Filing Number: 804515
|
| Filing Accepted: 1/31/2025 |
| Last/Business Name
*
|
|
|
| Street Address
*
|
|
857 WOOD SORREL LANE |
| City, State Zip
*
|
|
VENICE,
FL
34293
|
| Email Address
*
|
|
HDC1993@VERIZON.NET |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
DAVIS |
|
First Name |
|
HARVEY |
| Policy # * |
|
FFH3-000037010 |
|
Claim #* |
|
01000069153 |
|
Attorney is Applicable
|
| Last Name* |
KRAPF
First Name *
GRANT
Initial
W
|
| Street Address* |
|
2790 SUNSET POINT RD |
| City, State Zip* |
|
CLEARWATER
,
FL
33759
|
| Email Address * |
|
GRANT@KRAPFLEGAL.COM |
|
|
| Insurer Type
*
|
|
Authorized Insurer
Unauthorized Insurer
|
|
|
| Insurer Name |
|
|
| Insurer Name* |
|
FRONTLINE INSURANCE UNLIMITED COMPANY
|
| Insurer Name* |
|
|
| Street Address* |
|
|
| City, State Zip* |
|
,
|
|
NAIC Company Code 10074 |
|
|
| Name of individual responsible for violation (if any):*
DEVIN MAPP, BRIAN MORRIS, NINA LAFOND, MSICHANA THOMPSON, DONALD PHILLIPS, P.E., AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, FIRST PROTECTIVE INSURANCE COMPANY D/B/A FRONTLINE INSURANCE WHO WAS INVOLVED IN THE CLAIM.
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
Claim Delay
|
|
Unfair Trade Practice
|
|
Other
:
Not treating the Insured with good faith claims conduct.
|
|
Other
:
Looking for ways to delay and deny full recovery to the Insured.
|
|
Other
:
Not training, supervising, or managing adjusters properly so that prompt and full payments are made
|
|
|
*
Statutory provision(s) which the insurer allegedly violated.
|
|
|
| 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 her or his interests.
|
| 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)(2) |
|
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.
|
| 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.
|
|
*
Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
627.70131 - upon the Insurer receiving a communication with respect to a claim, the Insurer shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgement. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer's claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer. As used in this subsection, "agent" means any person to whom an insurer has granted authority or responsibility to receive or make such communications with respect to claims on behalf of the insurer. This subsection shall not apply to Claimants represented by counsel beyond those communications necessary to provide forms and instructions.
627.70131 failing to make any payment of an initial or supplemental claim or portion of such claim within 90 days after the Insurer receives notice of the claim, or made more than 15 days after there are no longer factors beyond the control of the insurer which reasonably prevented such payment, whichever is later, bears interest.
Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language.
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
First Protective Insurance Company d/b/a Frontline Insurance and their agents (the "Insurer") has committed the following in handling the Insured's claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the Insured; 3) not adjusting the claims promptly and fairly; 4) shifting the burden of investigating the loss onto the Insured; 5) conducting inadequate investigations; 6) making material misrepresentations of the coverages afforded under the insurance policy; 7) failing to respond to communications made to the Insurer or their agent within 14 days; and 8) failing to pay interest on a payment made over 90 days after the Insurer received notice of the claim.
The Insured timely submitted a claim to the Insurer for hurricane damage sustained to the above-referenced Insured property that occurred on or about September 28, 2022, including any ensuing damage therefrom. Due to the scope and nature of the damage, the Insured retained a public adjuster who, in an estimate dated October 24, 2022, revealed covered damages of $212,040.21 to the dwelling and $12,000 to the screen enclosure. The Insurer initially responded with a coverage letter, dated December 22, 2022, wrongfully stating that the gross loss was $33,431.09 from which the Insurer withheld $7,424.64 as "recoverable depreciation" and issued three checks totaling $16,400.55. A supplemental coverage letter arrived, dated April 23, 2023, after a second inspection, showing a gross loss of $47,395.79 and a payment of $8,821.64. Another inspection occurred on May 1, 2023, for which the coverage determination letter asserted the gross loss was now $56,454.60 and a payment of $3,965.22 was issued based on that letter. This amounts to over six months of delay by the Insurer which is well documented and includes repeated re-assignments of this claim to different desk adjusters with the Insurer including Brian Morris, Msichana Thompson and Devin Mapp. While the Insurer's totals kept increasing, however, they are still not nearly enough to make their Insured whole in this case and indeed are not even complete for example, the Insured's agents communicated to the Insurer regarding the covered expenses to tarp the damage on November 13, 2022 and March 2, 2023 and these expenses were simply ignored in the Insurer's totals.
Further, the Insurer failed to respond within 14 days to Claimant, and his agents' requests. Upon an Insurer's receiving a communication with respect to a claim, the Insurer is required, within fourteen (14) calendar days, to review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevents such acknowledgement. There has been no response within the fourteen (14) calendar days of receipt of the Insureds' communication and the Insurer has not alleged any factors beyond their control that would make such communication impossible. Insurers have a duty to settle claims in good faith 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 her interests. The Insurer has failed or refused to promptly acknowledge the Claimants' communications in an attempt to frustrate and delay the resolution of Claimants' claim.
The Insurer upon the Insured's loss had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return their home to its pre-loss condition. Despite the obvious covered damage under this policy, the Insurer here placed its financial interest over the health and safety of the Insured.
The investigations by the Insurer's field adjuster were inadequate. As a result of the inadequate investigation and surrounding circumstances, it is apparent that the Insurer significantly repeatedly underestimated the scope of the loss to the Insured's property. The Insurer's estimate of the Insured property's loss simply would not restore the property to its pre-loss condition which is Insurer's duty under its own contract of insurance. The Insurer and its adjuster have colluded to misrepresent the true scope of damages to the Insured property and the true replacement cost of the damages. This is an underhanded attempt to place the financial interest of the Insurer over those of the Insured, to delay the Insured's claim, and to delay the Insured's ability to restore the property to its pre-loss condition.
The Insurer's total estimate of the insured property's loss resembles that of a classic "low-ball" offer and would not restore the property to its pre-loss condition which is Insurer's duty under the contract of insurance issued by it. Insurer and its adjuster have colluded to misrepresent the true scope of damages to the insured property and the true replacement costs of the damages. This is an underhanded attempt to place the financial interest of the Insurer over those of the Insured, to delay the Insured's claim, and to delay the Insured in restoring the property to its pre-loss condition.
Moreover, Insurer shifted the burden and cost of investigating and insuring the loss onto the Insured. The Insurer upon the Insured's loss had the duty to provide the full benefits under the policy. This includes providing the Insured with the proper investigation and the funds necessary to return their home to its pre-loss condition. The Insurer is placing its financial interest over the health and safety of the Insured.
Although there was interior moisture damage, the adjuster did not use a moisture meter or inspect for mold. A moisture meter can be purchased online from Amazon for around $44 before tax. The Insurer could purchase a moisture meter and assess thousands of properties with one meter. The Insurer's adjuster should have a full tool belt to thoroughly investigate claims. Instead, the Insurer's adjuster has no need for a tool belt because they don't have the necessary tools to fill it. It is clear the Insurer would rather place its financial interests over those of the Insured by failing to provide the adjuster with the necessary tools to correctly inspect the loss. As a result of the inadequate investigation and surrounding circumstances, it is apparent that the Insurer significantly underestimated the scope of the loss to the Insureds property.
Moreover, the Insurer unreasonably inflated the amount of recoverable depreciation in this case, thereby artificially lowering the Claimant's recoverable value, to the detriment of the Claimant. The Insurer withheld an exorbitant amount of the net claim determined by the Insurer as recoverable depreciation. The Insurer has attempted to gain an unreasonable financial benefit by inflating the recoverable depreciation because it knows that it is unlikely, or at least less likely, that the Claimant can actually complete the repairs which is a condition precedent to the recovery of the depreciation withheld under the claim. In other words, the Insurer pays an unreasonable amount less on the front end of a claim, which makes it more difficult for the Claimant to restore the property to its pre-loss condition and recover the withheld depreciation from the Insurer. Only after Insured pays to restore the property out of pocket, if he can, will the Insurer fully pay its Insured under the policy. Withholding an inflated amount of depreciation is a creative, sneaky, and deceptive practice that is employed as to limit the amount the Insurer will ever have to pay out on a claim and essentially make the homeowner a self-insured. The Insurer is hoping that the Claimant is unaware of her right to recover the recoverable depreciation so that it can pay Claimant less than it is obligated. The Insurer is shifting the cost and the burden of investigating the loss onto the Claimant. The Insurer has the duty to inspect the loss and provide the Claimant with the full benefits under the policy. The Insurer has breached that duty by not providing the Claimant with the full value of the loss and caused the Claimant to take on the burden of investigating the loss.
In addition, the Insurer further delayed and frustrated Claimant's ability to have this supplemental claim adjusted promptly to begin restoring the home by waiting more than ninety (90) days after receiving notice of the Insured's claim to issue a payment. Pursuant to Florida Statute 627.70131, "any payment of an initial or supplemental claim or portion of such claim made 90 days after the Insurer receives notice of the claim, or made more than 15 days after there are no longer factors beyond the control of the insurer which reasonably prevented such payment, whichever is later, bears interest." The Insurer has failed to pay any interest on this claim. The purpose of this section of the Florida Statutes was to set a time limit in which to resolve policyholder's claims. Upon information and belief, the Insurer has failed to do this. Because the Insurer has delayed the Claimant's resolution of the above-referenced claim, it is obligated to pay the interest on the claim, in addition to the money it owes the Claimant to restore the property to its pre-loss condition.
In short, Insurer is not acting with due regard for the Insured's interests or safety. In Florida the work of adjusting insurance claims engages the public trust. Insurers have a duty to treat all Insured equally and the Insurer has breached this duty. The Insurer has conducted poor and inadequate investigations and has significantly underestimated the replacement costs of Insured's property to further frustrate and delay the Insured's claim. The Insurer is placing their financial interests over those of the Insured and the Insured's safety. The foregoing has only delayed the Insured's ability to begin restoring their home to its pre-loss condition.
The Insurer's actions amount to but are not limited to the following:
1. Not treating the policyholder with good faith claims conduct.
2. Looking for ways to reduce recovery to the Insured.
3. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured.
4. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the policyholder's interests.
5. Placing the financial interest of the Insurer over that of the Insured.
6. Shifting the burden of investigating the loss onto the Insured.
7. Conducting inadequate investigations.
8. Making material misrepresentations of the coverages afforded under the insurance policy.
Therefore, to cure the defects outlined in this Civil Remedy Notice, the Insurer must:
(1) Admit full coverage for the Insured's loss.
(2) Tender full benefits owed to the Insured under the insurance contract.
A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com.
Via Electronic Mail:
First Protective Insurance Company
d/b/a Frontline Insurance
P.O. Box 958405
Lake Mary, FL 32795-8405
info@flhi.com
|
|
*
|
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.
|
DFS-10-363
Rev. 10/14/2008
|