Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 805080

Filing Accepted: 2/4/2025

Print Filing

Complainant

Last/Business Name *

SHIRLEY & HUTSON

First Name

DELIUS AND CYNTHIA

Street Address *

12200 SW 70TH COURT

City, State Zip *

PINCREST, FL 33156

Email Address *

DELIUSSHIRLEY@GMAIL.COM

Complainant Type: *

Insured

Last/Business Name*		SHIRLEY & HUTSON		First Name		DELIUS AND CYNTHIA
Policy # *		BWH140698		Claim #*		23C6416

Attorney

Attorney is Applicable

Last Name*	TRUPPMAN First Name * KEITH Initial A
Street Address*		1700 SANS SOUCI BLVD.
City, State Zip*		NO MIAMI , FLORIDA 33181
Email Address *		KTRUPPMAN@MINTZTRUPPMAN.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		EVANSTON INSURANCE COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 35378

Name of individual responsible for violation (if any):* KIMBERLY STOKES / JAKE O'LESKE / GLEN ALLEN - MARKEL CLAIMS JEFF GREGORY DOI CLAIMS
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Denial
	Claim Delay
	Unfair Trade Practice
	Unsatisfactory Settlement Offer

* 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.
	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.
	626.9541(1)(i)(3)(c)		Failing to acknowledge and act promptly upon communications with respect to claims.
	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 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.
	626.9541(1)(i)(3)(g)		Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
	626.9541(1)(i)(3)(h)		Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
	626.9541(1)(i)(3)(i)		Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

POLICY PROVISIONS SECTION I - PERILS INSURED AGAINST A Coverage A- Dwelling and Coverage B - Other Structures 1. We insure against direct physical loss to property described in Coverages A and B. 3. Trees, Shrubs and Other Plants We cover trees, shrubs, plants or lawns, on the "residence premises", for loss caused by the following Perils Insured Against: a. Fire or Lightning. We will pay up to 5% of the limit of liability that applies to the dwelling or $25,000 whichever is less, for all trees, shrubs, plants or lawns. No more than $500 of this limit will be paid for any one tree, shrub or plant. We do not cover property grown for "business" purposes. This coverage is additional insurance. E. Additional Coverages 1. Debris Removal a. We will pay your reasonable expense for the removal of: (1) Debris of covered property if a Peril Insured Against that applies to the damaged property causes the loss; or This expense is included in the limit of liability that applies to the damaged property. If the amount to be paid for the actual damage to the property plus the debris removal expense is more than the limit of liability for the damaged property, an additional 5% of that limit is available for such expense. 11. Ordinance Or Law a. You may use up to 10% of the limit of liability that applies to Coverage A for the increased costs you incur due to the enforcement of any ordinance or law which requires or regulates: (1) The construction, demolition, remodeling, renovation or repair of that part of a covered building or other structure damaged by a Peril Insured Against. (2) The demolition and reconstruction of the undamaged part of a covered building or other structure, when that building or other structure must be totally demolished because of damage by a Peril Insured Against to another part of that covered building or other structure or (3) The remodeling, removal or replacement of the portion of the undamaged part of a covered building or other structure necessary to complete the remodeling, repair or replacement of that part of the covered building or other structure damaged by a Peril Insured Against. b. You may use all or part of this ordinance or law coverage to pay for the increased costs you incur to remove debris resulting from the construction, demolition, remodeling, renovation, repair or replacement of property as stated in a. above. TOTAL LOSS ENDORSEMENT In consideration of the premium charged, it is hereby understood and agreed that in the event of a total loss under Coverage A - Dwelling, with corresponding payment under this policy, the full annual premium shall be deemed earned with no return due or payable to the insured.

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

FACTS On July 7, 2023, Delius Shirley and Cynthia Hudson (hereinafter “Insureds”), suffered a total loss of their home located at 12200 SW 70th Court, Pinecrest, FL 33156 due to an accidental fire. The fire was so severe that the fire fighters reported encountering very high heat conditions upon entering the structure and they attempted fire suppression with no progress. When the fire was noted venting through the roof and rolling over the fire crews heads on the rear patio and after several explosions were heard in the garage, the fire fighters abandoned the structure to change to a defensive strategy. The Insureds home with all its personal property was devastated by this fire and they were rendered homeless. Yet Evanston Insurance Company (hereinafter “Insurance Company”) rather than acting in good faith and helping their Insureds at their time of need they violated FS 624.155 & 626.9541 relative to all aspects of their handling of the subject claim. The Insureds promptly reported the fire loss and fully cooperated with Evanston Insurance Company. The Insureds relied upon the Insurance Company’s adjusters to act in good faith relative to all aspects of adjusting and paying the subject claim. The Insurance Company assigned claim number 23C6416 relative to the subject loss and acknowledged full coverage for the fire pursuant to the insurance policy BWH140698 with effective dates of coverage 4/26/23 -4/26/24). The Insurance Company assigned Markel Service, Inc to act as the claim manager on behalf of Evanston Insurance Company and to properly adjust the subject claim on the Insurance Company’s behalf in accordance with the policy terms and Florida Statutes 624.155 & 626.9541. The Insurance Company acknowledged full coverage for the subject fire loss and tendered payment under Coverage A ($418, 633.93 - $ 8,937.60 (depreciation) = $409, 633.60) however made no payment for Other Structure coverage of $50,000 nor the additional coverages addressed herein. The Insurance company acknowledged this was a total loss as to Coverages C & D and paid the policy limits for both personal property ($200,000) and loss of use ($80,000). The structure has been red tagged by the Village of Pinecrest as an unsafe structure and is required to be demolished in order to raise the house to comply with both FEMA and the local municipalities ordinances .The Village of Pinecrest has required the insureds to demolish the remaining structure due to the sevity of the fire damage and 50% Substantial Damage FEMA rule .The Insurance Company knew or should have known that the Village of Pinecrest would require that the home be demolished and rebuilt at a higher elevation ( 50% rule ) in accordance with both FEMA requirements and their local ordinances. The new structure must comply with all required code upgrades relative to all structural; electrical; mechanical; plumbing; hvac ; roof etc . The Insurance company not only failed to tender the policy limits and all applicable additional coverages but “low balled” the Insureds and grossly under paid the claim and misrepresented the indemnity owed under the Evanston Insurance Company policy. The Insurance Company utilized one methodology to determine the value of the home for premium purposes (worksheet) $800,000 and then used a different methodology to adjust the claim. There is no dispute that this home must be demolished and rebuilt to comply with all present building code requirements (FEMA) as well as all additional requirements of the Village of Pinecrest Building Department. The Insurance Company was well aware that this home was in a “AE FLOOD ZONE” and as the cost of repairs was clearly more than 50% of the value of the home based on the Insurance Company’s own estimate and both FEMA and Village of Pinecrest building department would require the home to be demolished in order to elevate the structure and be rebuilt in compliance with all FEMA requirements as well as all building codes and local ordinances.Evanston Insurance Company failed to adopt and implement standards for the proper investigation of claims including this fire claim and intentionally misrepresented pertinent facts and insurance policy provisions relating to coverages at issue. The Insurance Company intentionally failed to advise their Insureds of the FEMA requirements as well as the requirements of the Village of Pinecrest building department relative to required repairs of the subject home due to the substantial fire damage. The Insurance Company also failed to advise their Insureds of the additional coverages available under the subject policy. Evanston Insurance Company failed to act in good faith in violation of FS 624.155 & 626.9541 relative to all aspects of their adjustment of this claim and failed to act with due regard to their Insureds interests. Additionally, the Insurance Company improperly applied depreciation relative to the subject fire loss. The property was clearly rendered a total constructive loss as the cost of repairs pursuant to the Insurance Company’s own “low ball” estimate exceeded the value of the home at the time of loss. The Insureds’ estimates as to the damages and cost of repairs obtained from numerous general contractors all exceeded the limited insurance coverage and greatly exceeded the value of the home at the time of the fire loss. The most recent estimate from the Insured’s licensed general contractor totals $1,238,824.39. The Insurance Company would clearly owe the balance of the policy limits and any additional coverages to wit: Ordinance or Law; Debris removal and Landscaping (plants shrubs & trees). The Insurance company’s own expert JS/HELD specifically stated that their estimate failed to address code upgrades which undisputedly would be required by the Village of Pinecrest building department to repair /replace the subject structure. The code upgrades required clearly would exceed the limited $80,000 in coverage. The Insurance Company also failed to make payment of the policy limits for Coverage B – Other Structures of $50,000; debris removal of $40,000; Trees, shrubs & other plants of $25,000. The Insurance Company owes their Insureds $585,336.40 relative to balance of the policy limits under Coverage A /B: ordinance or law and the additional coverages for debris removal and landscaping. The Insurance Company failed to attempt in good faith to settle the claim when, under all the circumstances, it could have and should have done so, had it acted fairly and honestly toward its insured and with due regard for the Insureds’ interests. The Insurance Company has failed to place their Insureds in their pre-loss condition. The Insurance Company knew or should have known that this home was in a “AE FLOOD ZONE” and as the cost of repairs was clearly more than 50% of the value of the home that both FEMA and Pinecrest building department would require the home to be elevated requiring the structure to be demolished and rebuilt in compliance with all building codes and local ordinances. The Insurance Company has failed to adopt and implement standards for the proper investigation of the subject claim and misrepresented pertinent facts and insurance policy provisions relating to coverages with regards to that issue. The Insurance company misrepresented the scope of required repairs as well as the costs to repair or replace the structure to comply with all FEMA guidelines; Florida Building Codes and requirements of the Village of Pinecrest building department. The Insurance Company intentionally made numerous misrepresentations and /or omissions placing the Insurance company’s interests before the policy holders’ interests. The Insurance Company intentionally failed to disclose the FEMA requirements to elevate the structure as well as the requirements of the Pinecrest building department relative to the rebuilding of the subject home and required code upgrades. The Insurance company failed to acknowledge and act promptly upon communications with respect to the claim and failed to promptly respond to their Insureds. The Insurance Company has denied coverage and/or failed to pay the full amount of the claim or portions of the claim without conducting reasonable investigations based upon available information when it was clear the home was rendered a total constructive loss due to the FEMA guidelines; Florida Building code and requirements of the Village of Pinecrest and failed to pay any of the additional coverages due and owing. The Insurance Company failed 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 portions of the claim or for the offer of a compromised settlement in an attempt to place their Insureds in their pre-loss condition. The Insurance Company failed to promptly notify the insured of any additional information necessary for the processing of a claim and/or failed to clearly explain the nature of the requested information and the reasons why such information is necessary in order to attempt to place their Insureds in their pre-loss condition. The Insurance Company’s wrongful conduct and omissions includes, but are not limited to: 1) improperly underpaying the claim 2) not conducting full, prompt and proper investigation 3) not treating the insureds with good faith claims conduct; 4) looking for ways to deny full recovery to the insureds ; 5) looking for ways to reduce recovery to the insured; 6) looking for ways to delay full recovery to the insured; 7) Not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and complete indemnity to the insureds ; 8) failing to implement proper standards for the adjustment and investigation of claims; and 9) not training, supervising or managing adjusters properly so that prompt and full resolution of the claim is made in accordance with Florida law and the policy provisions , but rather placing the Insurance company’s interests before the policy holders’ interests. All of the actions of the Evanston Insurance Company are of a general business practice and are willful, wanton and with reckless disregard for the rights of their Insureds. Evanston Insurance Company can rectify these violations by acting fairly and honestly towards their Insureds with due regard for their interests and making full payment of all amounts due and owing under the Policy ($585,336.40 ) relative to the damages sustained as a result of the subject fire loss and paying all costs unnecessarily incurred by the Insureds including prejudgment interest from the date of loss as a result of the Insurance Company’s violations of Florida Statutes 624.155 and 626.9541.

Comments

User Id		Date Added		Comment
kat.assistant@mintztruppman.com		04-01-2025		The parties have reached an agreement

Acknowledgement
*	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