Filing Number: 806165
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| Filing Accepted: 2/10/2025 |
| Last/Business Name
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ARIZA
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First Name |
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JON AND ANDREA |
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| Street Address
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11577 48TH AVE N |
| City, State Zip
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SAINT PETERSBURG,
FL
33708
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| Email Address
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N/A |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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ARIZA |
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First Name |
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JON AND ANDREA |
| Policy # * |
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FPH3-000122746 |
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Claim #* |
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01000119531 |
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Attorney is Applicable
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| Last Name* |
ELIMELECH
First Name *
REBECCA
Initial
R
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| Street Address* |
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1500 N.E. 162ND ST. |
| City, State Zip* |
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MIAMI
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FLORIDA
33162
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| Email Address * |
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RELIMELECH@ILGPA.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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FIRST PROTECTIVE 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 10897 |
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| Name of individual responsible for violation (if any):*
N/A
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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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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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| 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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| 626.9541(1)(i)(3)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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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.
SECTION I – PROPERTY COVERAGES
A. Coverage A – Dwelling
1. We cover:
a. The dwelling on the "residence premises" shown in the Declarations, including structures attached to the dwelling; and
b. Materials and supplies located on or next to the "residence premises" used to construct, alter or repair the dwelling or other structures on the "residence premises".
B. Coverage B – Other Structures
1. We cover other structures on the "residence premises" set apart from the dwelling by clear space. This includes structures connected to the dwelling by only a fence, utility line, or similar connection.
C. Coverage C – Personal Property
1. Covered Property
We cover personal property owned or used by an "insured" while it is anywhere in the world. After a loss and at your request, we will cover personal property owned by:
a. Others while the property is on the part of the "residence premises" occupied by an "insured"; or
b. A guest or a "residence employee", while the property is in any residence occupied by an "insured".
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.
B. Coverage C – Personal Property
We insure for direct physical loss to the property described in Coverage C caused by any of the following perils unless the loss is excluded in Section I – Exclusions.
2. Windstorm Or Hail
This peril includes loss to watercraft of all types and their trailers, furnishings, equipment, and outboard engines or motors, only while inside a fully enclosed building.
This peril does not include loss to the property contained in a building caused by rain, snow, sleet, sand or dust unless the direct force of wind or hail damages the building causing an opening in a roof or wall and the rain, snow, sleet, sand or dust enters through this opening.
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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.
Jon Ariza and Andrea Ariza (hereinafter the “Insureds”), paid for a policy of insurance with First Protective Insurance Company d/b/a Frontline Insurance (hereinafter, “Insurer”) bearing policy number FPH3-000122746 (the “Policy”). The Policy provides coverage for damage to the Insureds’ property located at 11577 48th Ave. N, Saint Petersburg, FL 33708 (the “Property”), including the significant damage that occurred as a result of Hurricane Helene on or about September 26, 2024 (the “loss”). Specifically, the Insureds’ Property sustained substantial damage to the roof, interior and exterior. The home was flooded with three feet of contaminated water, a mix of saltwater and sewer water, which caused extensive damage throughout the property. All personal contents were affected, along with pool equipment, air conditioning units, and filters, which were completely destroyed. The air handler was ripped from the garage ceiling and wall, and a licensed professional has condemned the entire unit. The fence is missing, and the dock has a noticeable bow in it. The pavers near the pool have sunk due to lost silt. A built-in grill and smoker were thrown around, and sheds were torn apart. The pool is now filled with black and brown water, with fish swimming in it. The pavers in the driveway have large gaps and have sunk, as the sand and filler have shifted. The washing machine was displaced and is now lying on its side. The stone and stucco grill were heavily damaged. There has been no electrical or plumbing work done yet. Water from the flood, a contaminated mix of saltwater and sewer water, went over the toilet. Shingles are missing from the roof, which is relatively new.
The Insureds promptly reported their claim to the Insurer. On November 14, 2024, the Insurer sent a reservation of rights letter to the Insureds requesting documents and information, including cause of loss documentation, photos and videos of the damages at the time of the loss, an inspection, emergency services documents and rebuild estimates and invoices. On November 19, 2024, the Insurer sent a letter to the Insureds advising that their inspection of the property on November 14, 2024, revealed damages caused by wind to the roof and damages to the fence and interior damages caused by flood and/or surge. The Insurer informed the Insureds that they are unable to issue payment as the damages to the property totaled $776.20, which is less than the policy deductible of $ 6,580.00. In this letter, the Insurer also denied coverage for the repair to the fence, contents, and interior damages, alleging that the Homeowners Policy excludes coverage for flood and storm surge. The Insureds contacted the Insurance Litigation Group, P.A. (hereafter, ILGPA), who conducted a thorough inspection of the property and compiled an estimate of damages. ILGPA, on behalf of the Insureds, forwarded said estimate which fully detailed the Insureds’ damages and total $45,015.66. However, the Insurer refuses to resolve the Insureds’ claim and pay for all damages to the Property.
The Insurer’s conduct is in bad faith and violates Florida’s statutes concerning the adjustment of insurance claims. First, Florida Statute § 624.155(1)(B)(1) requires good faith in the settlement of claims. The Insurer is in violation of this Statute for failing to provide a reasonable repair estimate. What is more, the Insurer violated Florida Statute § 624.155(1)(b)(3) by failing to promptly settle the claim, when the obligation to settle the claim became reasonably clear. Again, the Insurer failed to make a good faith offer to settle this claim and failed to account for the full scope of the damages. They failed to respond to the estimate provided by ILGPA, on the Insureds’ behalf, in a timely manner. They are obligated to provide coverage for all damages to the Insureds’ Property, and not attempt to resolve this claim with lowball offers.
Additionally, the Insurer’s conduct violates Florida Statute § 626.9541, which prohibits unfair settlement practices. More specifically, the Insurer has violated Florida Statute § 626.9541(1)(i)(3)(a) by failing to adopt and implement standards for the proper investigation of claims. The Insureds complied with the Insurer’s request for information on December 23, 2024. However, the Insurer has failed to fairly adjust the Insureds’ loss. Further, the Insurer has violated Florida Statute § 626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly with the Insureds and its counsel. As mentioned above, the Insurer failed to account for the full scope of the damages and has additionally failed to respond to the estimate provided by ILGPA, on behalf of the Insureds, in a timely manner, delaying the resolution of this claim. Had the Insurer done so, it would have immediately settled this claim on a fair and reasonable basis and provided full coverage to its Insureds.
Moreover, the Insurer violated Florida Statute § 626.9541(1)(i)(3)(g), by failing to promptly notify the Insureds of any additional information necessary for the processing of a claim. The Insureds timely reported their claim on October 06, 2024. However, the Insurer did not request documents and information from the Insureds that are material to the Insurer’s evaluation of the claim until November 14, 2024.
Therefore, to cure the defects outlined in this Civil Remedy Notice, the Insurer must: (1) create and implement adequate guidelines for the proper investigation and evaluation of claims and for the training and supervision of employees, which will avoid future statutory violations and avoid this from occurring in the future; (2) immediately tender all insurance proceeds due and owing its Insureds under the Policy in the amount of $45,015.66 (less the deductible and any prior payments), plus all statutory interest; (3) act fairly and honestly towards its Insureds and with due regard for their interests in attempting to settle their Insureds’ claim; (4) hold the claim open in the event that its errors and delay does or may cause the Insureds to suffer either further loss and/or damage; and, (5) stipulate to the Insureds’ entitlement to attorney’s fees and court costs pursuant to Florida Statutes §§ 627.428 and 626.9373.
Acknowledgment
This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statutes section 624.155, should First Protective Insurance Company d/b/a Frontline Insurance 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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