Filing Number: 807744
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| Filing Accepted: 2/20/2025 |
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6156 THORMAN RD. |
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PORT CHARLOTTE,
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33981
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CHERGROWINGINTHELORD@YAHOO.COM |
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Insured |
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ALLEN |
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First Name |
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CHERYL |
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09 1151750173 03 |
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Claim #* |
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224897 |
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Attorney is Applicable
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O'NEIL
First Name *
JONATHAN
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203 FORT WADE, SUITE 260 |
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PONTE VEDRA
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FLORIDA
32081
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JONATHAN@WOOLSEYMORCOM.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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WRIGHT NATIONAL FLOOD INSURANCE COMPANY
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NAIC Company Code 11523 |
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| Name of individual responsible for violation (if any):*
GREG THACKER
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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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Unfair Trade Practice
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Other
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Wrongful claim denial
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Other
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Unfair claim settlement practices
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Other
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Unreasonable investigation
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Other
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Failure to act on claim
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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 complaint handling procedures
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Other
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Misrepresenting the insurance policy provisions to the insured
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Other
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Misrepresenting Florida statutory provisions to the insured
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Other
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Misrepresenting facts to the insured
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Other
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Failure to acknowledge and act promptly upon communications with respect to claims
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Other
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Denying claims without conducting reasonable investigations based upon available information
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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)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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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.
Residential Condominium Building Policy Form
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A. Coverage A—Building Property
We insure against direct physical loss by or from flood to: 1. The dwelling at the described location, or for a period of 45 days at another location as set forth in III.C.2.b, Property Removed to Safety. 2. Additions and extensions attached to and in contact with the dwelling by means of a rigid exterior wall, a solid load-bearing interior wall, a stairway, an elevated walkway, or a roof. At your option, additions and extensions connected by any of these methods may be separately insured. Additions and extensions attached to and in contact with the building by means of a common interior wall that is not a solid load-bearing wall are always considered part of the dwelling and cannot be separately insured. 3. A detached garage at the described location. Coverage is limited to no more than 10 percent of the limit of liability on the dwelling. Use of this insurance is at your option but reduces the building limit of liability. We do not cover any detached garage used or held for use for residential (i.e., dwelling), business, or farming purposes. 4. Materials and supplies to be used for construction, alteration, or repair of the dwelling or a detached garage while the materials and supplies are stored in a fully enclosed building at the described location or on an adjacent property. 5. A building under construction, alteration, or repair at the described location. a. If the structure is not yet walled or roofed as described in the definition for building (see II.B.6.a) then coverage applies: (1) Only while such work is in progress; or (2)If such work is halted, only for a period of up to 90 continuous days thereafter. b. However, coverage does not apply until the building is walled and roofed if the lowest floor, including the basement floor, of a non-elevated building or the lowest elevated floor of an elevated building is: (1) Below the base flood elevation in Zones AH, AE, A1–A30, AR, AR/AE, AR/ AH, AR/A1–A30, AR/A, AR/AO; or (2) Below the base flood elevation adjusted to include the effect of wave action in Zones VE or V1–V30. The lowest floor level is based on the bottom of the lowest horizontal structural member of the floor in Zones VE or V1–V30 or the top of the floor in Zones AH, AE, A1–A30, AR, AR/AE, AR/AH, AR/ A1–A30, AR/A, and AR/AO. 6. A manufactured home or a travel trailer, as described in the II.C.6. If the manufactured home or travel trailer is in a special flood hazard area, it must be anchored in the following manner at the time of the loss: a. By over-the-top or frame ties to ground anchors; or b. In accordance with the manufacturer’s specifications; or c. In compliance with the community’s floodplain management requirements unless it has been continuously insured by the NFIP at the same described location since September 30, 1982. 7. The following items of property which are insured under Coverage A only: a. Awnings and canopies; b. Blinds; c. Built-in dishwashers; d. Built-in microwave ovens; e. Carpet permanently installed over unfinished flooring; f. Central air conditioners; g. Elevator equipment; h. Fire sprinkler systems; i. Walk-in freezers; j. Furnaces and radiators; k. Garbage disposal units; l. Hot water heaters, including solar water heaters; m. Light fixtures; n. Outdoor antennas and aerials fastened to buildings; o. Permanently installed cupboards, bookcases, cabinets, paneling, and wallpaper; p. Plumbing fixtures; q. Pumps and machinery for operating pumps; r. Ranges, cooking stoves, and ovens; s. Refrigerators; and t. Wall mirrors, permanently installed. 8. Items of property below the lowest elevated floor of an elevated postFIRM building located in Zones SFIP DWELLING FORM PAGE 5 OF 30 A1–A30, AE, AH, AR, AR/A, AR/ AE, AR/AH, AR/A1–A30, V1–V30, or VE, or in a basement regardless of the zone. Coverage is limited to the following: a. Any of the following items, if installed in their functioning locations and, if necessary for operation, connected to a power source: (1) Central air conditioners; (2) Cisterns and the water in them; (3) Drywall for walls and ceilings in a basement and the cost of labor to nail it, unfinished and unfloated and not taped, to the framing; (4) Electrical junction and circuit breaker boxes; (5) Electrical outlets and switches; (6) Elevators, dumbwaiters and related equipment, except for related equipment installed below the base flood elevation after September 30, 1987; (7) Fuel tanks and the fuel in them; (8) Furnaces and hot water heaters; (9) Heat pumps; (10) Nonflammable insulation in a basement; (11) Pumps and tanks used in solar energy systems; (12) Stairways and staircases attached to the building, not separated from it by elevated walkways; (13) Sump pumps; (14) Water softeners and the chemicals in them, water filters, and faucets installed as an integral part of the plumbing system; (15) Well water tanks and pumps; (16) Required utility connections for any item in this list; and (17) Footings, foundations, posts, pilings, piers, or other foundation walls and anchorage systems required to support a building. b. Clean-up. B. 5.
Coverage B—Personal Property 1. If you have purchased personal property coverage, we insure against direct physical loss by or from flood to personal property inside a building at the described location, if: a. The property is owned by you or your household family members; and b. At your option, the property is owned by guests or servants. 2. Personal property is also insured for a period of 45 days at another location as set forth in III.C.2.b, Property Removed to Safety. 3. Personal property in a building that is not fully enclosed must be secured to prevent flotation out of the building. If the personal property does float out during a flood, it will be conclusively presumed that it was not reasonably secured. In that case, there is no coverage for such property. 4. Coverage for personal property includes the following property, subject to B.1 above, which is insured under Coverage B only: a. Air conditioning units, portable or window type; b. Carpets, not permanently installed, over unfinished flooring; c. Carpets over finished flooring; d. Clothes washers and dryers; e. “Cook-out” grills; f. Food freezers, other than walk-in, and food in any freezer; and g. Portable microwave ovens and portable dishwashers. Coverage for items of property below the lowest elevated floor of an elevated post-FIRM building located in Zones A1–A30, AE, AH, AR, AR/A, AR/AE, AR/AH, AR/ A1–A30, V1–V30, or VE, or in a basement regardless of the zone, is limited to the following items, if installed in their functioning locations and, if necessary for operation, connected to a power source: a. Air conditioning units, portable or window type; b. Clothes washers and dryers; and c. Food freezers, other than walk-in, and food in any freezer. 6. If you are a tenant and have insured personal property under Coverage B in this policy, we will cover such property, including your cooking stove or range and refrigerator. The policy will also cover improvements made or acquired solely at your expense in the dwelling or apartment in which you reside, but for not more than 10 percent of the limit of liability shown for personal property on the Declarations Page. Use of this insurance is at your option but reduces the personal property limit of liability. 7. If you are the owner of a unit and have insured personal property under Coverage B in this policy, we will also cover your interior walls, floor, and ceiling (not otherwise insured under a flood insurance policy purchased by your condominium association) for not more than 10 percent of the limit of liability shown for personal property on the Declarations Page. Use of this insurance is at your option but reduces the personal property limit of liability. 8. Special Limits. We will pay no more than $2,500 for any one loss to one or more of the following kinds of personal property: a. Artwork, photographs, collectibles, or memorabilia, including but not limited to, porcelain or other figures, and sports cards; b. Rare books or autographed items; c. Jewelry, watches, precious and semi-precious stones, or articles of gold, silver, or platinum; d. Furs or any article containing fur that represents its principal value; or e. Personal property used in any business. 9. We will pay only for the functional value of antiques. C.
Coverage C—Other Coverages 1. Debris Removal a. We will pay the expense to remove non-owned debris that is on or in insured property and debris of insured property anywhere. b. If you or a member of your household perform the removal work, the value of your work will be based on the Federal minimum wage. c. This coverage does not increase the Coverage A or Coverage B limit of liability. a. Sandbags, Supplies, and Labor (1) We will pay up to $1,000 for costs you incur to protect the insured building from a flood or imminent danger of flood, for the following: (a) Your reasonable expenses to buy: (i) Sandbags, including sand to fill them; (ii) Fill for temporary levees; (iii) Pumps; and (iv) Plastic sheeting and lumber used in connection with these items. (b) The value of work, at the Federal minimum wage, that you or a member of your house-hold perform. (2) This coverage for Sandbags, Supplies, and Labor only applies if damage to insured property by or from flood is imminent and the threat of flood damage is apparent enough to lead a person of common prudence to anticipate flood damage. One of the following must also occur: (a) A general and temporary condition of flooding in the area near the described location must occur, even if the flood does not reach the building; or (b) A legally authorized official must issue an evacuation order or other civil order for the community in which the building is located calling for measures to preserve life and property from the peril of flood. This coverage does not increase the Coverage A or Coverage B limit of liability. b. Property Removed to Safety (1) We will pay up to $1,000 for the reasonable expenses you incur to move insured property to a place other than the described location that contains the property in order to protect it from flood or the imminent danger of flood. Reasonable expenses include the value of work, at the Federal minimum wage, you or a member of your household perform. (2) If you move insured property to a location other than the described location that contains the property in order to protect it from flood or the imminent danger of flood, we will cover such property while at that location for a period of 45 consecutive days from the date you begin to move it there. The personal property that is moved must be placed in a fully enclosed building or otherwise reasonably protected from the elements. (3) Any property removed, including a moveable home described in II.6.b and c, must be placed above ground level or outside of the special flood hazard area. (4) This coverage does not increase the Coverage A or Coverage B limit of liability. 3. Condominium Loss Assessments a. Subject to III.C.3.b below, if this policy insures a condominium unit, we will pay, up to the Coverage A limit of liability, your share of loss assessments charged against you by the condominium association in accordance with the condominium association’s articles of association, declarations and your deed. The assessment must be made because of direct physical loss by or from flood during the policy term, to the unit or to the common elements of the NFIP insured condominium building in which this unit is located. b. We will not pay any loss assessment: (1) Charged against you and the condominium association by any governmental body; (2) That results from a deductible under the insurance purchased by the condominium association insuring common elements; (3) That results from a loss to personal property, including contents of a condominium building; (4) In which the total payment combined under all policies exceeds the maximum amount of coverage available under the Act for a single unit in a condominium building where the unit is insured under both a Dwelling Policy and a RCBAP; or (5) On any item of damage that has already been paid under a RCBAP where a single unit in a condominium building is insured by both a Dwelling Policy and a RCBAP. c. Condominium Loss Assessment coverage does not increase the Coverage A Limit of Liability and is subject to the maximum coverage limits available for a single-family dwelling under the Act, payable between all policies issued and covering the unit, under the Act. D. Coverage D—Increased Cost of Compliance 1. General This policy pays you to comply with a State or local floodplain management law or ordinance affecting repair or reconstruction of a building suffering flood damage. Compliance activities eligible for payment are: elevation, floodproofing, relocation, or demolition (or any combination of these activities) of your building. Eligible floodproofing activities are limited to: a. Non-residential buildings. b. Residential buildings with basements that satisfy FEMA’s standards published in the Code of Federal Regulations [44 CFR 60.6(b) or (c)]. 2. Limit of Liability We will pay you up to $30,000 under this Coverage D—Increased Cost of Compliance, which only applies to policies with building coverage (Coverage A). Our payment of claims under Coverage D is in addition to the amount of coverage which you selected on the application and which appears on the Declarations Page. But the maximum you can collect under this policy for both Coverage A—Building Property and Coverage D—Increased Cost of Compliance cannot exceed the maximum permitted under the Act. We do not charge a separate deductible for a claim under Coverage D. 3. Eligibility a. A building insured under Coverage A— Building Property sustaining a loss caused by a flood as defined by this policy must: (1) Be a “repetitive loss building.” A repetitive loss building is one that meets the following conditions: (a) The building is insured by a contract of flood insurance issued under the NFIP. (b) The building has suffered flood damage on two occasions during a 10-year period which ends on the date of the second loss. (c) The cost to repair the flood damage, on average, equaled or exceeded 25 percent of the market value of the building at the time of each flood loss. (d) In addition to the current claim, the NFIP must have paid the previous qualifying claim, and the State or community must have a cumulative, substantial damage provision or repetitive loss provision in its floodplain management law or ordinance being enforced against the building; or (2) Be a building that has had flood damage in which the cost to repair equals or exceeds 50 percent of the market value of the building at the time of the flood. The State or community must have a substantial damage provision in its floodplain management law or ordinance being enforced against the building. b. This Coverage D pays you to comply with State or local floodplain management laws or ordinances that meet the minimum standards of the National Flood Insurance Program found in the Code of Federal Regulations at 44 CFR 60.3. We pay for compliance activities that exceed those standards under these conditions: (1) 3.a.1 above. (2) Elevation or floodproofing in any risk zone to preliminary or advisory base flood elevations provided by FEMA which the State or local government has adopted and is enforcing for flooddamaged buildings in such areas. (This includes compliance activities in B, C, X, or D zones which are being changed to zones with base flood elevations. This also includes compliance activities in zones where base flood elevations are being increased, and a flood-damaged building must comply with the higher advisory base flood elevation.) Increased Cost of Compliance coverage does not apply to situations in B, C, X, or D zones where the community has derived its own elevations and is enforcing elevation or floodproofing requirements for flooddamaged buildings to elevations derived solely by the community. (3) Elevation or floodproofing above the base flood elevation to meet State or local “free-board” requirements, i.e., that a building must be elevated above the base flood elevation. c. Under the minimum NFIP criteria at 44 CFR 60.3(b)(4), States and communities must require the elevation or floodproofing of buildings in unnumbered A zones to the base flood elevation where elevation data is obtained from a Federal, State, or other source. Such compliance activities are eligible for Coverage D. d. Coverage D will pay for the incremental cost, after demolition or relocation, of elevating or floodproofing a building during its rebuilding at the same or another site to meet State or local floodplain management laws or ordinances, subject to Coverage D Exclusion 5.g below. e. Coverage D will pay to bring a flood-damaged building into compliance with State or local floodplain management laws or ordinances even if the building had received a variance before the present loss from the applicable floodplain management requirements.
Also refer to:
Coverage A provision, coverage B provision, coverage C provision, coverage D provision, all additional coverages provisions, all coverages provided by endorsement or rider, the declarations page, loss payment or settlement provision, duties in event of loss policy provision, all terms and conditions of section I of the insurance policy, the insurance policy definitions section, the insurance policy‘s exclusion of coverage provisions, all insurance policy provisions that provide coverage to the insured property, and all policy provisions.
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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.
624.155(1)(a)(1) – violating 626.9541(1)(i)
626.9541(1)(a)(1) -- misrepresenting the terms of an insurance policy.
626.9541(1)(i) -- unfair claim settlement practices.
Facts of the case:
Wright National Flood Insurance Company (hereinafter referred to as “WRIGHT”) has committed the following in handling the insured’s claim: 1) failure to pay benefits owed; 2) failure to act in due diligence and good faith to resolve claims; 3) placing the financial interest of the insurer before that of the policy holder and claimant; 4) failure to properly train, evaluate, and manage adjusters retained to represent the policies and procedures of WRIGHT; 5) looking for ways to delay benefit payments and otherwise “low ball” or “stone wall” claims; 6) looking for ways to deny the insured’s claim; 7) looking for ways to reduce recovery to the insured; 8) failure to perform a reasonable investigation; 9) misrepresenting Florida statutory provisions to its insured; 10) misrepresenting insurance policy provisions to the insured; 11) WRIGHT has failed and refused to acknowledge coverage and promptly pay the benefits due and owed to the insured; 12) the reasons for this may be attributed to improper training, supervision, and/or motivation of outside adjusters and claims supervisors to promptly and fairly adjust and pay full benefits available to the insured. The insurer may have failed to adopt proper standards of investigation and adjustment of losses or is otherwise not implementing those standards because a proper investigation and full and prompt payment for the loss is not occurring.
In Florida, the work of adjusting insurance claims engages the public trust. WRIGHT has breached this duty by its adjustment of the insured’s claim of loss. WRIGHT has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees resulting in violations as set forth above. WRIGHT has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the insured’s insurance claim for damages. Despite the insured’s timely notification to WRIGHT of their insurance claim, WRIGHT has failed and refused to acknowledge the covered loss and pay all amounts due and owing to the insured under the policy of insurance. WRIGHT has failed to promptly settle the insured’s insurance claim, when the obligation to settle the claim had become reasonably clear, under one portion of the insurance, in order to influence settlements under other portions of the insurance policy coverage. Despite the insured’s pleas otherwise, WRIGHT has failed and refused to acknowledge its obligation to tender all insurance proceed monies due and owing the insured or assist the insured in mitigation of the damages.
In exchange for a premium paid by the insured, WRIGHT issued the subject insurance policy which provided coverage for the insured property for “direct physical loss by or from flood.” As such, the subject Policy contains coverage for all direct physical losses to the insured property caused by flood unless the loss is specifically and unambiguously excluded from coverage by the Policy. On or about September 28, 2022, the insured property suffered a flood loss (Hurricane Ian), and the insured immediately submitted a claim to WRIGHT for flood damage throughout the insured property. Hence, the insured suffered a substantial loss regarding the real property and continue to suffer such loss. Having suffered such substantial damage, the insured promptly notified WRIGHT of the loss in an effort to mitigate the current damage and prevent the exacerbation of any additional losses. The desired result did not follow. WRIGHT since being presented the Insured’s claim has misrepresented policy provisions to avoid paying the insured what they are owed under the policy. Ultimately, WRIGHT has failed and refused to properly settle the insured’s claim in good faith. The insured have requested that WRIGHT conduct an investigation, admit coverage, and pay damages; WRIGHT has failed and refused to do so. In short, WRIGHT has failed to handle its insured’s claim in good faith in violation of Fla. Stat. 624.155(1)(b)(1), 624.155(1)(b)(3), and 626.9541(1)(i).
Based upon WRIGHT’s investigation and property inspection, which confirmed flood damage, on or about January 31, 2023, WRIGHT sent correspondence to the insured confirming partial coverage, denying the remainder, and issuing payment for only $19,846.42. In regard to insurance contracts, a specific refusal to pay a claim is the breach which triggers the cause of action. 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) (finding that a breach of contract takes place at the moment the insurance company refuses to pay a claim). Therefore, WRIGHT breached the Policy.
Concerned with the accuracy of WRIGHT’s coverage determination and partial denial, and given the extensive nature of the physical damage, the insured retained a loss consultant, River City Claims (“RCC”), to perform an investigation and damage evaluation in accordance with industry standards and Florida law. Based on its investigation, RCC determined that a flood (Hurricane Ian) on or about September 28, 2022 caused flood damage throughout the insured property. Moreover, RCC determined that at least $107,473.15 (dwelling) and $36,000.00 (contents), totaling $143,473.15 worth of repairs would be required to return the property to its pre-loss condition as a result of the flood loss. Nevertheless, WRIGHT failed and refused to acknowledge the covered loss and pay all amounts due and owing under the Policy. Therefore, WRIGHT breached the Policy. Thereafter, the insured sent correspondence to WRIGHT enclosing the Sworn Statement in Proof of Loss and the supporting RCC report outlining the cause, scope, and cost of the loss along with other supporting documents and requested WRIGHT to reconsider its coverage denial. Nevertheless, WRIGHT failed and refused to acknowledge the covered loss and pay all amounts due and owing under the Policy, including specifically rejecting appraisal via correspondence dated February 16, 2024 and specifically rejecting the Sworn Statement in Proof of Loss via correspondence dated August 13, 2024. Therefore, WRIGHT breached the Policy.
Questioning the propriety of WRIGHT’s continued coverage denial, and given the extensive nature of the physical damage, the insured retained a licensed contractor and independent adjuster, Tom Gannon with LSC Construction Consultants, LLC (“LSC”), to perform an investigation and damage evaluation in accordance with industry standards and Florida law. Based on his investigation, Mr. Gannon concluded that a flood (Hurricane Ian) on or about September 28, 2022 caused covered flood damage throughout the insured property. Moreover, Mr. Gannon determined that at least $77,921.63 RCV / $74,171.63 ACV (dwelling) worth of repairs would be required to return the property to its pre-loss condition as a result of the flood loss. Nevertheless, WRIGHT failed and refused to acknowledge the covered loss and pay all amounts due and owing under the Policy. Therefore, WRIGHT breached the Policy.
On February 20, 2025, the insured sent correspondence to WRIGHT enclosing the Sworn Statement in Proof of Loss, the supporting LSC report outlining the cause, scope, and cost of the loss along with other supporting documents, the Notice of Intent to Initiate Litigation, and requested WRIGHT to reconsider its coverage denial. To date, WRIGHT has failed and refused to acknowledge the covered loss and pay all amounts due and owing under the Policy. Therefore, WRIGHT breached the Policy.
As such, WRIGHT’s coverage denial is a blatant misrepresentation of the available coverages under the Policy in direct violation of Fla. Stats. 626.9541(1)(a)(1), 626.9541(1)(i)(3)(b), 626.9541(1)(a)(1), and 626.9541(1)(i)(2) and is nothing more than a mere pretext to wrongfully deny and delay this claim. As a result, WRIGHT has materially misrepresented the coverages under the subject policy to the insured for the purpose and with the intent of effecting settlement of the insured’s claim on less favorable terms than those provided in, and contemplated by, the subject policy in direct violation of Fla. Stat. § 626.9541(1)(i)(2). Further, WRIGHT 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 Fla. Stat. 626.9541(1)(i)(3)(d) by denying the insured’s claim without conducting a reasonable investigation based upon available information.
In summary, the insured’s loss is clearly covered by the terms of the policy of insurance with WRIGHT. However, WRIGHT chose to deny coverage for the insured’s loss. Despite clear evidence that the damage was covered and caused by a covered peril, the claim was denied. To date, WRIGHT continues to deny the insured and its insured full indemnity for the claim. While WRIGHT refuses to honor this claim, a jury in Charlotte County will likely do what WRIGHT has refused; exercise the benefit of doubt in favor of the insured in finding full coverage for this loss. Indeed, the insured will undoubtedly meet the burden of proof at trial, under the WRIGHT policy, to show that, while WRIGHT provided insurance coverage, flood damage occurred to the insured property. See Jones v. Federated Nat'l Ins. Co., 235 So. 3d 936, 942 (Fla. 4th DCA 2018). With the data presented within the WRIGHT’s investigation, RCC’s investigation, and LSC’s investigation, WRIGHT’s burden to demonstrate by the greater weight of the evidence that all the physical damage to the insured property was caused solely by excluded perils under the policy and not in combination with a covered peril has not and cannot be met. See Sebo v. Am. Home Assurance Co., Inc., 208 So. 3d 694 (Fla. 2016). Despite clear indicators of covered damage, WRIGHT nevertheless inexplicably denied the insured’s claim.
As of today, WRIGHT has failed and refused to inform the insured of their rights under the policy of insurance and Florida statutes, has improperly delayed the insured’s claim, has wrongfully denied the insured’s claim, and has failed and refused to adequately indemnify the insured for the loss and defiantly continues to do so. Indeed, from the time of receiving the claim, WRIGHT has purposely and maliciously delayed in adjusting the subject claim in an effort to either avoid paying the claim altogether or, at the very least, avoid paying the full extent of the loss. Notably, under Florida law, “[t]he filing of a lawsuit does not extinguish the insurer’s obligations under the policy to adjust and pay the claim.” Tristar Lodging, Inc. V. WRIGHT Specialty Ins. Co., 434 F. Supp. 2d 1286, 1289 (M.D. Fla. 2006).
To date, the insured has made a good faith effort to comply with all of the requirements under the subject policy of insurance, and it is only fair that WRIGHT do the same. Yet, that is not the case. The insured feels that the insured property is a valuable asset, and, by continuously delaying the proper handling of this claim, WRIGHT is putting the insured property at risk. As a responsible property owner, the insured purchased insurance to protect the property, paid all of the premiums, and has kept up to date with the responsibilities under the policy. Yet, when the insured needed to rely on the insurance because of this unforeseen loss, WRIGHT turned its back and delayed and wrongfully denied coverage that the insured are rightfully owed.
Ultimately, WRIGHT has failed and refused to properly investigate the loss. The insured has requested that WRIGHT admit coverage and pay damages, WRIGHT has failed and refused to do so, and continues to refuse to fully indemnify the insured for the loss and pay the amounts necessary to properly repair the insured’s property, despite knowing it is required to do so. In short, WRIGHT has failed to handle its insured’s claim in good faith.
In Florida, the work of adjusting insurance claims engages the public trust; WRIGHT has breached this duty by its insufficient adjustment of the insured’s claim. WRIGHT has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees resulting in statutory violations set forth above. WRIGHT has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the insured’s insurance claim for damages.
Florida statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that the insured may mitigate their damages to put them back into the position they were prior to loss as quickly as possible. WRIGHT breached this duty.
The actions taken by WRIGHT in the handling / adjustment of the insured’s claim were willful, wanton, and with complete disregard for the rights of its insured and occur with such a frequency as to indicate a general business practice and are in violation of Fla. Stat. 624.155 and 626.9541.
WRIGHT’s actions amount to but are not limited to the following:
1. Claim delay
2. Wrongful claim denial
3. Unfair trade practice
4. Unfair claim settlement practices
5. Unreasonable investigation
6. Failure to act on claim
7. Failure to conduct a reasonable investigation based on available information
8. Failure to maintain proper complaint handling procedures
9. Misrepresenting the insurance policy provisions to the insured
10. Misrepresenting Florida statutory provisions to the insured
11. Misrepresenting facts to the insured
12. Failure to acknowledge and act promptly upon communications with respect to claims
13. Denying claims without conducting reasonable investigations based upon available information
14. 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.
15. 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.
16. Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
17. Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
18. Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 90 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 an act of God, prevented by the impossibility of performance, or due to actions by the insured or claimant that constitute fraud, lack of cooperation, or intentional misrepresentation regarding the claim for which benefits are owed.
Therefore, to cure the defects outlined in this civil remedy notice, WRIGHT must:
(1): Admit full coverage for the insured’s loss; and
(2): Tender all insurance monies due and owing to the insured for the loss under the subject Policy.
A copy of this form submitted to the FDFS has been emailed and/or uploaded and also printed out and mailed to the following parties providing them notice of the filing of this civil remedy notice:
Wright National Flood Insurance Company
P.O. Box 33064
St. Petersburg, FL 33733
Floodclaims@weareflood.com
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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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