Filing Number: 804867
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| Filing Accepted: 2/3/2025 |
| Last/Business Name
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GREEN TEE VILLAGE CONDOMINIUM ASSOCIATION, INC.
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First Name |
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| Street Address
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1830 MARAVILLA AVE. |
| City, State Zip
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FORT MYERS,
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33901
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| Email Address
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GREENTEECONDO@GMAIL.COM |
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Insured |
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| Last/Business Name* |
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GREEN TEE VILLAGE CONDOMINIUM ASSOCIATION, INC. |
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First Name |
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| Policy # * |
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WKFCC-04395-00 |
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Claim #* |
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QCC22248430 |
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Attorney is Applicable
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| Last Name* |
LOPEZ
First Name *
GUILLERMO
Initial
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| Street Address* |
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350 N LAKE DESTINY RD |
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MAITLAND
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FLORIDA
32751
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| Email Address * |
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GLOPEZ@ITSABOUTJUSTICE.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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OLD REPUBLIC UNION 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 31143 |
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| Name of individual responsible for violation (if any):*
CLAIMS DEPARTMENT
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| Type of Insurance
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Commercial 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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Unsatisfactory Settlement Offer
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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)(2) |
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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.
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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)(4) |
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Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
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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.
A. Coverage
We will pay for direct physical loss of or damage to Covered Property at the premises described in the
Declarations caused by or resulting from any Covered Cause of Loss.
D. The Loss Payment Condition dealing with the number of days within which we must pay for the coveredloss or damage is replaced by the following:
Provided you have complied with all the terms of this Coverage Part, we will pay for covered loss or
damage upon the earliest of the following:
(1) Within 20 days after we receive the sworn proof of loss and reach written agreement with you;
(2) Within 30 days after we receive the sworn proof of loss and:
a. There is an entry of a final judgment; or
b. There is a filing of an appraisal award with us; or
(3) Within 90 days of receiving notice of an initial, reopened or supplemental claim, unless we deny the
claim during that time or factors beyond our control reasonably prevent such payment. If a portion of the
claim is denied, then the 90-day time period for payment of claim relates to the portion of the claim that is
not denied.
Hurricane Damage is a Covered Cause of Loss in this policy. The property was damaged by Hurricane Ian,and the insurers have already admitted coverage. The insurers have refused to tender the undisputed actual cash value benefits within the time prescribed by the applicable policy provision as stated above
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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.
Complainant: Green Tee Village Condominium Association
Insurers: Aspen Specialty Insurance Company, Lexington Insurance Company, Old Republic Union Insurance, and Scottsdale Insurance Company (“Insurers”)
Policy Number: WKFCC-04395-00
Claim Number: QCC22248430
Date of Loss: September 28, 2022
Property Address: 1830 Maravilla Ave., Fort Myers, Florida 33901
Statement of Facts and Legal Basis for the Complaint
On or about September 28, 2022, the Insured, Green Tee Village Condominium Association, sustained substantial damage to its commercial property as a result of Hurricane Ian. At the time of the loss, the Insurers had issued an insurance policy (Policy No. WKFCC-04395-00) that provided coverage for hurricane-related damages. The policy was in full force and effect, and the Insured had a reasonable expectation of coverage for the damages sustained.
The Insured promptly notified the Insurers of the loss and fully complied with all post-loss obligations under the policy, including but not limited to:
Providing timely notice of the claim;
Allowing property inspections;
Submitting a comprehensive public adjuster’s estimate detailing the full scope of necessary repairs;
Providing extensive photographic evidence clearly documenting the extent of hurricane-related damages; and
Submitting a sworn proof of loss, in accordance with the policy requirements.
Despite receiving these materials, the Insurers failed to meaningfully consider, acknowledge, or properly evaluate the public adjuster’s estimate, photographic evidence, and sworn proof of loss. Instead, the Insurers conducted an inadequate and biased investigation, culminating in a severely underpaid claim that does not reflect the actual damage sustained.
Bad Faith Conduct by the Insurers
The Insurers’ handling of this claim demonstrates a clear pattern of bad faith in violation of Florida Statutes §§ 624.155 and 626.9541. Specifically:
Failure to Conduct an Adequate Investigation: The Insurers disregarded critical evidence provided by the Insured’s public adjuster and contractors. Rather than considering all available documentation, the Insurers relied on incomplete, inaccurate, and self-serving assessments that minimized the true extent of the damage. This conduct violates Fla. Stat. § 626.9541(1)(i)(3)(d), which prohibits insurers from denying claims without conducting reasonable investigations.
Ignoring the Public Adjuster’s Estimate and Supporting Documentation: The Insured, through its public adjuster, submitted a detailed estimate reflecting the true cost of repairs. This estimate was supported by photographic evidence and industry-standard pricing. However, the Insurers failed to acknowledge or respond to the public adjuster’s assessment in good faith. Instead, the Insurers unreasonably disregarded this essential evidence, violating Fla. Stat. § 626.9541(1)(i)(3)(c), which requires insurers to act promptly and fairly upon communications regarding claims.
Failure to Address the Sworn Proof of Loss: The Insured submitted a sworn proof of loss in accordance with the policy's requirements. The Insurers failed to either properly contest or accept the sworn proof of loss in a timely manner, effectively ignoring it to the detriment of the Insured. This conduct constitutes a violation of Fla. Stat. § 626.9541(1)(i)(3)(e), which prohibits an insurer from failing to affirm or deny full or partial coverage within a reasonable time after proof of loss statements have been completed.
Misrepresentation of Policy Terms and Coverage Determinations: The Insurers misrepresented the cause, scope, and value of the damages in an effort to justify a reduced payment. Rather than honoring their contractual obligations, the Insurers selectively interpreted the policy to exclude or limit covered damages, all while ignoring conclusive evidence provided by the Insured. This conduct is in direct violation of Fla. Stat. § 626.9541(1)(i)(2), which prohibits an insurer from making material misrepresentations to avoid coverage.
Willful Disregard of Favorable Evidence and Industry Standards: The Insurers have engaged in a pattern of disregarding evidence that contradicts their self-serving conclusions. By failing to give proper weight to the public adjuster’s estimate, photographic evidence, and sworn proof of loss, the Insurers have demonstrated an intentional effort to underpay the claim rather than to engage in an honest and fair evaluation.
General Business Practice of Unfair Claims Handling: The Insurers' actions in this claim are not isolated but rather part of a broader pattern of bad faith conduct designed to delay, underpay, and deny valid claims. The Insurers have established a practice of:
Hiring biased consultants who routinely understate damages,
Disregarding independent evaluations provided by insureds,
Misapplying policy exclusions to limit payments unfairly, and
Deliberately withholding payments owed under the policy.
Cure Provision
To remedy these violations and act in good faith, the Insurers must:
Immediately tender payment in the amount of $1,797,614.08, made payable to Cohen Law Group Trust Account, to properly indemnify the Insured in accordance with the policy and Florida law.
Provide a detailed written explanation of how the Insurers reached their valuation, including the specific basis for disregarding the public adjuster’s estimate, photographic evidence, and sworn proof of loss.
Acknowledge in writing that the Insurers will implement proper claims-handling procedures to ensure that similar bad faith conduct does not occur in future claims.
The Insurers must provide written confirmation of compliance and payment to the Insured’s counsel, Guillermo Lopez, Esq., at the following address:
Cohen Law Group
350 N. Lake Destiny Road
Maitland, Florida 32751
Failure to cure these violations within 60 days of this notice may result in additional legal action, including a bad faith lawsuit under Fla. Stat. § 624.155, seeking damages beyond the policy limits, including attorney’s fees, costs, and statutory interest.
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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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