risk of direct physical loss to property described in Coverages A and B.
SECTION I – CONDITIONS
I. Loss Payment.
We will adjust all losses with you.
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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.
Eileen Gillen and Brian Gillen (the “Insureds”) purchased an insurance policy from Slide Insurance Company (“Insurer”), with Policy number SJ31153919 (the “Policy”), to cover their property located at 1110 93rd St NW, Bradenton, FL 34209 (the “Property”). On October 9, 2024, Hurricane Milton struck the Property. The excessive winds from Milton caused damage to the roof and various exterior elements of the Property, which necessitate the following repairs to return the Property to its pre-loss condition: gutters, stucco, exterior painting, exterior lights, garage door, screen enclosure, pavers, pool, awning, and fence. Milton also caused damage to the interior of the Property necessitating repairs in the following areas to return the Property to its pre-loss condition: living room, dining room, kitchen, office, hallway, entryway, and a guest bedroom and closets. The Insureds immediately reported the loss to Insurer, mitigated the damages, and complied with all applicable post-loss obligations. They also hired a public adjuster to assist them with their damages and the claims process.
The Insurer assigned claim number 202410012129 (the “Claim”) to the claim. The Insurer inspected the Property and prepared a woefully deficient initial estimate that failed to address the full scope of damages and repairs necessary to return the Property to its pre-loss condition. The Insurer’s evaluation of the Property’s loss was insultingly low given the observable damages. Among other things, the Insurer failed to render any coverage for the interior damages sustained at the Property.
The Insureds provided the Insurer with a true and accurate estimate of the related damages, extensive photographs of the damages, and complied with all of the Insurer’s requests for documentation and information. The Insurer acknowledged coverage and admitted liability for damages to the Property. The Insureds dispute that the meager amount unilaterally determined by the Insurer is sufficient to restore their Property to its pre-loss condition.
The Insureds understandably became extremely frustrated by the Insurer’s clear delay tactics, failure to properly indemnify them for this Claim in a timely fashion, and failure to adjust the Claim in good-faith. To combat any further attempts by the Insurer to delay the Claim and its failure to make the Insureds whole, the Insureds had no choice but to retain legal counsel to assist with the Claim. Without sufficient funds to repair their property, the Insureds continue to suffer additional damages. The Insurer failed to make any meaningful effort to inspect the Property or adjust the Claim despite the Insureds expressing their clear disagreement with the Insurer’s handling of the Claim. Despite providing all necessary documentation to the Insurer to make good on its duty to restore the Insureds to their pre-loss condition, Insurer grossly undervalued the claim and only contemplated a fraction of the amount of Insureds’ damages. The scope of the damages considered by the Insurer is an insult to the Insureds and is far less money than necessary to complete the repairs to their Property.
The Insurer’s refusal to properly investigate, adjust and fully compensate the Insureds for this Claim undoubtedly evidences the Insurer’s violation of Section 626.9541(1)(i)(3)(a), Florida Statutes, which requires the Insurer to “adopt and implement standards for the proper investigation of claims.” All available information leads to one conclusion – the Property was damaged by a covered cause of loss for which the Insureds are entitled to full and complete compensation. The Insurer’s obligation to promptly settle the Insureds’ claim is undeniable, and therefore, the Insurer has also violated Fla. Stat. Section 624.155(1)(b)(1) and 624.155(1)(b)(3).
The Insurer’s conduct continues to be egregious because the Insurer retained biased and inexperienced individuals who approached the loss with an eye towards underpayment. The actions taken by the Insurer in the handling and adjustment of the Claim are willful, wanton, and in disregard for the rights of the Insureds, and have occurred with such frequency as to indicate a general business practice in violation of the law. This practice includes the Insurer hiring biased and inexperienced adjusters and failing to properly and timely pay for obvious damages owed to its Insureds. The Insurer’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 the insured and with due regard for her or his interests;”
B. “Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue”;
C. “Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear;”
D. “Failing to adopt and implement standards for the proper investigation of claims;”
E. Claim Delay;
F. Unsatisfactory Settlement Offers; and
G. Unfair Trade Practices.
In addition to the above statutory violations, the Insurer’s adjuster violated the following ethical requirements of the 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.
The Insureds are dutiful customers who made it a priority to pay their insurance premiums and to ensure that in such an event as the one here, their property would be covered. The Insureds timely filed their claim and fulfilled all post-loss obligations. Insurer acknowledged the loss, assigned a claim number, inspected the property, accepted coverage for the loss, and then grossly undervalued the claim. Insurer has failed to provide the Insureds with qualified representatives to ensure the claim was initially adjusted, evaluated, and paid properly. To deny the Insureds the benefit of the bargain after they have satisfied all of their obligations is morally and ethically reprehensible, and reeks of Unfair Trade Practice. Insurer is putting its profits ahead of its contractual and statutory obligations.
In Florida the work of adjusting insurance claims engages the public trust. The Insurer has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees. The Insurer has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insureds’ insurance claim and damages. Therefore, the Insurer breached its statutory and ethical duties, and has put profits ahead of the duties it owed to its Insureds when they most needed the insurance coverage they had paid for.
Florida Statute § 624.02 defines “insurance” as a contract where one undertakes to indemnify another or pay or allow specified amounts, or determinable benefit, upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly. This timely and prompt payment allows the insured to mitigate their damages and place them back to the position they were in prior to the loss, as quickly as possible. The Insurer breached this duty. The Insurer has refused and failed to tender all insurance proceeds to the Insureds upon demand. The Insurer’s refusal and/or failure to settle the insurance claim when it, under all circumstances, should have done so, is wrongful conduct. The Insurer is failing to promptly settle the Insureds’ claim as it is required to do so by contract, in order to influence settlements.
To cure the defects outlined in this civil remedy notice, the Insurer must (1) immediately, and under no circumstances no later than sixty days from the date of this civil remedy notice, tender all insurance monies due and owing to the Insured under the Policy, specifically $83,760 pursuant to the public adjuster’s repair estimate, less applicable deductible and prior payment; (2) ensure that payment made would be adequate to place the Insureds and their Property back in the pre-loss condition; and (3) reimburse the Insureds’ attorney’s fees and costs, since the Insured was forced to hire legal counsel in order to receive adequate payment. Should the Insurer fail to comply with the demands set forth in this civil remedy notice, the Insurer must prepare to pay the full cost of its failure to rightfully indemnify the Insureds, including all future damages that come about as a result of the Insurer’s failure to comply with the demands set forth in this civil remedy notice. This Notice is giving in order to perfect the right to pursue the civil remedy authorized by section 624.155(3)(b), Florida Statutes.
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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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