Filing Number: 807416
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| Filing Accepted: 2/18/2025 |
| Last/Business Name
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WOLFF
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First Name |
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LISA AND DYLAN |
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| Street Address
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13451 GERONA DRIVE NORTH |
| City, State Zip
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JACKSONVILLE,
FL
32246
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| Email Address
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LMORRIS64@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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WOLFF |
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First Name |
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LISA AND DYLAN |
| Policy # * |
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SJ30378354 |
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Claim #* |
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202408002273 |
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Attorney is Applicable
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| Last Name* |
PIASECKI
First Name *
JACOB
Initial
D
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| Street Address* |
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4016 SOUTH THIRD STREET, #1156 |
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JACKSONVILLE BEACH
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FLORIDA
32250
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| Email Address * |
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JAKE@JDP-LAW.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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SLIDE INSURANCE COMPANY
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| Insurer Name* |
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| Street Address* |
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,
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NAIC Company Code 17227 |
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| Name of individual responsible for violation (if any):*
DARIELLE THOMPSON, CLAIMS ADJUSTER, FL LICENSE #W866339; TAYLOR STRUNK, ESTIMATOR, FL LICENSE W489367; AND EVERY ADJUSTER, AGENT, CLAIM REPRESENTATIVE, MANAGER, SUPERVISOR, DIRECTOR, OFFICER, AND INDEPENDENT CONTRACTOR WHO WAS INVOLVED IN THE HANDL
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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 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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Other
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Unfair claim settlement practices.
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Other
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Failure to conduct a reasonable investigation based on available information.
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Other
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Failure to maintain proper claim handling procedures.
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Other
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Misrepresenting the benefits, advantages, conditions, or terms of any insurance policy
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Other
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Misrepresenting the insurance policy provisions to the insured(s) or any person(s) with an interest
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Other
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Misrepresenting Florida statutory provisions to an insured.
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Other
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Misrepresenting facts to an insured.
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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)(2) |
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A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
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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)(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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| 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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| 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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| 626.9541(1)(i)(4) |
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Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
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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.
***ADDITIONAL STATUTORY PROVISIONS ALLEGED TO HAVE BEEN VIOLATED ARE AS FOLLOWS:***
FLORIDA ADMINISTRATIVE CODE SECTIONS & OTHER APPLICABLE STATUTES
Fla. Stat. §626.877 Every adjuster shall adjust or investigate every claim, damage, or loss made or occurring under an insurance contract, in accordance with the terms and conditions of the contract and of the applicable laws of this state.
69B-220.201(3)(b)(2) An adjuster shall adjust all claims strictly in accordance with the insurance contract.
69B-220.201(3)(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
69B-220.201(3)(f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim.
69B-220.201(3)(j) An adjuster shall not knowingly fail to advise a claimant of the claimant’s claim options in accordance with the terms and conditions of the insurance contract.
69B-220.201(3)(m) An adjuster shall not knowingly fail to advise a claimant of their rights in accordance with the terms and conditions of the contract and applicable laws of the state of Florida.
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Lisa Wolff and Dylan Wolff consider the following specific policy language relevant to the Violation(s) described in this Notice:
HOMEOWNERS 3 – SPECIAL FORM
AGREEMENT
We will provide the insurance described in this policy
in return for the premium and compliance with all
applicable provisions of this policy.
DEFINITIONS
A. In this policy, "you" and "your" refer to the "named
insured" shown in the Declarations and the
spouse if a resident of the same household. "We",
"us" and "our" refer to the Company providing this
insurance.
…
5. "Insured" means:
a. You and residents of your household who
are:
(1) Your relatives; or
(2) Other persons under the age of 21 and
in the care of any person named above;
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6. "Insured location" means:
a. The "residence premises";
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8. "Occurrence" means an accident, including
continuous or repeated exposure to substantially
the same general harmful conditions,
which results, during the policy period, in:
a. "Bodily injury"; or
b. "Property damage".
9. "Property damage" means physical injury to,
destruction of, or loss of use of tangible property.
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11. "Residence premises" means:
a. The one family dwelling where you reside;
b. The two, three or four family dwelling
where you reside in at least one of the family
units; or
c. That part of any other building where you
reside;
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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".
…
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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SECTION I – PERILS INSURED AGAINST
A. Coverage A – Dwelling And Coverage B –
Other Structures
1. We insure against risk of direct physical loss to
property described in Coverages A and B.
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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
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B. Duties After Loss
In case of a loss to covered property, we have no
duty to provide coverage under this policy if the
failure to comply with the following duties is prejudicial
to us. These duties must be performed either
by you, an "insured" seeking coverage, or a
representative of either:
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4. Protect the property from further damage. If
repairs to the property are required, you must:
a. Make reasonable and necessary repairs to
protect the property; and
b. Keep an accurate record of repair expenses;
5. Cooperate with us in the investigation of a
claim;
6. Prepare an inventory of damaged personal
property showing the quantity, description, actual
cash value and amount of loss. Attach all
bills, receipts and related documents that justify
the figures in the inventory;
7. As often as we reasonably require:
a. Show the damaged property;
b. Provide us with records and documents we
request and permit us to make copies; and
c. Submit to examination under oath, while
not in the presence of another "insured",
and sign the same;
8. Send to us, within 60 days after our request,
your signed, sworn proof of loss which sets
forth, to the best of your knowledge and belief:
a. The time and cause of loss;
b. The interests of all "insureds" and all others
in the property involved and all liens on the
property;
c. Other insurance which may cover the loss;
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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.
In Florida, insurance claims adjustment engages the public trust. Slide Insurance Company (hereinafter Slide) breached this duty in its adjustment of claim number 202408002273 (the “Claim”) from Lisa Wolff and Dylan Wolff (“Lisa and Dylan”) for their home located at 13451 Gerona Drive North, Jacksonville, Florida 32246, (the “Property”). The Property was covered by a policy of insurance issued by the Insurer numbered SJ30378354 (the “Policy”).
Without limitation, Slide: 1) failed to promptly pay all benefits due; 2) failed to fairly and completely investigate the Claim; 3) failed to act in due diligence and good faith to resolve the Claim; 4) placed its financial interests ahead of that of Lisa and Dylan; 5) failed to properly train, evaluate, and manage adjusters so that policyholders receive fair, prompt, and accurate adjustment of claims in good faith; 6) failed to provide facts and reasons to Lisa and Dylan for elements of the Claim that were not covered in its adjustment; 7) sought to delay full benefit payments and to “low ball” the Claim; 8) improperly constructively denied the Claim without reasonable investigation; and 9) engaged in unfair claim underestimation and delay resulting in the violation of Florida statutes as set forth in this civil remedy notice.
Specific Facts:
Lisa and Dylan paid premiums to Slide in exchange for the Policy which insured the Property against all direct physical losses unless specifically excluded. On or around August 1, 2024, the Property suffered significant damage from water (the “Loss”). The Loss was a covered peril under the Policy.
Lisa and Dylan reported the Loss to Slide on August 6, 2024, requesting an investigation, coverage admission, and full indemnity, less deductible. Slide failed to handle the claim in good faith, breaching the Policy by constructively denying the Claim by completely failing to communicate to Lisa and Dylan, denying multiple areas of damages in their estimate of the Loss, underestimating multiple areas of damages, performing an inadequate investigation, taking unwarranted delay and not communicating with the insureds, and misrepresenting Policy coverage and exclusions.
Slide investigated and confirmed damages. On or around August 21, 2024, Slide sent a letter and an estimate to Lisa and Dylan which acknowledged the Claim, itemized damages according to Slide’s inspection, but failed to either extend coverage or deny coverage (the “Damages Letter & Estimate”). Dylan and Lisa then sent Slide emails which included their costs incurred for the Loss and photo reports of the damages. Slide acknowledged receipt of the expenses incurred and reports, but Slide never extended or denied coverage. In fact, Slide ceased all communications with Lisa and Dylan for no apparent reason.. Lisa and Dylan then sent Slide their Sworn Proof of Loss on or around September 30, 2024. Still, Slide never responded to the sworn proof of loss, and no communication from Slide has been received as of the date of this civil remedy notice.
Pursuant to Florida statutes § 626.9541(1)(i)(3)(e), an insurer must affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage within 30 days after proof-of-loss statements have been completed. In this case, Lisa and Dylan provided Slide with their sworn proof of loss over four months before this civil remedy notice. Florida specifically recognizes failure to acknowledge and act promptly in response to a claim as an unfair claim settlement practice. By its conduct of ignoring the Claim, Slide also violated Florida Statutes: § 626.9541(1)(i)(3)(c) - Failing to acknowledge and act promptly upon communications with respect to claims; § 626.9541(1)(i)(3)(f) - 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; and (potentially) § 626.9541(1)(i)(3)(g) - Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
Further, Slide’s delay is so substantial and accompanied by no communication that it is a constructive or tacit denial of the Claim. See Fla. Stat. § 627.70131 - requires insurers to pay or deny a claim in 60 days. Under Florida law, a specific refusal to pay a claim triggers a cause of action for breach of contract. Allstate Ins. Co. v. Kaklamanos, 843 So. 2d 885, 892 (Fla. 2003); Donovan v. State Farm Fire and Cas. Co., 574 So. 2d 285, 286 (Fla. 2nd DCA 1991). It follows that Slide breached the Policy when it failed to respond to the Claim beyond the time proscribed by statute.
Concerned with the accuracy and completeness of Slide’s investigation, Lisa and Dylan retained public adjuster Andrew Howell to investigate and evaluate the damage in accordance with industry standards and Florida law. Mr. Howell concluded that a water loss caused the damages to the Property and estimated that at least $23,814.96 was needed to restore the dwelling to its pre-loss condition. Additionally, Lisa and Dylan sustained expenses of $20,399.15 in emergency mitigation services from Santi Clean, $48.71 in contents losses, $1,520.00 in mold testing and post remediation verification from Luce Air Quality, totaling $45,782.82 in damages as a result of the Loss. Slide was provided with Mr. Howell’s report as well as the reports from Santi Clean and Luce Air Quality.
In contrast, Slide’s investigation omitted conspicuous damages to the Property’s bathroom and utility room as well as the necessary water mitigation measures needed for the Loss and estimated total damages of only $7,307.20.
Slide misadjusted the Claim by, without limitation, half-curing the necessary steps and costs for the water mitigation and the covered repairs to the dwelling, especially the bathroom and utility room; Slide also omitted reimbursement for mold evaluation and testing expenses. Specifically, the Loss is covered under the Policy, and Slide misapplied the Policy by not not extending coverage, and wholly failed its statutory duties to acknowledge and communicate with its insureds with respect to the Claim.
On or around February 18, 2025, Lisa and Dylan sent correspondence to Slide, enclosing their Sworn Statement in Proof of Loss, along with the Mr. Howell’s report outlining the cause, scope, and cost of the loss, the Santi Clean report, the Luce Air Quality report, and requested Slide to extend coverage in accordance with their demand.
Slide’s constructive denial of coverage and underestimation misrepresents the available coverages under the Policy in direct violation of Florida Statutes Sections: 626.9541(1)(a)(1) – misrepresenting the benefits, advantages, conditions, or terms of any insurance policy; 626.9541(1)(i)(3)(b) - misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; and 626.9541(1)(i)(2) - material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
As a result, Slide has materially misrepresented the coverages under the subject policy to the insured for the purpose and with the intent of affecting settlement of the insureds’ claim on less favorable terms than those provided in, and contemplated by, the subject policy in direct violation of Florida Statutes § 626.9541(1)(i)(2). Further, Slide is in violation of Florida Statutes §§ 626.9541(1)(a)(1), 626.9541(1)(i)(3)(b), and 626.9541(1)(a)(1) by misrepresenting pertinent facts and insurance policy provisions relating to coverages at issue; and also in violation of Florida Statutes § 626.9541(1)(i)(3)(d) - Denying claims without conducting reasonable investigations based upon available information by denying the insureds’ claim without conducting a reasonable investigation based upon available information.
Slide's constructive denial of coverage and underestimation misrepresents the available coverages under the Policy in direct violation of Florida Statutes §§ 626.9541(1)(a)(1), 626.9541(1)(i)(3)(b), 626.9541(1)(a)(1), and 626.9541(1)(i)(2) and is pretext to wrongfully deny and delay this claim. It follows that Slide has materially misrepresented the coverages under the subject policy to the insured for the purpose and with the intent of affecting settlement of the insureds’ claim on less favorable terms than those provided in, and contemplated by, the subject policy in direct violation of Florida Statutes § 626.9541(1)(i)(2). Further, Slide is in violation of Florida Statutes §§ 626.9541(1)(a)(1), 626.9541(1)(i)(3)(b), and 626.9541(1)(a)(1) by misrepresenting pertinent facts and insurance policy provisions relating to coverages at issue. Slide is also in violation of Florida Statutes § 626.9541(1)(i)(3)(d) by excluding portions of Loss from its estimate for the insureds’ claim without conducting a reasonable investigation based upon available information and Florida Statutes § 626.9541(1)(i)(3)(a) for failing to adopt and implement standards for the proper investigation of claims.
Lisa Wolff and Dylan Wolff have made every effort to comply with all policy requirements, and it is only fair that the insurance company reciprocates the same. Slide has failed to properly investigate the Loss and promptly indemnify the insureds causing delay. An insurer’s obligation to make prompt communications and payment is an essential part of the contract for insurance, and an insurer’s failure to make prompt payment constitutes a breach of the implied covenant of good faith and fair dealing. Fla. Stat. § 627.70131; See also Vest v. Travelers Ins. Co., 753 So. 2d 1270, 1275 (Fla. 2000).
In summary, the Loss is clearly covered by the terms of the policy of insurance with Slide as evidenced by the investigations of Mr. Howell, Santi Clean, and Luce Air Quality. Notwithstanding, Slide has wholly abrogated its statutory duties to Lisa and Dillon by ceasing all communication with them. Despite clear evidence that the damages were covered and caused by a covered peril, the Claim was constructively denied by lack of contact exceeding the statutory maximum and constructively low-balled by Slide’s providing an underestimation of the Loss. To date, Slide continues to deny Lisa and Dylan full indemnity for the claim. Under the Slide all-risk policy, while Slide provided insurance coverage, covered damage occurred to the insured property far in excess to what Slide provided coverage for in the Claim. See Jones v. Federated Nat'l Ins. Co., 235 So. 3d 936, 942 (Fla. 4th DCA 2018). Despite clear indicators of covered damage, Slide nevertheless inexplicably ceased all communication with Lisa and Dylan regarding the Claim and has refused to issue a coverage determination or payment.
The concept of insurance in a state like Florida, where adjustment of claims engages the public trust, necessitates that insurers actually communicate their coverage determinations with their insureds timely and fully and fairly value policyholder claims and issue timely payment for the full value of those claims according to the unambiguous terms of the involved policies. Slide failed to do this for the Claim and thereby breached its duty to Lisa and Dylan.
Additional wrongful conduct by the Insurer may exist that has not yet been discovered. Certain conduct or actions cannot be verified without a review of the Insurer’s claim file, claim guidelines, and other internal documentation.
This notice is provided to Slide so that it may cure the defects described herein, or so that Lisa and Dylan may pursue civil remedies pursuant to Fla. Stat. § 624.155 if Slide does not cure. To cure, Slide must:
1. Tender all monies due for the Claim pursuant to the Policy;
2. Pay statutory interest on the amount of unpaid contract damages from the date of loss to the date of cure pursuant to Florida Statutes § 627.70131.
3. Pay the insureds’ attorney’s fees and costs pursuant to Florida Statutes § 624.155.
Failure to cure all defects during the 60-day safe harbor period may result in additional extra-contractual damages.
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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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