Filing Number: 807627
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| Filing Accepted: 2/20/2025 |
| Last/Business Name
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MYRTLE TRACE CONDOMINIUM ASSOCIATION INC.
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First Name |
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| Street Address
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302-304 PEMBROKE DRIVE |
| City, State Zip
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VENICE,
FL
34293
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| Email Address
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BRIAN@HLLAWGROUP.COM |
| Complainant Type:
*
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Insured |
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| Last/Business Name* |
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MYRTLE TRACE CONDOMINIUM ASSOCIATION INC. |
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First Name |
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| Policy # * |
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AMC – 38162-00 |
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Claim #* |
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4199851 |
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Attorney is Applicable
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| Last Name* |
LEWIS
First Name *
BRIAN
Initial
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| Street Address* |
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2601 EAST OAKLAND PARK BOULEVARD #503 |
| City, State Zip* |
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FORT LAUDERDALE
,
FL
33306
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| Email Address * |
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BRIAN@HLLAWGROUP.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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AMERICAN COASTAL 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 12968 |
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| Name of individual responsible for violation (if any):*
STEPHEN WHITTEN; HELEN SINGLETARY; ANASTASIA HOCH; SYLVIA SOLAR; LINNETTE FRANCOIS; ADAM MARKOWITZ; ZAMAL DWARKA; AND ANY AND ALL ADJUSTERS, SUPERVISORS, MANAGEMENT, AND ANY OTHER INDIVIDUALS ASSOCIATED WITH OR RETAINED BY AMERICAN COASTAL INSURANCE
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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 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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
MYRTLE TRACE CONDOMINIUM ASSOCIATION INC. (THE “COMPLAINANT”), UPON INFORMATION AND BELIEF, ASSERTS THAT THE FOLLOWING POLICY PROVISIONS ARE APPLICABLE:
THE POLICY LANGUAGE RELEVANT TO THE VIOLATIONS ALLEGED INCLUDES, BUT IS NOT LIMITED TO:
1) THOSE RELATED TO THE CONDOMINIUM ASSOCIATION COVERAGE FORM,
2) THOSE RELATED TO “BUILDING” DAMAGES,
3) THOSE RELATED TO COVERED PROPERTY,
4) THOSE RELATED TO COVERED CAUSES OF LOSS,
5) THOSE RELATED TO THE INSURER'S DUTY TO ACKNOWLEDGE THE LOSS AND/OR CLAIM,
6) THOSE RELATED TO THE INSURER’S DUTY TO ADJUST THE LOSS AND/OR CLAIM,
7) THOSE RELATED TO THE INSURER’S DUTY TO ACT ON AND TIMELY PAY CLAIMS,
8) THOSE RELATED TO LOSS CONDITIONS.
9) THOSE RELATED SPECIFICALLY TO REPLACEMENT COST VALUE,
10) THOSE RELATED SPECIFICALLY TO THE HURRICANE DEDUCTIBLE
ALSO,
1) PROEPRTY ENHANCEMENT ENDORESMENT,
2) BUILDING AND PERSONAL COVERAGE FORM,
3) CAUSE OF LOSS- SPECIAL FORM,
4) STANDARD PROPERTY POLICY - DECLARATION,
5) THE "DUTIES IN THE EVENT OF LOSS OR DAMAGE" PROVISIONS,
6) THE "LOSS SETTLEMENT" CLAUSE,
7) THE "LOSS PAYMENT" SECTION, AS WELL AS
8) ORDINANCE OR LAW COVERAGE – ENDORSEMENT
9) OTHER PORTIONS OF THE "CONDITIONS" PORTION OF THE POLICY GENERALLY, AND ANY OTHER CONTRACTUAL PROVISIONS THAT ARE OR APPEAR RELEVANT BASED ON A REASONABLE READING OF THE FOLLOWING EXPLANATION OF THE "FACTS AND CIRCUMSTANCES".
AND FINALLY,
1) COVERAGE A LIMIT OF INSURANCE,
2) PROPERTY NOT COVERED SECTION OF THE POLICY,
3) ADDITIONAL COVERAGES
4) INCREASED COST OF CONSTRUCTION,
5) THE VALUATION SECTION OF THE POLICY.
Complainant reserves its right to amend to include any and all additional Coverage provisions that may become applicable upon further investigation.
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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.
The notice is given in order to perfect the right to pursue the civil remedy authorized by F.S §624.155.
The immediate repair/replacement of an Insured’s damages after a covered loss serves an important public policy concern. Despite this, AMERICAN COASTAL INSURANCE COMPANY (hereinafter “Carrier”) has still refused and failed to fully pay MYRTLE TRACE CONDOMINIUM ASSOCIATION INC, (hereinafter the “Complainant”) reasonable and necessary insurance benefits for services necessary to be rendered to the buildings as a result of a loss caused by Hurricane Ian, on or about September 28, 2022.
In Florida, the adjusting of insurance claims involves a special relationship of trust with the public. As such, insurance adjusters and insurance company claims representatives are imposed with a duty of good faith claims conduct, and must adhere to the Code of Ethics which can be found in the Florida Administrative Code in rule 69B-220.201, F.A.C. This duty of good faith transfers to claims for insurance benefits. Carrier has breached this duty by its adjustment of the Complainant’s claim for insurance benefits as a result of Hurricane Ian.
If the insurance company fails to fulfill its obligations, such as Carrier has done with regard to this claim, the policyholder, not only suffers contractual damages but also extra-contractual damages. When an insurance company fails to pay fully and properly on claims it owes or engages in wrongful practices, contractual damages alone are inadequate. It is hardly a penalty to require an insurer to pay an insured what it owed all along. Accordingly, the Florida legislature addressed the need for a bad faith action against an insurer in §624.155, Fla. Stat., and the Complainant adopts and incorporates all provisions of that statute into this Civil Remedy Notice including all of the applicable provisions of §624.155.
I. Carrier has violated the following statutory provisions, specifically, Fla. Stat. § 626.9541(1)(i)(3)(a); § 624.155(1)(b)(3); § 624.155(1)(b)(1)
Complainant timely filed a claim for insurance benefits on November 18, 2022, as a result of property damage discovered to have been the result of Hurricane Ian, or on about September 28, 2022.
Carrier has failed to create and implement adequate guidelines for proper investigation and evaluation of claims and for training and supervision of employees and adjusters resulting in statutory violations as set forth herein, such as to Fla Stat. § 626.9541(1)(i)(3)(a). Carrier has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Complainant’s claim for insurance benefits, as is evidenced by the claim investigation.
Carrier’s assigned Jonathan Humphries with Sedewick on November 30, 2022 to inspect the subject buildings with a building consultant present. It was acknowledged that a covered loss occurred at the Property. The Carrier valued the claim at $517,994.13 less recoverable depreciation and deductible, which lead to an Actual Cash Value of $48,396.80. No additional payment was send after the $100,000 advance was issued.
The valuation was based on the following:
Summary for Location 90
Line Item Total 4,918.36
Material Sales Tax 31.47
Subtotal 4,949.83
Overhead 358.24
Profit 358.24
Total Cleaning Tax 4.67
Replacement Cost Value $5,670.98
Less Deductible [Full Deductible = 12,439.10] (5,670.98)
Net Claim $0.00
Summary for Location 89
Line Item Total 4,262.08
Material Sales Tax 30.93
Subtotal 4,293.01
Overhead 292.54
Profit 292.54
Total Cleaning Tax 4.67
Replacement Cost Value $4,882.76
Less Deductible [Full Deductible = 28,331.45] (4,882.76)
Net Claim $0.00
Summary for Location 88
Line Item Total 9,155.25
Material Sales Tax 107.71
Subtotal 9,262.96
Overhead 789.53
Profit 789.53
Total Cleaning Tax 9.35
Replacement Cost Value $10,851.37
Less Deductible [Full Deductible = 25,595.07] (10,851.37)
Net Claim $0.00
Summary for Location 87
Line Item Total 7,466.72
Material Sales Tax 6.10
Subtotal 7,472.82
Overhead 610.52
Profit 610.52
Total Cleaning Tax 4.67
Replacement Cost Value $8,698.53
Less Deductible [Full Deductible = 25,637.37] (8,698.53)
Net Claim $0.00
Summary for Location 86
Line Item Total 4,323.86
Material Sales Tax 3.39
Subtotal 4,327.25
Overhead 295.96
Profit 295.96
Total Cleaning Tax 4.67
Replacement Cost Value $4,923.84
Less Deductible [Full Deductible = 27,922.55] (4,923.84)
Net Claim $0.00
Summary for Location 85
Line Item Total 11,093.72
Material Sales Tax 12.71
Subtotal 11,106.43
Overhead 973.88
Profit 973.88
Total Cleaning Tax 4.67
Replacement Cost Value $13,058.86
Less Deductible [Full Deductible = 25,637.37] (13,058.86)
Net Claim $0.00
Summary for Location 84
Line Item Total 4,323.86
Material Sales Tax 3.39
Subtotal 4,327.25
Overhead 295.96
Profit 295.96
Total Cleaning Tax 4.67
Replacement Cost Value $4,923.84
Less Deductible [Full Deductible = 28,331.45] (4,923.84)
Net Claim $0.00
Summary for Location 83
Line Item Total 6,462.86
Material Sales Tax 7.28
Subtotal 6,470.14
Overhead 510.25
Profit 510.25
Total Cleaning Tax 4.67
Replacement Cost Value $7,495.31
Less Deductible [Full Deductible = 27,922.55] (7,495.31)
Net Claim $0.00
Summary for Location 82
Line Item Total 4,509.86
Material Sales Tax 3.73
Subtotal 4,513.59
Overhead 314.59
Profit 314.59
Total Cleaning Tax 4.67
Replacement Cost Value $5,147.44
Less Deductible [Full Deductible = 27,321.60] (5,147.44)
Net Claim $0.00
Summary for Location 81
Line Item Total 5,341.71
Material Sales Tax 4.07
Subtotal 5,345.78
Overhead 397.81
Profit 397.81
Total Cleaning Tax 4.67
Replacement Cost Value $6,146.07
Less Deductible [Full Deductible = 27,922.55] (6,146.07)
Net Claim $0.00
Summary for Location 80
Line Item Total 5,194.89
Material Sales Tax 6.32
Subtotal 5,201.21
Overhead 383.35
Profit 383.35
Total Cleaning Tax 4.67
Replacement Cost Value $5,972.58
Less Deductible [Full Deductible = 28,331.45] (5,972.58)
Net Claim $0.00
Summary for Location 79
Line Item Total 5,040.85
Material Sales Tax 10.11
Subtotal 5,050.96
Overhead 368.32
Profit 368.32
Total Cleaning Tax 4.67
Replacement Cost Value $5,792.27
Less Deductible [Full Deductible = 28,331.45] (5,792.27)
Net Claim $0.00
Summary for Location 78
Line Item Total 6,579.25
Material Sales Tax 49.41
Subtotal 6,628.66
Overhead 526.12
Profit 526.12
Total Cleaning Tax 4.67
Replacement Cost Value $7,685.57
Less Deductible [Full Deductible = 27,922.55] (7,685.57)
Net Claim $0.00
Summary for Location 77
Line Item Total 6,539.25
Material Sales Tax 12.80
Subtotal 6,552.05
Overhead 518.44
Profit 518.44
Total Cleaning Tax 4.67
Replacement Cost Value $7,593.60
Less Deductible [Full Deductible = 27,325.25] (7,593.60)
Net Claim $0.00
Summary for Location 76
Line Item Total 5,532.86
Material Sales Tax 5.59
Subtotal 5,538.45
Overhead 417.08
Profit 417.08
Total Cleaning Tax 4.67
Replacement Cost Value $6,377.28
Less Deductible [Full Deductible = 27,922.55] (6,377.28)
Net Claim $0.00
Summary for Location 75
Line Item Total 4,881.86
Material Sales Tax 4.40
Subtotal 4,886.26
Overhead 351.86
Profit 351.86
Total Cleaning Tax 4.67
Replacement Cost Value $5,594.65
Less Deductible [Full Deductible = 27,321.60] (5,594.65)
Net Claim $0.00
Summary for Location 74
Line Item Total 3,951.86
Material Sales Tax 2.71
Subtotal 3,954.57
Overhead 258.69
Profit 258.69
Total Cleaning Tax 4.67
Replacement Cost Value $4,476.62
Less Deductible [Full Deductible = 27,298.90] (4,476.62)
Net Claim $0.00
Summary for Location 73
Line Item Total 3,858.86
Material Sales Tax 2.54
Subtotal 3,861.40
Overhead 249.37
Profit 249.37
Total Cleaning Tax 4.67
Replacement Cost Value $4,364.81
Less Deductible [Full Deductible = 24,189.30] (4,364.81)
Net Claim $0.00
Summary for Location 72
Line Item Total 3,493.73
Material Sales Tax 0.59
Subtotal 3,494.32
Overhead 212.66
Profit 212.66
Total Cleaning Tax 4.67
Replacement Cost Value $3,924.31
Less Deductible [Full Deductible = 25,760.15] (3,924.31)
Net Claim $0.00
Summary for Location 71
Line Item Total 4,788.86
Material Sales Tax 4.24
Subtotal 4,793.10
Overhead 342.54
Profit 342.54
Total Cleaning Tax 4.67
Replacement Cost Value $5,482.85
Less Deductible [Full Deductible = 26,559.75] (5,482.85)
Net Claim $0.00
Summary for Location 70
Line Item Total 4,788.86
Material Sales Tax 4.24
Subtotal 4,793.10
Overhead 342.54
Profit 342.54
Total Cleaning Tax 4.67
Replacement Cost Value $5,482.85
Less Deductible [Full Deductible = 25,453.60] (5,482.85)
Net Claim $0.00
Summary for Location 69
Line Item Total 5,575.83
Material Sales Tax 6.03
Subtotal 5,581.86
Overhead 421.41
Profit 421.41
Total Cleaning Tax 4.67
Replacement Cost Value $6,429.35
Less Deductible [Full Deductible = 25,453.60] (6,429.35)
Net Claim $0.00
Summary for Location 68
Line Item Total 8,224.71
Material Sales Tax 9.32
Subtotal 8,234.03
Overhead 686.63
Profit 686.63
Total Cleaning Tax 4.67
Replacement Cost Value $9,611.96
Less Deductible [Full Deductible = 25,453.60] (9,611.96)
Net Claim $0.00
Summary for Location 67
Line Item Total 6,834.86
Material Sales Tax 7.96
Subtotal 6,842.82
Overhead 547.52
Profit 547.52
Total Cleaning Tax 4.67
Replacement Cost Value $7,942.53
Less Deductible [Full Deductible = 28,331.45] (7,942.53)
Net Claim $0.00
Summary for Location 66
Line Item Total 6,648.86
Material Sales Tax 7.62
Subtotal 6,656.48
Overhead 528.88
Profit 528.88
Total Cleaning Tax 4.67
Replacement Cost Value $7,718.91
Less Deductible [Full Deductible = 25,758.65] (7,718.91)
Net Claim $0.00
Summary for Location 65
Line Item Total 5,997.86
Material Sales Tax 6.44
Subtotal 6,004.30
Overhead 463.66
Profit 463.66
Total Cleaning Tax 4.67
Replacement Cost Value $6,936.29
Less Deductible [Full Deductible = 25,758.65] (6,936.29)
Net Claim $0.00
Summary for Location 64
Line Item Total 6,849.56
Material Sales Tax 25.15
Subtotal 6,874.71
Overhead 550.71
Profit 550.71
Total Cleaning Tax 4.67
Replacement Cost Value $7,980.80
Less Deductible [Full Deductible = 25,758.65] (7,980.80)
Net Claim $0.00
Summary for Location 63
Line Item Total 5,160.86
Material Sales Tax 4.91
Subtotal 5,165.77
Overhead 379.81
Profit 379.81
Total Cleaning Tax 4.67
Replacement Cost Value $5,930.06
Less Deductible [Full Deductible = 25,760.15] (5,930.06)
Net Claim $0.00
Summary for Location 62
Line Item Total 9,679.36
Material Sales Tax 117.82
Subtotal 9,797.18
Overhead 842.95
Profit 842.95
Total Cleaning Tax 4.67
Replacement Cost Value $11,487.75
Less Deductible [Full Deductible = 25,834.15] (11,487.75)
Net Claim $0.00
Compass Building Services, LLC
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Summary for Location 61
Line Item Total 10,482.95
Material Sales Tax 60.96
Subtotal 10,543.91
Overhead 917.63
Profit 917.63
Total Cleaning Tax 4.67
Replacement Cost Value $12,383.84
Less Deductible [Full Deductible = 24,189.30] (12,383.84)
Net Claim $0.00
Compass Building Services, LLC
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Compass
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Summary for Location 60
Line Item Total 13,957.54
Material Sales Tax 31.15
Subtotal 13,988.69
Overhead 1,262.11
Profit 1,262.11
Total Cleaning Tax 4.67
Replacement Cost Value $16,517.58
Less Deductible [Full Deductible = 25,758.65] (16,517.58)
Net Claim $0.00
Compass Building Services, LLC
181
Compass
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Summary for Location 59
Line Item Total 4,881.86
Material Sales Tax 4.40
Subtotal 4,886.26
Overhead 351.86
Profit 351.86
Total Cleaning Tax 4.67
Replacement Cost Value $5,594.65
Less Deductible [Full Deductible = 25,834.15] (5,594.65)
Net Claim $0.00
Compass Building Services, LLC
180
Compass
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Summary for Location 58
Line Item Total 5,620.71
Material Sales Tax 4.57
Subtotal 5,625.28
Overhead 425.76
Profit 425.76
Total Cleaning Tax 4.67
Replacement Cost Value $6,481.47
Less Deductible [Full Deductible = 25,453.60] (6,481.47)
Net Claim $0.00
Compass Building Services, LLC
179
Compass
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Summary for Location 57
Line Item Total 4,066.16
Material Sales Tax 9.20
Subtotal 4,075.36
Overhead 270.77
Profit 270.77
Total Cleaning Tax 4.67
Replacement Cost Value $4,621.57
Less Deductible [Full Deductible = 25,760.15] (4,621.57)
Net Claim $0.00
Compass Building Services, LLC
178
Compass
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Summary for Location 56
Line Item Total 4,974.86
Material Sales Tax 4.57
Subtotal 4,979.43
Overhead 361.18
Profit 361.18
Total Cleaning Tax 4.67
Replacement Cost Value $5,706.46
Less Deductible [Full Deductible = 25,758.65] (5,706.46)
Net Claim $0.00
Compass Building Services, LLC
177
Compass
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Summary for Location 55
Line Item Total 8,544.30
Material Sales Tax 43.82
Subtotal 8,588.12
Overhead 722.04
Profit 722.04
Total Cleaning Tax 4.67
Replacement Cost Value $10,036.87
Less Deductible [Full Deductible = 26,073.60] (10,036.87)
Net Claim $0.00
Compass Building Services, LLC
176
Compass
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Summary for Location 54
Line Item Total 11,788.73
Material Sales Tax 60.66
Subtotal 11,849.39
Overhead 1,048.15
Profit 1,048.15
Total Cleaning Tax 4.67
Replacement Cost Value $13,950.36
Less Deductible [Full Deductible = 25,453.60] (13,950.36)
Net Claim $0.00
Compass Building Services, LLC
175
Compass
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Summary for Location 53
Line Item Total 2,928.86
Material Sales Tax 0.85
Subtotal 2,929.71
Overhead 156.21
Profit 156.21
Total Cleaning Tax 4.67
Replacement Cost Value $3,246.80
Less Deductible [Full Deductible = 25,758.65] (3,246.80)
Net Claim $0.00
Compass Building Services, LLC
174
Compass
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Summary for Location 52
Line Item Total 3,579.86
Material Sales Tax 2.03
Subtotal 3,581.89
Overhead 221.42
Profit 221.42
Total Cleaning Tax 4.67
Replacement Cost Value $4,029.40
Less Deductible [Full Deductible = 25,758.65] (4,029.40)
Net Claim $0.00
Compass Building Services, LLC
173
Compass
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Summary for Location 51
Line Item Total 4,137.86
Material Sales Tax 3.05
Subtotal 4,140.91
Overhead 277.33
Profit 277.33
Total Cleaning Tax 4.67
Replacement Cost Value $4,700.24
Less Deductible [Full Deductible = 25,453.60] (4,700.24)
Net Claim $0.00
Compass Building Services, LLC
172
Compass
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Summary for Location 50
Line Item Total 3,658.31
Material Sales Tax 0.85
Subtotal 3,659.16
Overhead 229.15
Profit 229.15
Total Cleaning Tax 4.67
Replacement Cost Value $4,122.13
Less Deductible [Full Deductible = 25,453.60] (4,122.13)
Net Claim $0.00
Compass Building Services, LLC
171
Compass
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Summary for Location 49
Line Item Total 6,205.91
Material Sales Tax 32.57
Subtotal 6,238.48
Overhead 487.09
Profit 487.09
Total Cleaning Tax 4.67
Replacement Cost Value $7,217.33
Less Deductible [Full Deductible = 25,758.65] (7,217.33)
Net Claim $0.00
Compass Building Services, LLC
170
Compass
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Summary for Location 48
Line Item Total 6,741.86
Material Sales Tax 7.79
Subtotal 6,749.65
Overhead 538.20
Profit 538.20
Total Cleaning Tax 4.67
Replacement Cost Value $7,830.72
Less Deductible [Full Deductible = 25,758.65] (7,830.72)
Net Claim $0.00
Compass Building Services, LLC
169
Compass
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Summary for Location 47
Line Item Total 4,044.86
Material Sales Tax 2.88
Subtotal 4,047.74
Overhead 268.01
Profit 268.01
Total Cleaning Tax 4.67
Replacement Cost Value $4,588.43
Less Deductible [Full Deductible = 25,453.60] (4,588.43)
Net Claim $0.00
Compass Building Services, LLC
168
Compass
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Summary for Location 46
Line Item Total 4,044.86
Material Sales Tax 2.88
Subtotal 4,047.74
Overhead 268.01
Profit 268.01
Total Cleaning Tax 4.67
Replacement Cost Value $4,588.43
Less Deductible [Full Deductible = 25,453.60] (4,588.43)
Net Claim $0.00
Compass Building Services, LLC
167
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Summary for Location 45
Line Item Total 4,717.91
Material Sales Tax 29.86
Subtotal 4,747.77
Overhead 338.02
Profit 338.02
Total Cleaning Tax 4.67
Replacement Cost Value $5,428.48
Less Deductible [Full Deductible = 26,559.75] (5,428.48)
Net Claim $0.00
Compass Building Services, LLC
166
Compass
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Summary for Location 44
Line Item Total 3,393.86
Material Sales Tax 1.69
Subtotal 3,395.55
Overhead 202.79
Profit 202.79
Total Cleaning Tax 4.67
Replacement Cost Value $3,805.80
Less Deductible [Full Deductible = 26,559.75] (3,805.80)
Net Claim $0.00
Compass Building Services, LLC
165
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Summary for Location 43
Line Item Total 5,395.22
Material Sales Tax 8.58
Subtotal 5,403.80
Overhead 403.62
Profit 403.62
Total Cleaning Tax 4.67
Replacement Cost Value $6,215.71
Less Deductible [Full Deductible = 26,559.75] (6,215.71)
Net Claim $0.00
Compass Building Services, LLC
164
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Summary for Location 42
Line Item Total 3,393.86
Material Sales Tax 1.69
Subtotal 3,395.55
Overhead 202.79
Profit 202.79
Total Cleaning Tax 4.67
Replacement Cost Value $3,805.80
Less Deductible [Full Deductible = 25,453.60] (3,805.80)
Net Claim $0.00
Compass Building Services, LLC
163
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Summary for Location 41
Line Item Total 8,328.56
Material Sales Tax 8.36
Subtotal 8,336.92
Overhead 696.92
Profit 696.92
Total Cleaning Tax 4.67
Replacement Cost Value $9,735.43
Less Deductible [Full Deductible = 25,453.60] (9,735.43)
Net Claim $0.00
Compass Building Services, LLC
162
Compass
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Summary for Location 40
Line Item Total 5,625.86
Material Sales Tax 5.76
Subtotal 5,631.62
Overhead 426.40
Profit 426.40
Total Cleaning Tax 4.67
Replacement Cost Value $6,489.09
Less Deductible [Full Deductible = 25,520.45] (6,489.09)
Net Claim $0.00
Compass Building Services, LLC
161
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 161
Summary for Location 39
Line Item Total 3,858.86
Material Sales Tax 2.54
Subtotal 3,861.40
Overhead 249.37
Profit 249.37
Total Cleaning Tax 4.67
Replacement Cost Value $4,364.81
Less Deductible [Full Deductible = 25,453.60] (4,364.81)
Net Claim $0.00
Compass Building Services, LLC
160
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 160
Summary for Location 38
Line Item Total 3,858.86
Material Sales Tax 2.54
Subtotal 3,861.40
Overhead 249.37
Profit 249.37
Total Cleaning Tax 4.67
Replacement Cost Value $4,364.81
Less Deductible [Full Deductible = 25,758.65] (4,364.81)
Net Claim $0.00
Compass Building Services, LLC
159
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 159
Summary for Location 37
Line Item Total 6,648.86
Material Sales Tax 7.62
Subtotal 6,656.48
Overhead 528.88
Profit 528.88
Total Cleaning Tax 4.67
Replacement Cost Value $7,718.91
Less Deductible [Full Deductible = 25,453.60] (7,718.91)
Net Claim $0.00
Compass Building Services, LLC
158
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 158
Summary for Location 36
Line Item Total 4,682.86
Material Sales Tax 61.26
Subtotal 4,744.12
Overhead 337.65
Profit 337.65
Total Cleaning Tax 4.67
Replacement Cost Value $5,424.09
Less Deductible [Full Deductible = 25,758.65] (5,424.09)
Net Claim $0.00
Compass Building Services, LLC
157
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 157
Summary for Location 35
Line Item Total 7,247.87
Material Sales Tax 44.58
Subtotal 7,292.45
Overhead 592.48
Profit 592.48
Total Cleaning Tax 4.67
Replacement Cost Value $8,482.08
Less Deductible [Full Deductible = 25,758.65] (8,482.08)
Net Claim $0.00
Compass Building Services, LLC
156
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 156
Summary for Location 34
Line Item Total 6,369.86
Material Sales Tax 7.11
Subtotal 6,376.97
Overhead 500.93
Profit 500.93
Total Cleaning Tax 4.67
Replacement Cost Value $7,383.50
Less Deductible [Full Deductible = 25,758.65] (7,383.50)
Net Claim $0.00
Compass Building Services, LLC
155
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 155
Summary for Location 33
Line Item Total 6,648.86
Material Sales Tax 7.62
Subtotal 6,656.48
Overhead 528.88
Profit 528.88
Total Cleaning Tax 4.67
Replacement Cost Value $7,718.91
Less Deductible [Full Deductible = 25,453.60] (7,718.91)
Net Claim $0.00
Compass Building Services, LLC
154
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 154
Summary for Location 32
Line Item Total 4,881.86
Material Sales Tax 4.40
Subtotal 4,886.26
Overhead 351.86
Profit 351.86
Total Cleaning Tax 4.67
Replacement Cost Value $5,594.65
Less Deductible [Full Deductible = 26,739.95] (5,594.65)
Net Claim $0.00
Compass Building Services, LLC
153
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 153
Summary for Location 31
Line Item Total 5,221.07
Material Sales Tax 3.11
Subtotal 5,224.18
Overhead 385.66
Profit 385.66
Total Cleaning Tax 4.67
Replacement Cost Value $6,000.17
Less Deductible [Full Deductible = 28,331.45] (6,000.17)
Net Claim $0.00
Compass Building Services, LLC
152
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 152
Summary for Location 30
Line Item Total 4,230.86
Material Sales Tax 3.22
Subtotal 4,234.08
Overhead 286.64
Profit 286.64
Total Cleaning Tax 4.67
Replacement Cost Value $4,812.03
Less Deductible [Full Deductible = 27,148.35] (4,812.03)
Net Claim $0.00
Compass Building Services, LLC
151
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 151
Summary for Location 29
Line Item Total 15,948.54
Material Sales Tax 24.17
Subtotal 15,972.71
Overhead 1,460.51
Profit 1,460.51
Total Cleaning Tax 4.67
Replacement Cost Value $18,898.40
Less Deductible [Full Deductible = 26,073.60] (18,898.40)
Net Claim $0.00
Compass Building Services, LLC
150
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 150
Summary for Location 28
Line Item Total 4,472.05
Material Sales Tax 6.05
Subtotal 4,478.10
Overhead 311.04
Profit 311.04
Total Cleaning Tax 4.67
Replacement Cost Value $5,104.85
Less Deductible [Full Deductible = 28,331.45] (5,104.85)
Net Claim $0.00
Compass Building Services, LLC
149
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 149
Summary for Location 27
Line Item Total 4,932.56
Material Sales Tax 3.81
Subtotal 4,936.37
Overhead 356.87
Profit 356.87
Total Cleaning Tax 4.67
Replacement Cost Value $5,654.78
Less Deductible [Full Deductible = 28,331.45] (5,654.78)
Net Claim $0.00
Compass Building Services, LLC
148
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 148
Summary for Location 26
Line Item Total 3,858.86
Material Sales Tax 2.54
Subtotal 3,861.40
Overhead 249.37
Profit 249.37
Total Cleaning Tax 4.67
Replacement Cost Value $4,364.81
Less Deductible [Full Deductible = 28,331.45] (4,364.81)
Net Claim $0.00
Compass Building Services, LLC
147
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 147
Summary for Location 25
Line Item Total 4,932.56
Material Sales Tax 3.81
Subtotal 4,936.37
Overhead 356.87
Profit 356.87
Total Cleaning Tax 4.67
Replacement Cost Value $5,654.78
Less Deductible [Full Deductible = 28,331.45] (5,654.78)
Net Claim $0.00
Compass Building Services, LLC
146
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 146
Summary for Location 24
Line Item Total 7,627.74
Material Sales Tax 27.11
Subtotal 7,654.85
Overhead 628.73
Profit 628.73
Total Cleaning Tax 4.67
Replacement Cost Value $8,916.98
Less Deductible [Full Deductible = 25,758.65] (8,916.98)
Net Claim $0.00
Compass Building Services, LLC
145
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 145
Summary for Location 23
Line Item Total 4,881.86
Material Sales Tax 4.40
Subtotal 4,886.26
Overhead 351.86
Profit 351.86
Total Cleaning Tax 4.67
Replacement Cost Value $5,594.65
Less Deductible [Full Deductible = 25,760.15] (5,594.65)
Net Claim $0.00
Compass Building Services, LLC
144
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 144
Summary for Location 22
Line Item Total 4,044.86
Material Sales Tax 2.88
Subtotal 4,047.74
Overhead 268.01
Profit 268.01
Total Cleaning Tax 4.67
Replacement Cost Value $4,588.43
Less Deductible [Full Deductible = 26,073.60] (4,588.43)
Net Claim $0.00
Compass Building Services, LLC
143
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 143
Summary for Location 21
Line Item Total 3,114.86
Material Sales Tax 1.19
Subtotal 3,116.05
Overhead 174.84
Profit 174.84
Total Cleaning Tax 4.67
Replacement Cost Value $3,470.40
Less Deductible [Full Deductible = 25,453.60] (3,470.40)
Net Claim $0.00
Compass Building Services, LLC
142
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 142
Summary for Location 20
Line Item Total 3,139.90
Material Sales Tax 1.78
Subtotal 3,141.68
Overhead 177.41
Profit 177.41
Total Cleaning Tax 4.67
Replacement Cost Value $3,501.17
Less Deductible [Full Deductible = 25,829.15] (3,501.17)
Net Claim $0.00
Compass Building Services, LLC
141
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 141
Summary for Location 19
Line Item Total 11,769.76
Material Sales Tax 14.48
Subtotal 11,784.24
Overhead 1,041.67
Profit 1,041.67
Total Cleaning Tax 4.67
Replacement Cost Value $13,872.25
Less Deductible [Full Deductible = 24,028.42] (13,872.25)
Net Claim $0.00
Compass Building Services, LLC
140
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 140
Summary for Location 18
Line Item Total 5,487.12
Material Sales Tax 16.12
Subtotal 5,503.24
Overhead 413.56
Profit 413.56
Total Cleaning Tax 4.67
Replacement Cost Value $6,335.03
Less Deductible [Full Deductible = 25,758.65] (6,335.03)
Net Claim $0.00
Compass Building Services, LLC
139
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 139
Summary for Location 17
Line Item Total 5,904.86
Material Sales Tax 6.27
Subtotal 5,911.13
Overhead 454.35
Profit 454.35
Total Cleaning Tax 4.67
Replacement Cost Value $6,824.50
Less Deductible [Full Deductible = 25,760.15] (6,824.50)
Net Claim $0.00
Compass Building Services, LLC
138
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 138
Summary for Location 16
Line Item Total 4,132.71
Material Sales Tax 1.86
Subtotal 4,134.57
Overhead 276.69
Profit 276.69
Total Cleaning Tax 4.67
Replacement Cost Value $4,692.62
Less Deductible [Full Deductible = 26,073.60] (4,692.62)
Net Claim $0.00
Compass Building Services, LLC
137
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 137
Summary for Location 15
Line Item Total 5,346.86
Material Sales Tax 5.25
Subtotal 5,352.11
Overhead 398.45
Profit 398.45
Total Cleaning Tax 4.67
Replacement Cost Value $6,153.68
Less Deductible [Full Deductible = 25,484.90] (6,153.68)
Net Claim $0.00
Compass Building Services, LLC
136
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 136
Summary for Location 14
Line Item Total 4,881.86
Material Sales Tax 4.40
Subtotal 4,886.26
Overhead 351.86
Profit 351.86
Total Cleaning Tax 4.67
Replacement Cost Value $5,594.65
Less Deductible [Full Deductible = 25,760.15] (5,594.65)
Net Claim $0.00
Compass Building Services, LLC
135
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 135
Summary for Location 13
Line Item Total 5,088.42
Material Sales Tax 10.76
Subtotal 5,099.18
Overhead 373.16
Profit 373.16
Total Cleaning Tax 4.67
Replacement Cost Value $5,850.17
Less Deductible [Full Deductible = 25,453.60] (5,850.17)
Net Claim $0.00
Compass Building Services, LLC
134
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 134
Summary for Location 12
Line Item Total 5,219.37
Material Sales Tax 4.57
Subtotal 5,223.94
Overhead 385.63
Profit 385.63
Total Cleaning Tax 4.67
Replacement Cost Value $5,999.87
Less Deductible [Full Deductible = 25,585.15] (5,999.87)
Net Claim $0.00
Compass Building Services, LLC
133
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 133
Summary for Location 11
Line Item Total 6,757.46
Material Sales Tax 9.84
Subtotal 6,767.30
Overhead 539.96
Profit 539.96
Total Cleaning Tax 4.67
Replacement Cost Value $7,851.89
Less Deductible [Full Deductible = 25,453.60] (7,851.89)
Net Claim $0.00
Compass Building Services, LLC
132
Compass
MYRTLE_TRACE_CONDO 4/10/2024 Page: 132
Summary for Location 10
Line Item Total 6,855.84
Material Sales Tax 11.49
Subtotal 6,867.33
Overhead 549.96
Profit 549.96
Total Cleaning Tax 4.67
Replacement Cost Value $7,971.92
Less Deductible [Full Deductible = 25,328.87] (7,971.92)
Net Claim $0.00
Compass Building Services, LLC
131
Compass
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Summary for Location 9
Line Item Total 6,364.71
Material Sales Tax 5.93
Subtotal 6,370.64
Overhead 500.29
Profit 500.29
Total Cleaning Tax 4.67
Replacement Cost Value $7,375.89
Less Deductible [Full Deductible = 25,500.20] (7,375.89)
Net Claim $0.00
Summary for Location 8
Line Item Total 4,044.86
Material Sales Tax 2.88
Subtotal 4,047.74
Overhead 268.01
Profit 268.01
Total Cleaning Tax 4.67
Replacement Cost Value $4,588.43
Less Deductible [Full Deductible = 25,500.20] (4,588.43)
Net Claim $0.00
Summary for Location 7
Line Item Total 7,006.81
Material Sales Tax 19.55
Subtotal 7,026.36
Overhead 565.86
Profit 565.86
Total Cleaning Tax 4.67
Replacement Cost Value $8,162.75
Less Deductible [Full Deductible = 24,775.72] (8,162.75)
Net Claim $0.00
Summary for Location 6
Line Item Total 16,979.90
Material Sales Tax 55.78
Subtotal 17,035.68
Overhead 1,566.79
Profit 1,566.79
Total Cleaning Tax 4.67
Replacement Cost Value $20,173.93
Less Deductible [Full Deductible = 24,028.47] (20,173.93)
Net Claim $0.00
Summary for Location 5 - Code Upgrade
Line Item Total 0.00
Replacement Cost Value $0.00
Net Claim $0.00
Location 5 - Code Upgrade Paid When Incurred
Line Item Total 2,435.75
Material Sales Tax 11.37
Subtotal 2,447.12
Overhead 244.72
Profit 244.72
Replacement Cost Value $2,936.56
Total Paid When Incurred $2,936.56
Net Claim $0.00
Net Claim if Additional Amounts are Recovered $2,936.56
Summary for Location 5
Line Item Total 107,809.13
Material Sales Tax 1,408.80
Subtotal 109,217.93
Overhead 10,785.04
Profit 10,785.04
Total Cleaning Tax 23.36
Replacement Cost Value $130,811.37
Less Depreciation (30,555.35)
Actual Cash Value $100,256.02
Less Deductible (25,453.60)
Net Claim $74,802.42
Total Recoverable Depreciation 30,555.35
Net Claim if Depreciation is Recovered $105,357.77
Summary for Location 4
Line Item Total 7,350.89
Material Sales Tax 44.65
Subtotal 7,395.54
Overhead 602.79
Profit 602.79
Total Cleaning Tax 4.67
Replacement Cost Value $8,605.79
Less Deductible [Full Deductible = 25,453.60] (8,605.79)
Net Claim $0.00
Summary for Location 3
Line Item Total 6,648.86
Material Sales Tax 7.62
Subtotal 6,656.48
Overhead 528.88
Profit 528.88
Total Cleaning Tax 4.67
Replacement Cost Value $7,718.91
Less Deductible [Full Deductible = 25,758.65] (7,718.91)
Net Claim $0.00
Summary for Location 2
Line Item Total 4,841.70
Material Sales Tax 11.49
Subtotal 4,853.19
Overhead 348.54
Profit 348.54
Total Cleaning Tax 4.67
Replacement Cost Value $5,554.94
Less Deductible [Full Deductible = 25,520.45] (5,554.94)
Net Claim $0.00
Summary for Location 1
Line Item Total 6,279.07
Material Sales Tax 36.25
Subtotal 6,315.32
Overhead 494.76
Profit 494.76
Total Cleaning Tax 4.67
Replacement Cost Value $7,309.51
Less Depreciation (465.55)
Actual Cash Value $6,843.96
Less Deductible [Full Deductible = 25,758.65] (6,843.96)
Net Claim $0.00
Total Depreciation 465.55
Less Residual Deductible [Full Residual Deductible = 18,914.69] (465.55)
Total Recoverable Depreciation 0.00
Net Claim if Depreciation is Recovered $0.00
Complainant had to hire the services of Recovery Insurance Adjusters to assist the adjustment of the claim.
Contrary of the Carrier’s position, Recovery Insurance Adjusters prepared an estimate for the roof replacements of the buildings, along with the necessary work associated with roof replacements. The total value of the estimate came to $16,753,564.70.
Additionally, Complainant had performed temporary measures to protect the Property from further damages, which is consistent with the Policy. These documents were also submitted to the carrier.
Complainant also retained Roof Leak Detection Company, Inc, a Forensic Licensed Engineering Firm, that specializes in Forensic Roof Evaluations, and is a HAAG Certified Roofing Inspector to assess the cause and extent of damage, as well as the appropriate repair methodology of the buildings.
Part of their evaluation and report identified weather date from Weatherstrike from a Certified Meteorologist and Professional Engineer. The report indicated sustained wind speed of 64 mph a few miles from the Property, and wind gusts up to 82mph over a two-hour period.
The evaluation also included walking the slopes of the roofing systems, identifying the type of roofing material, determining the age of the roofs, performing tile testing, and determining weather there are any failures to the roofing systems.
The roofing tile was also identified to be an Entegra brand Skandia type concrete tile which no long has an active state of Florida notice of acceptance, and are no longer in production.
The underlayment consisted of a 90lb membrane adhered to a mechanically attached 30lb base sheet on a plywood substrate. The age of the roofs were approximately 15 years old at the time of Hurricane Ian, which is well withing the normal life expectancy of concrete tile roofs.
They observed fractured tiles, corner cracks, point load fracturing, de-bonded/ displaced hip and ridge cap tiles, temporary patched and active repairs.
• 336-338 Pembroke Drive: 100 tests resulting in 5 failures. 5% failure rate
• 305-307 Pembroke Ln. North: 100 tests resulting in 4 failures. 4% failure rate
• 308-310 Pembroke Ln. North: 100tests resulting in 7 failures. 7% failure rate
• 311-313 Pembroke Ln. North: 120 tests resulting in 8 failures. 6% failure rate
Their opinion consisted of the following:
It is our opinion that the use of dissimilar profile tiles would inhibit and prevent the uniform integrity of tile interlock, thus resulting in point loading. The use of geometrically dissimilar products to repair the discontinued roof tile will prohibit the structural interlock to the original tile and causing the tile to “kick” or rise. These dissimilar profiles will not allow for the seating, thus not allowing the tile to be installed flush to the surface. This condition could also result in the creating of “pressure points” along the under-lock of the adjacent tiles, increasing the susceptibility to “point loading” and potentially resulting in an increased probability of tile failure and breakage under wind load conditions.
Broken field tiles exhibiting vertical fracturing along the points of fastening, point load fracturing, were identified during the evaluation It is our opinion that the extreme forces associated with Hurricane Ian exerted enough vertical uplift forces to fracture tiles at the point of fastening.
Broken field tiles exhibiting right/left hand corner fractures were identified during the evaluation. This is a result of tile movement as a direct physical result of wind forces. It is our opinion that these damages have prohibited tile interlock and resulted in the loss of structural integrity of the tiles. In a December 2008 published article at the Fourth International Conference on Forensic Engineering, Greg McLellan P.E. had the following comments about tiles breaks: “Typically, wind damage to tile roofs includes the tile being lifted, broken and or scattered about the roof and surrounding area. Also tiles with cracks across their lower corners were observed in many cases. While cracks of this nature are often the result of restrained expansion/contraction stresses at a weak location in the tile, these tiles may also be the result of fluttering of mechanically attached tiles under wind pressure”.
The roofing system was originally installed as a mechanically attached roofing system and a contractor would be altering the original installation.
An adhered tile roofing system is dependent upon the underlayment for its ability to resist wind loads. The attachment of the underlayment cannot be verified without removal of the underlayment to ensure that the base sheet to which it is attached to, is properly nailed and meets building code requirements. C. ROOFING APPLICATION STANDARD (RAS) No. 118-20 INSTALLATION OF MECHANICALLY FASTENED ROOF TILE SYSTEMS
GENERAL 1.01 A. Tiles shall not be installed over wet underlayment where moisture prohibits adhesion of mastic, mortar or adhesive. The inability to verify the presence of moisture in the concealed underlayment would further prohibit insert repairs with an adhesive.
Despite the availability of similar or matched roof tiles, a roof repair cannot be performed in cases where there is significant underlayment damage, where back lap issues may be caused by the repair, all while considering applicable building codes. Here is an analysis of these factors:
1. Underlayment damage: The underlayment is a critical component of a roofing system, as it serves as a protective barrier against water infiltration and helps in the overall weatherproofing of a structure. If the underlayment is damaged or compromised as a result of the repair process, a simple repair may not be sufficient to restore the integrity of the roof. In such cases, a complete replacement of the underlayment is necessary. Furthermore, if the damage has spread to the surrounding areas, such as the roof deck or insulation, this may require more extensive repairs or even a full roof replacement.
2. Back lap issues: Back lapping occurs when the upper edge of a roofing material (e.g., shingles, tiles, or metal panels) is not correctly overlapped with the lower edge of the piece above it. This can lead to water infiltration, which can damage the underlying roofing components, such as the underlayment, roof deck, and insulation. If back lap issues are widespread, it becomes difficult to perform targeted repairs, as the entire roof installation may be compromised. In such cases, correcting the back lap issues may necessitate a complete reinstallation of the roofing material, which is more extensive than a simple repair.
3. Florida code compliance: Florida has strict building codes in place to ensure that structures can withstand the extreme weather conditions experienced in the region, such as hurricanes and heavy rainfall. These codes include requirements for roofing materials, underlayment, fasteners, and installation methods. Such one consideration would be the Florida Building Code Section 706.5. If a roof does not meet these code requirements, it may not provide the necessary protection against the elements, putting the structure at risk. Adherence to Florida Building Codes, as described herein, is likely a more costly and labor-intensive undertaking than a repair.
4. When removing the roofing system all flashing components must be removed and this will require paint and stucco repairs.
Despite all this information being provided to the Carrier, the Carrier still refused to acknowledge their scope of damages was improper, and the repair methodology they based their coverage decision on is improper.
The Complainant, through their representative, as provided all necessary documents, complied with all applicable post loss obligations, and is still met with an outright refusal to properly adjust the claim consistent with the evidence before them.
Here it is evident that the Carrier has made every effort to save money by improperly acknowledging only minor repair was needed and discarded any notice of the true extend of what is needed to repair the Property to a pre-loss condition.
Between Claimant’s reports, incurred invoices associated with some of the repairs, and the estimate prepared on the Claimant’s behalf, to place the buildings in a pre-loss condition, the Carrier has had more than ample evidence to show their adjustment of the claim was inaccurate. Carrier has continuously failed to acknowledge the appropriate remedy.
It is clear that Carrier failed to implement standards for proper investigation of the Complainant’s insurance claim.
As a practice, it is far more profitable for an insurance company to take in an insured’s premium and not pay, rather than to promptly and fully pay what is owed. This financial incentive conflicts with the extreme public trust placed in the insurance industry which is the reason that the State of Florida also implemented codes of ethics and good faith duties articulated in the Florida Administrative Code. Insurers and their representatives must follow these ethical duties. Frontline violated the following ethical requirements in its adjustment of the Complainant’s claim for insurance benefits:
4-220.201 Ethical Requirements.
(4) Code of Ethics. The following code of ethics shall be binding on all adjusters:
a) The work of adjusting insurance claims engages the public trust. An adjuster must put the duty for fair and honest treatment of the claimant above the adjuster’s own interests, in every instance.
b) An adjuster shall have no undisclosed financial interest in any direct or indirect aspect of an adjusting transaction…
c) An adjuster shall treat all claimants equally; an adjuster shall not provide favored treatment to any claimant. An adjuster shall adjust all claims strictly in accordance with the insurance contract.
…
f) No adjuster may advise a claimant to refrain from seeking legal advice, nor advise against the retention of counsel to protect the claimant’s interest.
…
i) An adjuster shall not knowingly fail to advise a claimant of their claim rights in accordance with the terms and conditions of the contract and of the applicable laws of this state…
j) An adjuster shall approach investigations, adjustments, and settlements with an unprejudiced and open mind.
k) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.
l) An adjuster shall handle each and every adjustment and settlement with honesty and integrity and allow a fair adjustment or settlement to all parties without remuneration to himself except that to which he is legally entitled.
m) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition thereof.
n) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and acknowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise.
Another clear violation is the lack of communication and clear false statements made to Claimant by Carrier. The Claimant’s representative has reached out on numerous occasions to obtain the engineering report, or findings from the Carrier’s assessment. This report, or findings have been promised to be provided, yet to date, no report or findings to support the Carrier’s position have been sent. Instead, broken promises regarding the timing of certain disclosures appear to be the only consistent behavior form the Carrier. This constitutes a clear practice of ignoring phone calls, failing to communicate, and a deliberate disregard of the claim and the adjuster’s ethical code of conduct.
Not only has there been an egregious lack of communicate, but there have been numerous false statements made by the Carrier to the effect of the above. The Claimant has suffered tremendously from this, and has been the victim of these purposeful delays, and through these misrepresentations for months.
Further, Carrier has failed not only to create and implement adequate guidelines for proper investigation and evaluation of claims resulting in statutory violations as set forth above. The evidence shows by failing to review and adhere to the recommendations made by Claimant’s representatives and experts, a reasonable investigation did not occur. This failure by Carrier resulted in a claim where coverage was afforded, but significantly undervalued with an inaccurate assessment of the scope of damages. Misrepresentations regarding the existence of an engineer report from the carrier, the contents of the report, and a realistic timeframe regarding receiving the report has caused unnecessary delay and is solely the fault of the Carrier.
Carrier has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Complainant’s claim for insurance benefits requiring the Complainant to hire legal counsel.
Carrier has violated the following statutory provisions, specifically, Fla. Stat. § 624.155(1)(b)(1); § 624.155(1)(b)(3); & § 626.9541(1)(i)(3)(b)
Notwithstanding the insured’s timely filing of insurance, the insurance claim, Carrier has failed to settle this claim despite what has been presented and its own failures in its investigation.
As discussed previously, Complainant fully incorporated the above into this section for the basis of establishing the relevant timeline of events.
These representations to the Complainant have continued to be utilized to deter them from seeking proper coverage under the Policy.
Carrier has failed to promptly settle the Complainant’s insurance claim when the obligation to settle the claim has become reasonably clear. To date, Frontline has continued to refuse to acknowledge its obligation to tender all monies due and owing to the Complainant, as no offers were made.
Carrier’s actions are in direct contradiction to its duty to attempt in good faith to settle claims under Fla. Stat. § 624.155 and its previously asserted subparts.
Complainant timely filed a claim for insurance benefits as a result of property damage discovered to have been the result of Hurricane Ian.
Carrier has failed to create and implement adequate guidelines for proper investigation and evaluation of claims and for training and supervision of employees and adjusters resulting in statutory violations as set forth herein, such as to Fla Stat. § 626.9541(1)(i)(3)(a). Carrier has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Complainant’s claim for insurance benefits, as is evidenced by the claim investigation.
Carrier’s assigned adjusters acknowledged coverage for minor damages, but failed to acknowledge the full and proper scope of work needed to put the Complainant in a pre-loss condition. This clearly indicated that coverage was extended for this loss.
To date, Carrier has failed and refused to tender the proper insurance proceeds to the Complainant. Carrier has refused and/or failed to settle the Complainant’s claim for benefits under the insured’s policy when under all circumstances it could and should have done so had it acted fairly and honestly towards the insured. This is wrongful conduct.
Carrier’s failure to perform pursuant to the duties and responsibilities under Florida Statute, the Policy of insurance, and good faith and fair dealing, forced Complainant by and through counsel to file a lawsuit on its behalf.
Florida law imposes no requirement to specify a definite cure amount in a civil remedy notice. Talat Enterprises, Inc., v. Aetna Casualty & Surety Co., 753 So. 2d 1278 (Fla. 2000). However, for clarity purposes, to cure the defects outlined in this civil remedy notice, Frontline 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 to Complainant under the policy in the amount of $16,753,564.70 (less any prior payments and applicable deductible) plus all statutory interest to Complainant;
(3) Act fairly and honestly towards its insureds and with due regard for their interests in attempting to settle its insureds’ claim.
Finally, §624.155(5), Fla. Stat., specifically exposes insurers to the risk of punitive damages should a jury conclude that the acts giving rise to the violation occur with such frequency as to indicate a general business practice and these acts are: (1) willful, wanton and malicious; or (2) in reckless disregard of the rights of its insureds. Should discovery reveal that Carrier’s bad-faith conduct, as referenced above, is a general business practice frequently implemented by Carrier against other insureds, which was done intentionally or in reckless disregard to the insureds’ rights, the Complainant will seek an award of punitive damages from the jury.
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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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