Filing Number: 805698
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| Filing Accepted: 2/7/2025 |
| Last/Business Name
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| Street Address
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7384 HIGH LAKE DRIVE |
| City, State Zip
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ORLANDO,
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32818
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| Email Address
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LSOTO110@AOL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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SOTO |
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First Name |
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LOURDES |
| Policy # * |
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0768541028 |
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Claim #* |
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7005429407-1-1 |
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Attorney is Applicable
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| Last Name* |
KRAPF
First Name *
GRANT
Initial
W
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| Street Address* |
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2790 SUNSET POINT RD |
| City, State Zip* |
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CLEARWATER
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FL
33759
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| Email Address * |
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GRANT@KRAPFLEGAL.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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TRUCK INSURANCE EXCHANGE
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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 21709 |
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| Name of individual responsible for violation (if any):*
NICHOLAS MCKENNA, CASSIE MCLIN, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, TRUCK INSURANCE EXCHANGE WHO WAS INVOLVED IN THE CLAIM.
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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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Unfair Trade Practice
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Other
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Not treating the Insured with good faith claims conduct
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Other
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Looking for ways to deny full recovery to the Insured
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Other
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Looking for ways to delay full recovery to the Insured
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Other
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Failing to properly investigate the Insured's loss
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Other
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Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
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Other
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Not training, supervising, or managing adjusters properly so that prompt and full payments are made
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Other
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Not adjusting claims and evaluating loss properly
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Other
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Shifting the burden of insuring the loss to the Insured
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Other
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Failing to implement proper standards for the adjustment and investigation of claims
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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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language.
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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.
Truck Insurance Exchange (the "Insurer") has committed the following in handling the Insured's claim: 1) failing to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) shifting the burden of investigating the loss onto the Insured; and 9) artificially inflating the Insured's recoverable depreciation.
On or about September 29, 2022, while the subject policy was in full force and effect, the insured property suffered a loss caused by Hurricane Ian. The areas impacted include but are not limited to the roofing system, family room, garage, kitchen, pantry, master bedroom, master bathroom, pool area and enclosure, three guest rooms and closets, hallway and hall closet, living room, and general exterior. The Insured timely submitted a claim to the Insurer for damages caused by Hurricane Ian and ensuing wind and water damage therefrom. Thereafter, the Insurer assigned claim number 7005429407-1 to the loss and sent a field adjuster to inspect the property. The Insurer then notified the Insured, in a coverage determination letter dated January 11, 2023, that it was extending partial coverage for the loss. However, the Insurer wrongfully determined that it would only require $63,388.06 to restore the insured property to its pre-loss condition. The Insurer subtracted depreciation and the applicable deductible of $5,040.00, which resulted in a $25,711.74 net payment to the Insured. The Insurer's lowball estimate is that of a classic under scope and under value of the claim.
Given the vastly underestimated cost of repairs and the scope and nature of the damage, the Insured retained a public adjuster. After assessing the damage and the true scope of repairs, the public adjuster prepared an estimate identifying $195,019.15 in covered damage to the dwelling, $8,788.51 in covered damage to contents, and $9,126.37 in damage to other structures. Additionally, the Insured hired restoration, roof, and window experts to assess the damage caused by Hurricane Ian to these areas. The window estimate amounted to $29,857.00 to repair the windows alone. The restoration experts prepared an estimate detailing $1,200.00 for tarping to be done to the roof. The foregoing estimates, photographs, and a letter of representation from the public adjuster were sent to the Insurer.
Upon receiving notice of the loss, the Insurer 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 the home to its pre-loss condition. However, when the Insurer conducted its inspection of the insured property, the Insurer's adjuster failed to conduct a thorough and adequate investigation, or the adjuster intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss.
The Insurer misrepresented the loss and issued a wrongful partial denial. The Insurer denied coverage for the remaining damage sustained to the roof based on the rationale that the damage was a result of wear and tear. However, the Insurer never retained a professional engineer to ascertain the cause and scope of this damage. Although the Insurer and Insured are in dispute about how the damage was sustained, the Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. At 697.
Moreover, upon information and belief, the Insurer wrongfully underscoped for the Insured's roof because it knows or should have known that the Insured needs a new roof in order to comply with the Florida Building Code. Rather than the Insurer pay for a roof replacement consistent with all laws and ordinances, the Insurer contends the roof is repairable which is not true. All repairs to the roofing system must be done in accordance with applicable Florida Building Codes which require all repairs be done consistent with the manufacturer's specifications and warranties which this Insurer clearly did not account for.
The Insurer unreasonably inflated the amount of recoverable depreciation in this case, thereby artificially lowering the Insured's recoverable value, to the detriment of the Insured. The Insurer withheld almost 50 percent 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 Insured 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 Insured 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 to limit the amount the Insurer will ever have to pay out on a claim and make the homeowner a self-insured. The Insurer is hoping that the Insured is unaware of her right to recover the recoverable depreciation so that it can pay Insured less than it is obligated. The Insurer is shifting the cost and the burden of investigating the loss onto the Insured. The Insurer has the duty to inspect the loss and provide the Insured with the full benefits under the policy. The Insurer has breached that duty by not providing the Insured with the full value of the loss and caused the Insured to take on the burden of investigating the loss.
Additionally, although there was interior water damage the adjuster did not use a water meter. A water meter can be purchased online from Amazon for around $40 before tax. The Insurer could purchase a water meter and assess thousands of properties with one meter. Instead, 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 Insurer significantly underestimated the scope of the loss to the Insured's property. 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 Insurer over those of the Insured, to delay the Insured's claim, and to delay the Insured in restoring her property to its pre-loss condition.
The conduct outlined above is done within the Insurer's routine course of the business.
There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer's claim file and standards and procedures for the adjustment and investigation of claims.
In short, the 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. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully determined that it would only require $63,388.06 to restore the insured property to its pre-loss condition. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer's actions and inactions have continued to frustrate and delay the resolution of the Insured claim.
The Insurer's actions amount to but are not limited to the following:
1. Claim delay
2. Not treating the Insured with good faith claims conduct
3. Looking for way to reduce recovery to the Insured
4. Looking for ways to deny recovery to the Insured
5. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured
6. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's interests
7. Placing the financial interest of the Insurer over that of the health and safety of the Insured
8. Failing to provide an estimate that complies with the Florida Building Codes
9. Shifting the burden of investigating onto the Insured
10. Conducting inadequate investigations
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 E-mail:
Truck Insurance Exchange
6301 Owensmouth Avenue
Woodland Hills, CA 91367
myclaim@farmersinsurance.com
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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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