Filing Number: 805702
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| Filing Accepted: 2/7/2025 |
| Last/Business Name
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JOHNSON
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First Name |
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JOHNNY |
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| Street Address
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1297 PAR VIEW DRIVE |
| City, State Zip
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SANIBEL,
FL
33957
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| Email Address
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JJOHNSON1635@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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JOHNSON |
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First Name |
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JOHNNY |
| Policy # * |
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SFLW0477304-05 |
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Claim #* |
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54026 |
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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
,
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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SAFEPOINT 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 15341 |
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| Name of individual responsible for violation (if any):*
ERIK PEREZ AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, SAFEPOINT INSURANCE COMPANY 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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Failing to properly investigate the Insured's loss
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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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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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| 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)(e) |
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Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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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.
SAFEPOINT INSURANCE COMPANY (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 policyholder and 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; and 7) failing to employ policies and procedures to conduct adequate investigations.
On or about September 28, 2022, while the subject policy was in full force and effect, the insured property suffered a loss caused by Hurricane Ian. The areas impacted are believed to be the dwelling mailbox, roof system and master bathroom. The Insured timely submitted a claim to the Insurer on October 20, 2022. Thereafter, the Insurer assigned claim number 54026 to the loss and sent a field adjuster to inspect the property. Then in a letter dated, January 17, 2023, the Insurer notified the Insured that it was extending coverage for the loss; however, the Insurer wrongfully determined that the covered damages fell below the Hurricane Deductible of $29,650.00. The Insurer's lowball estimate is that of a classic under scope and under value of the claim. Given the nature and scope of the damage resulting from Hurricane Ian, the Insured retained a public adjuster. After assessing the damage and the true scope of repairs, the public adjuster produced an estimate identifying $110,443.32 in covered damages.
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 failed to allocate and pay for overhead and profit, pursuant to Florida Statute 627.7011(3)(a). Where the Insureds are reasonably likely to need a general contractor for the repairs, Florida Statute 626.7011(3) does not permit an Insurer to withhold overhead and profit pending the actual repair, unless absent a showing by the Insureds that it was likely to need a general contractor for the repairs. Trinidad v. Fla. Peninsula ins. Co., 121 So. 3d 433, 435 (Fla. 2013). The Insurer has implemented policies and procedures that are designed to wrongfully withhold costs associated with restoring the insured property to its pre-loss condition. This is an underhanded attempt to place the financial interest of the Insurer over that of the Insured.
Additionally, 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. These benefits include providing the Insured with a proper investigation of the loss in addition to the funds necessary to return the property to its pre-loss condition. However, during the course of its investigation, the insurer's adjuster did not use a moisture meter, despite the presence of interior water damage. A moisture meter can be purchased online from Amazon for around $40 before tax. The Insurer could purchase a moisture 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 the Insurer significantly underestimated the scope of the loss to the Insured's property. The 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.
Further, the Insurer has failed to affirm or deny full or partial coverage of claims within 30 days of the Insured providing a sworn proof of loss statement. Specifically, on July 26, 2023, Insured's legal counsel sent the Insurer a sworn statement in proof of loss and an estimate in support thereof. To date, Insured has not received a response from the Insurer as required by Florida Statute 626.9541(1)(i)(3)(e). The Insurer's actions and inactions continue to frustrate and delay the resolution of Insured's claim.
The foregoing wrongdoings of the insurance carrier are done in the routine course of its 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 the covered damages fell below the Hurricane Deductible of $29,650.00. 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. Not treating the Insured with good faith claims conduct
2. Looking for way to reduce recovery to the Insured
3. Looking for ways to deny recovery to the Insured
4. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured
5. 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
6. 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:
SAFEPOINT INSURANCE COMPANY
P. O. Box 291579
Tampa, FL 33687
claims@safepointins.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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