Filing Number: 806752
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| Filing Accepted: 2/13/2025 |
| Last/Business Name
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BOND
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First Name |
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DANIEL AND JEREMIA |
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| Street Address
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12216 SIESTA DR. |
| City, State Zip
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FORT MYERS BEACH,
FL
33931
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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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BOND |
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First Name |
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DANIEL AND JEREMIA |
| Policy # * |
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3077866960 |
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Claim #* |
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01000076344 |
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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
,
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):*
DORIS STEWARD
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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)(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)(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)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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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".
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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.
Daniel Bond and Jeremia Bond (hereinafter the “Insureds”), paid for a policy of insurance with First Protective Insurance Company d/b/a Frontline Insurance (hereinafter, “Insurer”) bearing policy number 3077866960 (the “Policy”). The Policy provides coverage for damage to the Insureds’ property located at 12216 Siesta Dr, Fort Myers Beach, FL 33931 (the “Property”), including the significant damage that occurred as a result of Hurricane Ian on or about September 28, 2022 (the “loss”). Specifically, the Insureds’ Property sustained substantial damage to the roof, interior and exterior of the home. Damages include the soffit, fascia, gutters, living room, kitchen, family room, office, hallway stairs, elevator, bedrooms, master closet, master bathroom, the screen enclosure, garage and lanai.
The Insureds promptly reported their claim to the Insurer. On November 17, 2022, the Insurer sent a letter to the Insureds advising that the damages to the Property totaled $4,532.05. On May 18, 2023, the Insurer issued a letter to the Insureds denying coverage for damages to the pool. Moreover, in the letter dated May 18, 2023, the Insurer denied coverage for the cracking to gypsum ceiling board finishes of the living room, master bedroom, master bathroom, and master closet. The Insureds subsequently contacted Soteria Public Adjusting, who conducted a thorough inspection of the property and compiled an estimate of damages. Soteria Public Adjusting, on behalf of the Insureds, forwarded said estimate which fully detailed the Insureds’ damages and total $305,085.41. On December 28, 2023, Soteria Public Adjusting, on behalf of the Insureds, sent a letter to the Insurer invoking the appraisal provision in the policy. On March 27, 2024, the appraisal inspection was completed. On August 3, 2024, the umpire issued the appraisal award in the amount of $358,275.21. However, the Insurer refuses to resolve the Insureds’ claim and pay for all damages to the Property.
On September 24, 2024, the Insurer sent a letter to the Insureds denying the storm surge damages to the property, including the mold mitigation, pool clean up and resurfacing, ground floor clean up, elevator, first floor interior repairs, and additional living expenses. The Insurer alleged policy exclusions for the foregoing damages due to flood and storm surge. As such, the Insurer issued payment in the amount of $183,670.66 after the appraisal award was issued. However, the damages to the dwelling were on the second and third floors and thus were not flood related at all. Additionally, the damage to the pool and pool deck were the result of impact from trees, and the collapsed frame of the patio, and not the flooding. The Insureds subsequently contacted the Insurance Litigation Group, P.A. (hereafter, ILGPA), as the Insurer acted in bad faith by underpaying the appraisal award and alleging that the award includes non-covered damages.
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 and refusing to pay the full amount of the appraisal award. Doris Steward, the Insurer’s claim adjuster, is handling this claim in bad faith because she has failed to pay in accordance with the legally binding appraisal award, which she arbitrarily and incorrectly applied exclusions to and is refusing to pay. Ms. Steward is improperly withholding portions of the appraisal award. Ms. Steward has no basis for overturning the appraisal award. Therefore, the only way to cure this is for the Insurer to pay the remaining balance of the appraisal award in the amount of $174,604.55. 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, failed to account for the full scope of the damages, and failed to pay per the appraisal award. They failed to respond to the estimate provided by Soteria Public Adjusting, on the Insureds’ behalf, in a timely manner. They are obligated to provide coverage for all damages to the Insureds’ Property, not attempt to resolve this claim with lowball offers, and pay the full amount of the legally binding appraisal award.
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 Insurer investigated the claim poorly initially by substantially underpaying and not accounting for all the damages. When the Insurer first investigated the claim, the field adjuster claimed there was no storm damage or wind damage. However, subsequent investigation showed there were such damages. The Insurer violated Florida Statute § 626.9541(1)(i)(3)(b) by misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. The Insurer is misrepresenting facts and wrongfully applying the policy language for damages to the second and third floor as well as damages to the exterior. 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. The Insurer delayed the claims process by taking several months until they issued payment. Furthermore, after the appraisal, the Insurer did not honor the appraisal award. The Insurer has clearly demonstrated bad faith conduct. Moreover, 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 Soteria Public Adjusting, on behalf of the Insureds, in a timely manner, delaying the resolution of this claim. Moreover, the Insurer failed to pay the full amount of the appraisal award. 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.
The Insurer violated Florida Statute § 626.9541(1)(i)(3)(d) by denying the claim without conducting reasonable investigations based upon available information. The Insurer originally denied the roof and initially alleged there was no damage to the upper two floors. The Insurer also denied coverage for damage to the patio. Moreover, the Insurer had to subsequently revise their assessment before the claim went to appraisal. 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 Insurer untimely sent their request for information to the Insureds. The Insureds reported their loss on October 4, 2022. However, the Insurer did not send their letter to the Insureds requesting records and documents until over two years later on December 16, 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 the remaining balance due and owing its Insureds pursuant to the appraisal award in the amount of $174,604.55 (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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