Filing Number: 804620
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| Filing Accepted: 1/31/2025 |
| Last/Business Name
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ELITE EMS RESTORATION (A/A/O ENSENADA CONDOMINIUM ASSOCIATION)
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First Name |
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| Street Address
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3401 NORTH COUNTRY CLUB DRIVE |
| City, State Zip
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AVENTURA,
FL
33180
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| Email Address
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CLAIMS@ELITEEMSRESTORATIONS.COM |
| Complainant Type:
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Third Party |
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| Last/Business Name* |
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ELITE EMS RESTORATION (A/A/O ENSENADA CONDOMINIUM ASSOCIATION) |
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First Name |
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| Policy # * |
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UB211264A1089 |
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Claim #* |
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116409 |
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Attorney is Applicable
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| Last Name* |
RAMPERSAD
First Name *
KRISTIN
Initial
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| Street Address* |
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925 S. FEDERAL HWY. |
| City, State Zip* |
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BOCA RATON
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FLORIDA
33432
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| Email Address * |
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KRAMPERSAD@KPATTORNEY.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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UNDERWRITERS AT LLOYD'S, LONDON
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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 |
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| Name of individual responsible for violation (if any):*
KIKKI L. BARNES
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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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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)(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)(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.
Loss settlement provision
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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.
The carrier was put on notice of the claimant’s water damage claim. Subsequently, the claimant prepared a loss package in the amount of $ 167,938.18 needed to restore the property back to its pre-loss condition. Whereas, the carrier has failed to appropriately investigate the insured’s loss in a timely manner, document the damage in good faith, come to a fair coverage determination and promptly pay the claim. In turn, the claimant has complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insured. About nine hundred ten days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of the damage sustained by the insured’s property and has not taken any meaningful ensuing action.
It is clear that the carrier is not treating the claimant with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to
provide full and prompt indemnity to the claimant; failing to implement proper standards for the adjustment and investigation of claims and placing the company’s interests before the claimant’s interests; not training, supervising or managing adjusters properly so that prompt and full payments are made; refusing to pay the full amount owed to the claimant despite the fact that the damages are covered under the policy; looking for ways to delay full recovery or any recovery to the claimant; and refusing to provide coverage for the claimant’s loss in a timely manner.
The carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $167,938.18, less any prior payments and less any applicable policy deductible; and 2.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier.
Please do not hesitate to contact the undersigned or Sandy Singh at 561-892-9666 if you have any questions or concerns.
Sincerely,
Kristin Rampersad
Attorney at Law
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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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