Filing Number: 805998
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| Filing Accepted: 2/10/2025 |
| Last/Business Name
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MERRYMAKERS CLUB OF TAMPA, FLORIDA, INCORPORATED
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First Name |
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| Street Address
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124 DANUBE AVENUE |
| City, State Zip
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TAMPA,
FL
33606
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| Email Address
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ALEXANDER.GLAZER2@GMAIL.COM |
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Insured |
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| Last/Business Name* |
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MERRYMAKERS CLUB OF TAMPA, FLORIDA, INCORPORATED |
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First Name |
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| Policy # * |
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350TBP100717 |
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Claim #* |
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12799141 |
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Attorney is Applicable
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| Last Name* |
WATSON
First Name *
TRAVIS
Initial
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| Street Address* |
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17862 HUNTING BOW CIRCLE, SUITE 102 |
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LUTZ
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FL
33558
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| Email Address * |
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TRAVIS@TRAVISWATSONLAW.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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UNDERWRITERS AT LLOYD'S, LONDON
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| Insurer Name* |
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| Street Address* |
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,
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NAIC Company Code |
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| Name of individual responsible for violation (if any):*
HENRY HONG (FIELD ADJUSTER), ROB BURRITT (DESK ADJUSTER), JUAN RAFOLS (DONAN ENGINEERING) AND ALL OTHER INDIVIDUALS AND ENTITIES EMPLOYED, RETAINED, OR RELIED UPON BY CERTAIN UNDERWRITERS AT LLOYD’S, LONDON AND CONVEX INSURANCE UK LIMITED AND DALE DU
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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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| 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)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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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)(3)(f) |
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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.
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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.
“Our commitment to you is to provide a fast and fair claim service.”
“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.”
“A. Covered Causes Of Loss When Special is shown in the Declarations, Covered Causes of Loss means direct physical loss unless the loss is excluded or limited in this policy.”
“4. Loss Payment a. In the event of loss or damage covered by this Coverage Form, at our option, we will either: (1) Pay the value of lost or damaged property;”
“B. Exclusions 2. We will not pay for loss or damage caused by or resulting from any of the following: d. (1) Wear and tear; (2) Rust or other corrosion, decay, deterioration, hidden or latent defect or any quality in property that causes it to damage or destroy itself. *** (4) Settling, cracking, shrinking or expansion; *** f. Continuous or repeated seepage or leakage of water, or the presence or condensation of humidity, moisture or vapor, that occurs over a period of 14 days or more. 3. We will not pay for loss or damage caused by or resulting from any of the following, 3.a. through 3.c. But if an excluded cause of loss that is listed in 3.a. through 3.c. results in a Covered Cause of Loss, we will pay for the loss or damage caused by that Covered Cause of Loss. *** c. Faulty, inadequate or defective: *** (2) Design, specifications, workmanship, repair, construction, renovation, remodeling, grading, compaction; (3) Materials used in repair, construction, renovation or remodeling; or (4) Maintenance. *** C. Limitations The following limitations apply to all policy forms and endorsements, unless otherwise stated: 1. We will not pay for loss of or damage to property, as described and limited in this section. In addition, we will not pay for any loss that is a consequence of loss or damage as described and limited in this section. *** c. The interior of any building or structure, or to personal property in the building or structure, caused by or resulting from rain, snow, sleet, ice, sand or dust, whether driven by wind or not, unless: (1) The building or structure first sustains damage by a Covered Cause of Loss to its roof or walls through which the rain, snow, sleet, ice, sand or dust enters;”
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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.
1) failure to pay claim in full;
2) claim denial and delay;
3) failure to promptly and properly investigate claim;
4) failure to act in due diligence and good faith to resolve claim;
5) placing financial interest of insurer before that of policy holder;
6) failure to properly train, evaluate and manage adjusters;
7) not treating the policyholder with good faith claims conduct;
8) looking for ways to deny coverage or “stone wall” claim;
9) the reasons for this may be attributed to improper training, supervision, and/or motivation of adjusters and claims supervisors to promptly and fairly investigate, adjust and pay full benefits available to all beneficiaries. Underwriters have failed to adopt proper standards of investigation and adjustment of losses, or is otherwise not implementing those standards because a reasonable investigation and full payment for the loss did not and is not occurring;
10) not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the Insured;
11) failing to implement proper standards for the adjustment and investigation of claims;
12) not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholder’s interests;
13) establishing severity control initiatives and otherwise establishing a culture of not fully and promptly paying claims following losses;
On or about September 27, 2024, the Insured’s (Merrymakers Club of Tampa, Florida, Incorporated) building located at 124 Danube Avenue, Tampa, FL 33606 sustained extensive wind and ensuing water damage as a result of Hurricane Helene.
The Insured timely reported the damage and submitted a claim to its insurer Certain Underwriters at Lloyd’s, London and Convex Insurance UK Limited and Dale Dual MGU Limited (“Underwriters”). In response to receipt of the Insured’s claim, Underwriters assigned Henry Hong to presumably investigate the claim. However, for unknown reasons, Underwriters, through Henry Hong, waited until October 22, 2024 to inspect the damage. Underwriters then waited until November 24, 2024 to again inspect the property through engineer Juan Rafols.
On December 6, 2024, Mr. Rafols authored a report in which he concluded that severe winds affected the area of the Insured’s building during Hurricane Helene, that the roof of the building exhibited missing and abraded shingles and the ridge vent was deformed and that these conditions were the result of wind uplift pressures, abrasion with tree limbs, and impact with wind-borne debris. Mr. Rafols also concluded that the roof’s dimensional shingles were damaged by wind and that with the exception of the water intrusion through the ridge vent on the second-story portion of the building, the water intrusion into the building was the result of imperfections in the building envelope allegedly unrelated to wind. He also opined that copious amounts of rain and wind-driven rain during the recent storm promoted water to infiltrate through the imperfections, and that with the exemption of the water infiltrating and affecting the Bar Room, the color of the stains in the affected building materials indicated that those components had been exposed to water for a short period (i.e., days).
Even though Mr. Rafols confirmed that the roofs of the insured building were damaged by wind and that water entered the building through a cause of loss not excluded under the policy (wind and/or imperfections in the building envelope), Mr. Hong prepared a recklessly low-ball estimate of the alleged covered damages in the amount of only $20,931.38 RCV / $20,297.38 ACV. Thereafter, Underwriters notified the Insured that because the amount of the replacement cost estimate was allegedly below the deductible, there was no claim payment to be made.
Underwriters’ inexplicable behavior towards the Insured forced the Insured to exercise its rights under the laws of the state of Florida and the United States of America to retain the services of the licensed, experienced, professional public adjuster, Robert S. Speer. Mr. Speer caused a thorough examination of the damaged property to be conducted and an estimate to bring the property to its pre-loss condition to be prepared. The estimate was in the amount of $373,397.84 RCV / $365,467.51 ACV. Mr. Speer submitted the estimate of covered damages to Underwriters, however, Underwriters have done nothing and refused to pay the amount reasonably necessary to bring the Insured’s property to its pre-loss condition subject to the terms of the Policy.
Underwriters have violated Florida law (Section 626.9541(1)(i)(3)(a)) by failing to adopt and implement standards for the proper investigation of claims. Had Underwriters adopted and implemented standards for the proper investigation of claims, they would have recognized that the Insured’s property sustained substantial covered wind damage, they would have hired adjusters who are properly trained to identify, correctly estimate, and pay for wind damage, they would have recognized that their own adjuster’s estimate was a reckless low-ball estimate and should be rejected, they would not have denied coverage for the interior water damage based on a cause of loss not excluded in the policy, they would have recognized that the Insured’s damage estimate of $373,397.84 RCV / $365,467.51 ACV is reasonable and should be paid, and they would have already paid the Insured the amount reasonably necessary to bring the Insured’s property to its pre-loss condition subject to the terms of the policy. Instead, Underwriters have either taught their adjusters how to low-ball claims by ignoring obvious covered damage or hired untrained and inexperienced adjusters who are incapable of properly adjusting claims.
Underwriters have violated Florida law (Section 626.9541(1)(i)(3)(b)) by misrepresenting pertinent facts and insurance policy provisions relating to coverages at issue. Specifically, Underwriters’ low-ball estimate is a misrepresentation of the actual amount of property damage payable under the Policy resulting from the wind loss. Furthermore, Underwriters under deductible letter contains numerous pertinent misrepresentations of facts and policy provisions relating to coverages at issue. Specifically, the letter states that the damages were caused by numerous excluded causes of loss, including damage that occurred before the policy incepted, wear and tear, deterioration, settling, continuous leakage of water that occurred over a period of 14 days or more, and faulty design, construction, repair, and maintenance. These are factual misrepresentations because the damage did not occur from these causes. Furthermore, Underwriters’ engineer concluded that the building did sustain wind damage. Thus, even if the excluded causes of loss cited in Underwriters’ letter caused some damage (which they didn’t), the damage was concurrently caused by wind (a covered cause of loss), and therefore all of the damage is covered pursuant to Florida law. Furthermore, Underwriters’ engineer specifically opined that the water intrusion occurred as a result of wind and/or imperfections in the building envelope, neither of which are excluded causes of loss in the Policy. Accordingly, Underwriters’ assertion in their under deductible letter that the limitation on interior water damage applies to limit coverage is a misrepresentation of insurance policy provisions relating to coverages at issue. Since Underwriters don’t know what caused the imperfections in the building envelope, all interior water damage is covered. Underwriters’ assertion to the contrary is a violation of Florida law.
Underwriters have violated Florida law (Section 626.9541(1)(i)(3)(d)) by denying the Insured’s claim (by refusing to pay the amount reasonably necessary to bring the Insured’s property to its pre-loss condition subject to the terms of the Policy) without conducting a reasonable investigation based upon available information. Underwriters’ investigation is unsatisfactory and unreasonable given that it created such a reckless low-ball estimate of the wind damage and because it has denied the Insured’s claim based on opinions that actually support coverage for the amount claimed by the Insured. Underwriters have ignored obvious facts and opinions (or misapplied them), including substantial wind damage and a valid estimate from a professional estimator.
Underwriters have violated Florida law (Section 626.9541(1)(i)(3)(f)) by failing to promptly provide a reasonable explanation in writing to the Insured of the basis in the insurance policy, in relation to the facts and applicable law, for not paying the amount reasonably necessary to bring the property to its pre-loss condition. As set forth above, Underwriters’ under deductible letter is not reasonable, misrepresents facts, and misapplies Policy provisions to wrongly deny coverage for the damages the Insured sustained.
Underwriters have violated Florida law (Section 624.155(1)(b)(1.)) by not attempting in good faith to settle the Insured’s claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward the Insured and with due regard for the Insured’s interests. Underwriters’ low-ball estimate and wrongful denial of roof replacement and interior water damage is evidence that they are not acting fairly or honestly with due regard for the Insured’s interests. Further, because Underwriters are ignoring and disregarding the Insured’s damage estimate and standing on their unjustified reasons for denying further payment, Underwriters are showing that they are not attempting in good faith to settle the Insured’s claim. Rather, Underwriters are putting their own financial interests above the Insured’s even though they know or should know that the Insured’s damage estimate is reasonable and/or that its own estimate is not reasonable.
Rather than carrying out its contractual, statutory, regulatory, and ethical duties that they owed to the Insured, Underwriters have committed acts which were not in good faith and were in violation of Florida Statute § 624.155(1)(b)(1) and Florida Statute § 626.9541(1)(i). These acts include:
a. Not attempting in good faith to settle the Insured’s claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward the Insured and with due regard for the Insured’s interests.
b. Failing to properly investigate the Insured’s claim.
c. Failing to properly apply expert opinions to policy provisions.
d. Unsatisfactory settlement offers.
e. Attempting to find ways to delay and improperly deny the Insured’s claim rather than providing prompt and proper indemnity to the Insured for its claim.
f. Creating a hostile and adversarial investigation and adjustment of the Insured’s insurance claim.
g. Failing to properly train, supervise, or otherwise manage adjusters, representatives, and investigators to properly, promptly, and in good faith, investigate and adjust claims so that a prompt and fair evaluation of the claim can be made, and proper indemnity paid, resulting in the failure to timely pay the Insured’s covered claim.
h. Failing to adopt and implement standards for the proper investigation of the Insured’s claim, resulting in the aforementioned conduct.
i. Retaining outcome-oriented adjusters and experts.
j. Misrepresenting, ignoring, and/or omitting pertinent facts relating to the coverages and/or facts of the loss at issue, so as to provide an illegitimate, unjustified, and/or unfounded basis for denying, delaying, and/or underpaying the Insured’s claim.
k. Denying and delaying the Insured’s claim without conducting a reasonable investigation based upon available information.
l. Failing to promptly provide a reasonable explanation in writing to the Insured of the basis in the Policy, in relation to the facts and/or applicable law, for the denial of the Insured’s claimed damages.
m. Failing to timely pay the contractual amount owed the Insured under the Policy for its claim in a manner consistent with the Policy and Florida law.
n. Training, evaluating, and promoting adjusters and claims management based on reduction of claim payments rather than promptly and fully paying the contractual amount owed to the Insured under the Policy for his claim.
Underwriters have not attempted in good faith to settle the Insured’s claim when, under all the circumstances, they could and should have done so, had they acted fairly and honestly toward the Insured and with due regard for its interests. This is a violation of Florida law.
Underwriters have failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim for damages. Instead, Underwriters are relying upon adjusters and claims representatives who are biased, untrained, and unable to properly and timely investigate and pay property damage claims. Underwriters have failed to pay for covered property damage caused by a Covered Cause of Loss, namely, substantial wind damage. By not completing a proper investigation of the Insured’s claim in a timely manner and paying the Insured’s the amount reasonably necessary to bring the Insured’s building to its pre-loss condition, Underwriters have improperly, illegally, and recklessly denied the Insured’s claim.
Underwriters have failed to complete a thorough and unbiased evaluation of the Insured’s damage and claim, and that failure has caused additional damages and financial harm to the Insured.
Underwriters have ignored important information that would benefit the Insured, including the valid estimate submitted by Robert Speer and the findings of their own engineer. The Insured has sustained a covered loss as a result of wind damage. The Insured timely reported the damage to Underwriters. Underwriters have failed to tender all insurance monies due and owing the Insured for the damage.
Underwriters charged the Insured a premium for property insurance but has refused and/or failed to tender all insurance monies under the policy, when under all circumstances they could have and should have done so had they acted fairly and honestly towards the Insured. Additionally, the Insured contends this is done company-wide and that other insureds have been refused insurance monies under Underwriters’ policies in the same or similar circumstances.
Underwriters have failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim for damages. Underwriters have refused and/or failed to tender all insurance proceeds to the Insured upon demand as required by the policy and/or law. Underwriters commit this practice only to keep claims adjustment process open and pending so they do not have to pay fully on the claim. This is wrong.
Therefore, to cure the defects outlined in this Civil Remedy Notice, Underwriters must:
1. Immediately tender the amount reasonably necessary to bring the Insured’s property to its pre-loss condition subject to the terms of the policy;
2. Pay statutory interest on the amount paid in number 1 above from the date of the loss to the date of its payment of the amount paid in number 1 above;
3. Act fairly and honestly towards the Insured and with due regard for its interests in attempting to settle the Insured’s claim;
4. Cease and desist all present and future bad faith actions with regard to the Insured’s claim.
Failure to cure all defects may result in additional extra-contractual damages.
This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statutes, including any and all bad faith/extra contractual and punitive damages, should Underwriters fail to cure the violations set forth in this Civil Remedy Notice within the given cure period.
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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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