Filing Number: 804331
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| Filing Accepted: 1/30/2025 |
| Last/Business Name
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PFENT
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First Name |
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DAVID & ELIZABETH |
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| Street Address
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5992 CYPRESS LANE |
| City, State Zip
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BONITA SPRINGS,
FL
34134
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| Email Address
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RS@WEKLAW.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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PFENT |
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First Name |
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DAVID & ELIZABETH |
| Policy # * |
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FPH4198154-03 |
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Claim #* |
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FPI230989 |
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Attorney is Applicable
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| Last Name* |
SUGATHAPALA
First Name *
RUWAN
Initial
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| Street Address* |
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800 EAST BROWARD BLVD., SUITE 500 |
| 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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RS@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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FLORIDA PENINSULA 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 10132 |
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| Name of individual responsible for violation (if any):*
JAMES NELSON, JIMMY MISSOURI, STEVEN BROWN, RANELL GREEN
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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 Delay
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Claim Denial
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Unsatisfactory Settlement Offer
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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)(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.
SECTION I – PERILS INSURED AGAINST
COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES
1. We insure for sudden and accidental direct loss to property described in Coverages A and B only if that loss is
a physical loss to covered property.
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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.
David Pfent and Elizabeth Pfent (hereinafter collectively referred to as the "Insured") purchased an insurance policy ("Policy") from Florida Peninsula Insurance Company ("Florida Peninsula"), with effective coverage on the date of the loss, on or about September 28, 2022, and policy number FPH4198154-03 to insure their home located at 5992 Cypress Lane, Bonita Springs, FL 34134 (the "Property").
The Insured hereby submit this civil remedy notice of insurer violation because the testimony of the adjusters involved with Claim # FPI230989 along with the documents and reports stemming from Florida Peninsula’s claim adjustment, confirm that Florida Peninsula knew and currently knows it has an obligation to extend coverage for covered damage unilaterally identified by Florida Peninsula and its agents/inspectors, but has yet to render a supplemental or additional coverage position or issue any payment.
On or about September 28, 2022, the aforementioned Property was damaged as a result of Hurricane Ian’s dangerous winds (the “Loss”). As a result of this event, the Property sustained immediate direct damage throughout its roofing system, to its elevations, including damage to related components and structures. Interior leaks also developed arising from the Loss. The Property additionally sustained damage resulting from debris impact to the exterior, hurricane shutters, and electrical damage.
Florida Peninsula’s claim adjustment included 2 inspections of the property. The first, performed on October 14, 2022 was done by field adjuster James Nelson who received the assignment through a Florida Peninsula third party administrator, Ryze. Upon information, belief, and testimony, Mr. Nelson failed his ethical obligations as an adjuster entrusted with the responsibilities of an insurance adjuster, because he viewed the claim from the outset as a flood loss. Further, Mr. Nelson does not possess the skill or training to evaluate the damage involved in this claim and even admitted to identifying storm damage in nearby areas of the Property following the catastrophic effects of Hurricane Ian.
Florida Peninsula issued a woefully undervalued claim adjustment for the damage via coverage determination correspondence dated on or about November 17, 2022. The estimate in support of this coverage determination erroneously included incorrect data, deductible information, and otherwise lacked the required information to reflect the correct adjustment of the claim, let alone failed to fully indemnify the Insured for their losses.
The Insured, disillusioned by its insurance company determination, retained a public adjuster to assist in advocating for a fair resolution and submission of the loss. Not until July 2023, several months after the claim was initially made, did Florida Peninsula perform a second inspection and reconsideration of the damage which was performed by Steven Brown. Much like the first adjuster, Mr. Brown failed to cover the full extent of damages claimed and then turned over his tasks to a desk adjuster named Ranell Green who, never having been on site, prepared an estimate for additional, missed damage, but was still woefully under-scoped, priced, or outright missed damage resulting from Hurricane Ian.
Florida Peninsula’s conduct, including the prolonged/delayed full adjustment of the Insured’s claim forced litigation as to coverage and damage.
The above conduct demonstrates that Florida Peninsula’s claim investigation and adjustment constitute bad-faith conduct and violations of 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 Insured and with due regard for their interest;
· 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) A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy; or
· 626.9541(1)(i)(3)(b) Failing to adopt and implement standards for the proper investigation of claims;
· 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims, by failing to respond to the Insured’ public adjuster, and Insured’ counsel with respect to supplemental requests for payments;
· 626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
· 626.9541(1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the Insured and/or their public adjuster of the basis in the insurance policy, in relation to the facts or applicable law, for the offer of a compromise settlement;
The above facts demonstrate that Florida Peninsula knew and currently knows it has a duty to extend additional coverage explanations and benefits but refuses to do so, failed to provide a statement or explanation of such additional coverage owed, has attempted to present a settlement offer instead of issue an undisputed payment as a means to influence settlement of the claim overall, delayed the claim investigation to the detriment of the Insured, and otherwise failed to meet its obligations of good-faith toward the Insured, who has dutifully paid premiums for their coverage and restoring their home and lives as victims of Hurricane Ian.
To date, Florida Peninsula has failed to accept and fully perform its obligations under the operable insurance contract. The Property remains in an unsafe condition because they have not been paid the necessary, covered insurance proceeds sufficient to return the Property to its pre-loss condition. As a direct result of Florida Peninsula’s initial insufficient investigation and handling of the claim, deficient extension of coverage and subsequent breaches of not only the policy of insurance, but also Florida Statutes, the Insured had no choice other than to seek the help of licensed professionals to assist them, including, but not limited to a public adjuster and legal counsel. Considering the aforementioned conduct, it is irrefutable that Florida Peninsula knowingly and intentionally, and in bad faith delays the claims process in order to further disadvantage the Insured. The financial detriment caused to the Insured is a direct result of Florida Peninsula’s dismissive, reckless treatment of the claims process. The Insured submitted all available requested documents in his custody and control in a timely fashion, repeatedly made the Property available for inspection and submitted additional documentation in support of the insurance proceeds sought under his insurance contract, including detailed reports and data.
To deny the Insured the remaining benefits clearly due and owing under the Policy, for which he has time and time again been making premium payments for and after he has satisfied all his obligations is morally and ethically reprehensible, and implicates the Unfair Claims Practice and Bad Faith. Upon information and belief, the above identified actions taken by Florida Peninsula, among others, were made so often as to constitute a general business practice, evidencing a motive to enhance Florida Peninsula’s profits, and designed to cause a detrimental effect to its policyholders. Such motive seems readily apparent to the participants of Florida Peninsula’s claim investigation concerning the initial field adjuster’s biased evaluation.
This notice is given to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should Florida Peninsula 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, Florida Peninsula must: (1) Immediately tender all proceeds due and owing to the Insured that are fairly owed to the Insured under the insurance policy that would reasonably compensate the Insured in order to put the loss property back to its pre-loss condition in the sum of at least $200,000; (2) Concede that the Policy affords coverage for all losses reported by the Insured; (3) Agree to reimburse the Insured's reasonable attorneys’ fees and costs for having to become involved to resolve the claim; (4) Agree to reimburse the Insured for interest on the amount of benefits that was found to be due and owing to the Insured, 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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