Filing Number: 805752
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| Filing Accepted: 2/7/2025 |
| Last/Business Name
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CAROL SUNSHINE
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First Name |
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JOSHUA LADWIG AND |
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| Street Address
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3496 CRYSTAL LAKES COURT |
| City, State Zip
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SARASOTA,
FL
34235
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| Email Address
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JLADWIG12@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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CAROL SUNSHINE |
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First Name |
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JOSHUA LADWIG AND |
| Policy # * |
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12-1062623-02 |
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Claim #* |
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12-3007270-22 |
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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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TYPTAP 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 15885 |
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| Name of individual responsible for violation (if any):*
SETH DECKER, LATOYA RICHARDS, FRANK HARRISON, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, TYPTAP 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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Claim Delay
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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.
627.70131 (1)(a) - upon the Insurer receiving a communication with respect to a claim, the insurer shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgement. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer's claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer. As used in this subsection, "agent" means any person to whom an insurer has granted authority or responsibility to receive or make such communications with respect to claims on behalf of the insurer. This subsection shall not apply to Insureds represented by counsel beyond those communications necessary to provide forms and instructions.
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.
TypTap Insurance Company (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 Insureds; 9) failing to acknowledge and act promptly upon communications with respect to claims; and 10) failing to respond to or acknowledge correspondence within statutory time period (14 days).
On or about August 26, 2022, while the subject policy was in full force and effect, the insured property suffered a loss caused by a water leak. The areas impacted include but are not limited to the main level, spare room, dining room, closets, kitchen, pantry, living room, and contents. The Insured timely submitted a claim to the Insurer for water damages and ensuing damage therefrom. Given the scope and emergency nature of the damage, the Insured retained a leak detection service who performed an examination, for which the Insured paid $550.00 out-of-pocket, and a public adjuster. After assessing the damage and the true scope of repairs, the public adjuster prepared an estimate identifying $88,747.74 in covered damage to the dwelling and $213.57 in damage to contents. The foregoing estimate, photographs, and a letter of representation from the public adjuster were sent to the Insurer who then assigned claim number 12-300-7270-22 to the loss and sent a field adjuster to inspect the property on August 29, 2022. Then in a coverage determination letter dated September 8, 2022, the Insurer notified the Insured that it was extending coverage for the loss. However, the Insurer wrongfully determined that it would only require $7,155.57 to restore the insured property to its pre-loss condition. The Insurer subtracted the applicable deductible of $2,500.00, which resulted in a $4,655.57 net payment to the Insured. The Insurer's lowball estimate is that of a classic under scope and under value of the claim.
Subsequently, the Insurer re-inspected the property on April 6, 2023, and discovered $31,286.71 in damage. The reinspection and subsequent findings clearly demonstrate that the Insurer's initial inspection was inadequate and was only meant to provide a "low-ball" estimate to wait and see if that amount would be accepted. In layman's terms, the Insurer tried to "pull a fast one" on the Insured. Ther Insurer then sent a second coverage determination letter, dated May 31, 2023, in which it notified the Insured that it was extending additional coverage for the loss. However, the Insurer continued to wrongfully undervalue the amount of covered damage to the subject property, resulting in a $24,131.14 supplemental payment to the insured. As this amount does not come close to fully indemnifying the Insured for their loss, the Insurer has continued its wrongful mishandling of the subject claim.
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 by the Insurer to place its financial interest above those of the Insured.
In addition, on March 22, 2023, March 27, 2023, April 3, 2023, April 5, 2023, April 10, 2023, April 17, 2023, April 19, 2023, April 24, 2023, and May 1, 2023, the Insured, through the public adjuster, asked for the Insurer's desk adjuster to confirm receipt of the repair estimate that was sent on March 20, 2022. It was not until May 4, 2023, that the Insurer's desk adjuster finally responded. This shows that Insurer has failed to acknowledge the receipt of communications within fourteen (14) days in violation of Florida Statute 627.70131(1)(a). Upon an Insurer's receiving a communication with respect to a claim, the Insurer shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the Insurer which reasonably prevents such acknowledgement.
Additionally, Insurer shifted the burden and cost of investigating and insuring the loss onto the Insured. During their 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.
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 $31,286.71 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. Shifting the burden of investigating onto the Insured
9. 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:
Attorney for TypTap Insurance Company
Kelli R. Bernstine, Esquire
kbernstine@hcpci.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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