Filing Number: 804301
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| Filing Accepted: 1/30/2025 |
| Last/Business Name
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VALLE
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First Name |
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JOSHUA AND VANESSA |
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| Street Address
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100 E. OAK TERRACE DRIVE, UNIT B3 |
| City, State Zip
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LEESBURG,
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34748
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| Email Address
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JOSHUAV0917@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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VALLE |
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First Name |
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JOSHUA AND VANESSA |
| Policy # * |
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988 879 788 |
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Claim #* |
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0766690200 |
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Attorney is Applicable
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| Last Name* |
GROOVER
First Name *
JEFF
Initial
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| Street Address* |
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400 NO. ASHLEY DRIVE, SUITE 1900 |
| City, State Zip* |
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TAMPA
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FLORIDA
33602
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| Email Address * |
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JG@GMA.LAW |
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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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CASTLE KEY INDEMNITY 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 10835 |
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| Name of individual responsible for violation (if any):*
SHANE LANCASTER
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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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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)(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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Florida Condominium Amendatory Endorsement – AP4992-1
1. The definition of item 5, catastrophic ground cover collapse, is replaced by the following:
5. Catastrophic ground cover collapse – means geological activity that results in all the following:
a) the abrupt collapse of the ground cover;
b) a depression in the ground cover clearly visible to the naked eye;
c) structural damage to a building structure, including the dwelling foundation, in which the residence premises is located; and
d) that building structure being condemned and ordered to be vacated by the governmental agency authorized by law to issue such an order for that building structure.
Catastrophic ground cover collapse does not include damage consisting merely of settling or cracking of a foundation or building structure.
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B. Under item 5, How We Pay For A Loss, the first paragraph is replaced by the following:
Within 60 days after we receive notice of an initial, reopened, or supplemental claim under Building Property Protection–Coverage A or Personal Property Protection–Coverage C from you, we shall pay or deny such claim or a portion of the claim unless the failure to pay such claim or a portion of the claim is caused by factors beyond our control. Claims will be paid within 20 days of written agreement between you and us, except as provided in subparagraph b)1) below regarding the payment of amounts for underpinning or grouting. Under Building Property Protection–Coverage A and Personal Property Protection–Coverage C, payment for covered loss will be by one or more of the following methods…
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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.
My firm has the pleasure of representing Joshua and Vanessa Valle in relation to the above-referenced claim. This civil remedy notice pertains to Castle Key Indemnity Company not attempting in good faith to settle this claim when, under all circumstances, it could and should have done so, had it acted fairly and honestly towards its insureds, Joshua and Vanessa Valle, and with due regard for their interests and making claim payments to them no accompanied by a statement setting forth the coverage under which payments are being made.
This loss pertains to catastrophic ground cover collapse at Mr. and Mrs. Valle’s property. It is not entirely clear what Castle Key’s claim determination was because it has failed to issue a written coverage determination. More specifically, the undersigned requested copies of all claim communication through letter dated January 23, 2025. In response to the letter and multiple email exchanges requesting a formal written coverage determination pursuant to a payment was made, Castle Key’s desk examiner, Shane Lancaster, wrote in an email dated January 29, 2025 – “Allstate does not have a coverage letter.” Request was also made for Mr. Lancaster’s supervisor because he was being obstructive and would not assist in obtaining claim documentation, but he refused to provide the information. This was apparently done with Castle Key’s knowledge since the email communication came from Castle Key’s corporate email address (as opposed to Mr. Lancaster’s individual email address).
At this juncture, Mr. and Mrs. Valle and their attorneys do not know what Castle Key’s coverage determination is on this claim, even though they issued some sort of payment. However, that payment was substantially less than policy limits, which is warranted in this claim pursuant to Florida Statutes § 627.702 since this property meets the statutory and policy definition of “catastrophic ground cover collapse”.
In this matter, the policy’s Florida Condominium Amendatory Endorsement – AP4992-1 provides coverage for “catastrophic ground cover collapse”. The definition of this term within the policy tracks the language of Florida Statutes § 627.706, and defines “catastrophic ground cover collapse” as follows:
1. The definition of item 5, catastrophic ground cover collapse, is replaced by the following:
5. Catastrophic ground cover collapse – means geological activity that results in all the following:
a) the abrupt collapse of the ground cover;
b) a depression in the ground cover clearly visible to the naked eye;
c) structural damage to a building structure, including the dwelling foundation, in which the residence premises is located; and
d) that building structure being condemned and ordered to be vacated by the governmental agency authorized by law to issue such an order for that building structure.
Catastrophic ground cover collapse does not include damage consisting merely of settling or cracking of a foundation or building structure.
The Florida Legislature has effectively created prongs for what constitutes “catastrophic ground cover collapse”, and if each of the prongs are satisfied, then coverage must be afforded. In this claim, every prong is satisfied, which demands Castle Key to open coverage. Each prong will discuss each in turn.
a) The abrupt collapse of the ground cover.
The policy does not define the term “ground cover”, but under Florida law, when a term is not defined by the insurance policy, its common definition applies. Florida courts obtain common definitions from dictionaries and other similar sources. According to Wikipedia, “ground cover” is “any plant that grow low over an area of ground, which protects the topsoil from erosion and drought…The most widespread ground covers are grasses of various types.”
In this matter, there was an abrupt collapse of the ground cover. Specifically, the ground cover (i.e., grass and flower beds) suddenly and unexpectedly collapsed in the areas of the condominium where the most substantial structural damage presented itself. As demonstrated in the photographs provided to Castle Key, the ground cover collapse ranges from roughly 5” to nearly 8” at multiple areas around the condominium. The photographs provided to Castle Key are a mere sampling. If Castle Key and its engineers truly examined the property close enough, they would have clearly seen this abrupt collapse of the ground cover. But it appears that they were either not looking for the ground cover collapse during its investigation or they did not what they were looking for. Either way, the conditions are present at the property.
Importantly, there is not a condition that the ground cover collapse must be a certain size. The policy and the statute only require it to be present. As demonstrated, it is clearly present.
b) A depression in the ground cover clearly visible to the naked eye.
In addition to the photographs provided to Castle Key, a cursory review of these areas demonstrates a depression in the ground cover that is clearly visible to the naked eye. While St. Augustine grass is naturally thick and provides dense ground cover, one who know what a depression looks like can clearly see a depression in the ground cover.
The photographs provided to Castle Key are overview photographs demonstrating a 5” depression. If one walked in this area, they would likely trip based on the significant collapse in the ground cover. As noted above, there is not a requirement that the ground cover collapse be a particular size. Therefore, as demonstrated, there is ground cover collapse that is clearly visible to the naked eye.
c) Structural damage to a building structure, including the dwelling foundation, in which the residence premises is located; and
As discussed further below, the City of Leesburg official designated the entirety of this building as an “Unsafe Building” and ordered the residents to evacuate and not occupy. The building was designated as an “Unsafe Building” because of the extensive structural damage to the structural and foundation. The photograph provided to Castle Key clearly demonstrate massive structural damage on the inside and outside of the building. Notably, the exterior has a massive structural crack (1/4”) at the porch-line and that crack extends all the way to the ground. Additionally, some photographs provided to Castle Key from the adjacent unit, demonstrate the rampant structural damage throughout the entirety of this building.
Finally, the floor elevation survey clearly demonstrates “structural damage” as defined by Florida Statues § 627.706. Specifically, the interior floor displacement is in excess of acceptable variances as defined by ACI 117-90. This section provides that the acceptable level alignment threshold for residential slab construction is ± ¾ of an inch, or 1.5 inches, in total differential as noted in ACI 117-90 Section 4.3.1.1 and the general requirements provided in Section 1.2.4. The maximum allowable relative alignment tolerance is ½ inch over ten feet as noted in ACI 117-90 Section 4.5.7. As demonstrated in Unit 1 and Unit 2, there are multiple areas that exceed ½ inch over a ten foot span and the overall foundation exceeds ± ¾ of an inch over the entirety of the slab. This is demonstrable in the SDII floor elevation survey taken on 07/26/2024, previously provided to Castle Key. Based upon the floor elevation survey, “structural damage” is present. Therefore, between the photographic evidence, the floor elevation data, and the “Unsafe Building” notice (discussed below), this building clearly has structural damage.
d) Building structure being condemned and ordered to be vacated by the governmental agency authorized by law to issue such an order for that building structure.
This prong is clearly satisfied by the City of Leesburg’s “Unsafe Building” and evacuation order. The term “condemned” is defined as “officially declared unfit for use.” By virtue of the City of Leesburg notice taped to the front entrance door of this building, it has been officially declared unfit for occupancy and use and demonstrates any persons who violates the notice is subject to a $500/day fine and imprisonment. Undoubtedly, this building has been condemned.
Based upon the foregoing, the property constitutes a total loss (actual or constructive), and Castle Key was required to tender full policy limits pursuant to Florida Statutes § 627.702. Here, it has failed to do so, which violates Florida Statutes § 627.155(1)(b)(1) because Castle Key is not attempting in good faith to settle this claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward Mr. and Mrs. Valle and with due regard for their interests. Instead, Castle Key is doubling down on its unwritten coverage determination, failing to permit a supervisor to speak on the claim where the claims examiner Mr. Lancaster is refusing to cooperate, is refusing to put anything in writing about the coverage determination, and is being downright obstructive. The actions by Mr. Lancaster and the coverage position of Castle Key demonstrates that they are failing to promptly this settle claim, 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, which amounts to a violation of § 624.155(1)(b)(3). Similarly, by making the claim payment to Mr. and Mrs. Valle without providing a statement setting forth the coverage under which the payment is made, Castle Key and Mr. Lancaster are violating § 624.155(1)(b)(2).
It is believed that Castle Key and Mr. Lancaster regularly refuse to provide written claim communications, estimates, statements of loss, or any other written documentation on Castle Key’s coverage position when requested and regularly refuse to provide contact information for supervisors as a business practice. In doing so, Castle Key and its adjusters are intentionally operating in the shadows by leaving its insureds (and their representatives) speculating on what the coverage determination is. In doing so, it is clear that Castle Key has failed to adopt or implement standards for the proper investigation of claims in violation of § 626.9541(1)(i)(3)(a). Additionally, by failing to promptly provide a reasonable explanation in writing to Mr. and Mrs. Valle of the basis in the insurance policy for the denial of the claim (as it relates to the building damages), Castle Key and Mr. Lancaster have also violated § 626.9541(1)(i)(3)(f)
Finally, because Mr. and Mrs. Valle have demonstrably shown that their loss constitutes “catastrophic ground cover collapse” and Castle Key has failed to tender policy limits pursuant to § 627.702 within 60 days of the loss in violation of the policy’s Florida Condominium Amendatory Endorsement – AP4992-1, which states:
B. Under item 5, How We Pay For A Loss, the first paragraph is replaced by the following:
Within 60 days after we receive notice of an initial, reopened, or supplemental claim under Building Property Protection–Coverage A or Personal Property Protection–Coverage C from you, we shall pay or deny such claim or a portion of the claim unless the failure to pay such claim or a portion of the claim is caused by factors beyond our control. Claims will be paid within 20 days of written agreement between you and us, except as provided in subparagraph b)1) below regarding the payment of amounts for underpinning or grouting. Under Building Property Protection–Coverage A and Personal Property Protection–Coverage C, payment for covered loss will be by one or more of the following methods…
In addition to the policy language referenced in this civil remedy notice, Florida insurance statutes are incorporated into Florida insurance policies. As such, the statutory violations noted herein also constitute specific insurance provisions violated.
This notice is provided to perfect a right to pursue the civil remedy authorized by Florida Statute §624.155. Therefore, to cure the defects outlined in this Civil Remedy Notice, Castle Key must: (1) provide a copy of all written claim communication and estimates prepared in this claim; (2) provide the contact information for a supervisor who can address the issues raised by Mr. and Mrs. Valle’s counsel in his written communications; (2) pay Mr. and Mrs. Valle the Coverage A limits, plus statutory interest pursuant to Florida Statute § 627.70131 from the date the loss was reported until payment is ultimately delivered to Mr. and Mrs. Valle’s attorney; and (3) require Mr. Lancaster and his supervisor to issue a written apology, on Castle Key letterhead, to Mr. and Mrs. Valle for refusing to cooperate with providing written information on their claim.
A copy of this letter and filed form submitted to the DFS has been printed out and mailed. Please do not hesitate to contact the undersigned if you have any questions or concerns.
Sincerely,
/s/ Jeff Groover
Jeffrey D. Groover, Esq.
For the Firm
Cc: Joshua and Vanessa Valle
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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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