Filing Number: 808678
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| Filing Accepted: 2/27/2025 |
| Last/Business Name
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ZAK
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First Name |
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CARISSA AND PAUL |
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| Street Address
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922 EAGLE ISLE COURT |
| City, State Zip
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OSPREY,
FL
34229
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| Email Address
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2PAULZAK@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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ZAK |
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First Name |
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CARISSA AND PAUL |
| Policy # * |
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6864421150 |
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Claim #* |
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01000127775 |
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Attorney is Applicable
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| Last Name* |
WEIDNER
First Name *
KEITH
Initial
W.
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| Street Address* |
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1700 W. MAIN ST., SUITE 100 |
| City, State Zip* |
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PENSACOLA
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FL
32502
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| Email Address * |
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KWEIDNER@TWWLAWFIRM.COM |
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| Insurer Type
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Authorized Insurer
Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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FIRST PROTECTIVE INSURANCE COMPANY
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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 10897 |
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| Name of individual responsible for violation (if any):*
CHAD PADGETT; IAN SWANSON; TYLETHA BIVENS
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Claim Delay
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
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| 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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
SECTION I - PROPERTY COVERAGES
A. Coverage A - Dwelling
1. We cover:
a. The dwelling on the "residence premises" shown in the Declarations, including structures attached to the dwelling;
D. Loss Settlement
2. Buildings covered under Coverage A or B at replacement cost without deduction for
depreciation, subject to the following:
a. If, at the time of loss, the amount of insurance in this policy on the damaged building is 80% or more of the full replacement cost of the building immediately before the loss, we will pay the cost to repair or replace, without deduction for depreciation, but not more than the least
of the following amounts:
(1) The limit of liability under this policy that applies to the building;
(2) The replacement cost of that part of the building damaged with material of like kind and quality and for like use; or
(3) The necessary amount actually spent to repair or replace the damaged building.
J. Loss Payment
We will adjust all losses with you. We will pay you unless some other person is named in the policy or is legally entitled to receive payment. Loss will be payable 60 days after we receive your proof of loss and;
SPECIAL PROVISIONS – FLORIDA
a. 20 days after we receive your proof of loss in compliance with SECTION I - CONDITIONS, C. Duties After Loss, paragraph 9, and reach written agreement with you; or
b. 60 days after we receive your proof of loss in compliance with SECTION I - CONDITIONS, C. Duties After Loss, paragraph 9; and
1) There is an entry of a final judgment; or
2) There is a filing of an appraisal award or a mediation settlement with us.
c. If payment is not denied, within 90 days after we receive notice of an initial, reopened or supplemental claim.
This Civil Remedy Notice is also grounded in First Protective Insurance Company d/b/a Frontline Insurance’s statutory duty to act in good faith and deal fairly with its insured when handling claims.
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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 policyholders, Carissa and Paul Zak (collectively “Zak”), sustained losses to their property located at 922 Eagle Isle Ct., Osprey, FL 34229 caused by and following Hurricane Milton as referenced in this Civil Remedy Notice. Zak timely notified First Protective Insurance Company d/b/a Frontline Insurance (“Frontline”) of the claim. In addition to the damage sustained to Zak’s lanai screen, landscaping, and other items, Zak’s roof suffered extensive hurricane damage to the concrete tiles on the front and rear slopes, leaving broken and shattered tiles throughout the roof as well as lifted and loose tiles that slid down and damaged the tiles beneath them. The right and left elevations of Zak’s roof also suffered multiple cracked and damaged tiles.
Frontline’s initial inspection of the property did not result in an accurate or complete estimate of the covered damage. Specifically, Frontline’s estimate did not identify all damage to Zak’s roof and grossly underestimated the cost to restore the roof to its pre-loss condition which could only be accomplished by a roof replacement. During the initial inspection, Frontline’s field adjuster, Ian Swanson, informed the insureds during his inspection that he found broken tiles below loose tiles that were not immediately visible—a finding that would necessitate a roof replacement. Despite this, Frontline chose to prepare and rely on an estimate of only $9,459.56, replacement cost value on the dwelling, that would only allow for an inadequate repair of Zak’s roof and resulted in a determination of the damage that fell below the deductible. As a result, Frontline refused to issue any payment to Zak on this claim that would allow them to repair the extensive hurricane damage to their roof. Frontline’s attempt to avoid its obligation in this manner was wrongful and in violation of Frontline’s contractual and statutory duties to Zak.
Distressed by Frontline’s refusal to issue any payment on this claim, Zak engaged several local roofers to inspect their roof and advise on the measures necessary to restore the concrete tile roof to its pre-loss condition. Each of these roofers independently determined Zak’s roof had suffered extensive tile damage necessitating a roof replacement and that due to the age of Zak’s roof, which was built in 2003, the tiles could not be matched because they had been discontinued many years prior. Several contractors refused to even provide Zak a repair estimate stating a repair cannot be done. The roof must be replaced. Frontline’s refusal of the roof replacement was wrongful, in bad faith, and caused unnecessary delay on this claim as well as other harms and losses over and above the amount owed on the policy of insurance.
As a result of Frontline’s failure to accurately and timely adjust and pay this claim, its errors and misinformation with respect to the damage to the roof, and its attempts to bully and intimidate Zak into accepting its coverage decision, Zak was forced to incur costs in hiring a reputable, skilled public adjuster to prepare an estimate of the cost to repair the covered damage. Zak’s public adjuster inspected the property and estimated the cost to repair the covered damage at $107,968.31, the majority of which was attributed to the need for a roof replacement. This estimate represents a far more accurate estimate of the cost to repair the entirety of the damage caused to Zak’s home and other structures by wind during the storm. Had Frontline adjusted the claim initially in good faith and in Zak’s best interest, Frontline’s inspection and estimate would have resulted in a fair amount of compensation that would not have forced Zak to have to hire a public adjuster to protect their interests and right to be paid in full on the claim.
Zak provided their public adjuster’s detailed estimate and photo report to Frontline in hopes of finally persuading Frontline to allow for the necessary roof replacement. In the estimate, Zak informed Frontline as follows:
There is extensive damage to the tiles on the front and rear slopes. In addition to the obvious broken and shattered tiles there are many loose and lifted tiles that have slid down or have damaged tiles below them. During the field adjuster’s inspection he informed the insureds that he found broken tile below loose tiles that were not immediately visible. These tiles were most likely damaged by "chattering" which occurs when high winds repeatedly lift tiles during a hurricane creating a "chattering" noise with the lift causing cracks, chips, and loose tiles. The right and left elevation have multiple cracked and damages tiles as well. Due to the age of the roof the decking does not meet the current nailing code requirements. Due to the amount of tiles damaged a complete re-nail of the roof decking will be necessary. In addition to the re-nail requirement the tiles on the roof are concrete LIFETILES tiles that are no longer manufactured. Contractors who have inspected the roof since the loss have refused to provide a repair estimate for the roof due to the extent of damage. Due to the above reasons complete roof replacement is required.
Despite this clear evidence supporting the need for the roof replacement, Frontline has continued in its refusal of the roof replacement. Comparing Frontline’s initial estimate of $9,459.56 to Zak’s public adjuster’s estimate of $107,968.31, Frontline’s estimate amounts to an unacceptable 9%—less than a tenth—of the actual claim value. An estimate this inexplicably low could only have been prepared in bad faith with the goal of undermining the claim value so Frontline could pay less on this claim. Frontline’s conduct in this regard—showing a lack of concern for its inadequate adjustment of this claim and its failure and/or refusal to pay Zak what it knows is the true amount required to repair the property—has been in bad faith.
In hopes of finally persuading Frontline to approach this claim in good faith and reassess its position on the roof, Zak submitted a sworn proof of loss for $107,968.31 per Frontline’s requirements supported by Zak’s public adjuster’s estimate and detailed photos showing the damage. Frontline, however, did not give this evidence any meaningful consideration by evaluating the roof damage in good faith and acknowledging the need for a roof replacement. Rather, Frontline chose to go on the attack and issue a reservation of rights to Zak now claiming the condition of the property suggests the damage may not have been caused by the extreme weather event but, rather, by wear, tear, marring, deterioration, settling, shrinking, bulging, or expansion (all excluded causes of damage) which could result in the cracking of bulkheads, pavements, patios, footings, foundations, walls, floors, roofs, or ceilings. Frontline’s decision at this juncture to weaponize its policy provisions in an effort to bully and intimidate Zak was in bad faith.
Despite Frontline’s wrongful conduct, Zak’s public adjuster continued its efforts to reach Frontline to discuss the necessary roof replacement during the month of January, 2025 to no avail. Multiple phone calls and emails went ignored and remain unanswered. At one point, after Zak’s public adjuster identified himself over the phone, Adjuster Padgett promptly hung up on him. This occurred during a time when Zak was stressed, worried, and anxious to get repairs underway so the integrity of their home could be restored. Frontline’s willful or careless failure to respond timely to communications, emails, and inquiries from its insured violated both its duty under the policy to timely adjust this claim and its duty under Fla. Stat. § 626.9541(1)(i)(3)(c) to acknowledge and act promptly upon communications with respect to claims.
Finally, in late January, as a result of Zak’s persistent and repeated efforts to get Frontline to reevaluate this claim and reassess its coverage decision, Frontline finally agreed to send a field adjuster to collect one of Zak’s roof tiles to obtain an ITEL report. Onsite, Frontline’s field adjuster confirmed Zak’s roof tiles are no longer available as new and have not been manufactured for many years. Despite this, Frontline continued in its efforts to avoid its obligation to extend coverage for Zak’s necessary roof replacement, Frontline has now advised Zak’s concrete tiles are available at a salvage tile yard—commonly referred to in the industry as a “boneyard” for tile—and that the tiles could be reglazed and the roof simply repaired. Frontline’s attempt to source tiles from an old stockpile rather than purchasing new ones and effect a roof repair, as opposed the necessary replacement, will not fulfill Frontline’s obligation to restore Zak’s property to its pre-loss condition because the decking does not meet the current nailing code and a complete re-nail of the roof decking is necessary due to the number of tiles damaged. In addition, salvaged tiles often do not match and result in a patchwork, aesthetically displeasing result that does not result in a restoration of the property to its pre-loss condition. Used tiles can also be more brittle or damaged, leading to future structural and performance issues. In all, Frontline’s attempt to save money on this claim by sourcing tiles from a boneyard to repair a roof that needs to be replaced violates its contractual and statutory duties to Zak to adjust and resolve this claim in good faith in Zak’s best interest.
Frontline’s failure and/or refusal to settle this insurance claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards Zak is wrongful conduct. As a result of Frontline’s wrongful conduct, Zak was and still is forced to expend out of pocket monies to submit their insurance claim, e.g., retaining a public adjuster to prepare an accurate estimate and legal counsel to file this Civil Remedy Notice in hopes of finally forcing Frontline to honor its obligations under the insurance policy to pay the entirety of the insurance proceeds due and owing to Zak.
Frontline is obligated to Zak to tender all insurance proceeds owing and due so that the necessary repairs can commence. Frontline’s refusal to tender the appropriate amount due has been in bad faith and is a breach of the insurance agreement which requires Frontline to pay timely and promptly so that Zak can mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible.
To date, Frontline has failed to timely pay or deny the claim in full in direct violation of Fla. Stat. § 627.70131. Frontline’s actions, in this regard, have been in bad faith.
It is clear from Frontline’s failure to issue the benefits owed and its intentional attempt to avoid its full obligations to Zak, that Frontline has engaged in a pattern of fraudulent and dilatory tactics to the prejudice and harm of Zak. To cure the defects outlined in this Civil Remedy Notice, Frontline must:
(1) Immediately tender all undisputed insurance proceeds to Zak with statutory interest owed;
(2) Act fairly and honestly towards Zak and with due regard for their interest in attempting to settle this claim;
(3) Immediately tender all insurance monies due and owing to Zak with statutory interest; and
(4) Pay Zak the fair value of their insurance claim.
First Protective Insurance Company d/b/a Frontline Insurance’s address is 500 International Parkway, Lake Mary, FL 32746.
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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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