Filing Number: 808825
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| Filing Accepted: 2/27/2025 |
| Last/Business Name
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BEACON WOODS EAST MASTER ASSOCIATION, INC.
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First Name |
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| Street Address
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8700 PAVILION DRIVE |
| City, State Zip
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HUDSON,
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34667
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| Email Address
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TIM.MILLWOODVILLAGE@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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BEACON WOODS EAST MASTER ASSOCIATION, INC. |
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First Name |
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| Policy # * |
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5107586239 |
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Claim #* |
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05000002536 |
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Attorney is Applicable
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| Last Name* |
JAMESON
First Name *
ROBERT
Initial
E
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| Street Address* |
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203 FORT WADE ROAD, SUITE 260 |
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PONTE VEDRA
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FLORIDA
32081
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| Email Address * |
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ROBERT@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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| Insurer Name* |
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FRONTLINE INSURANCE UNLIMITED COMPANY
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| Insurer Name* |
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NAIC Company Code 10074 |
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| Name of individual responsible for violation (if any):*
UNKNOWN – FRONTLINE INSURANCE UNLIMITED HAS NOT ISSUED A COVERAGE DETERMINATION WITHIN 90 DAYS OF THE INSURED REPORTING THE LOSS.
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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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Other
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Unfair trade practice
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Unfair Trade Practice
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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 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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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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Other
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Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dolla
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Other
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Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the i
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Other
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Failing to promptly notify the insured of any additional information necessary for the processing of
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Other
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Failing to clearly explain the nature of the requested information and the reasons why such informat
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Other
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Failing to pay undisputed amounts of partial or full benefits owed under first-party property insura
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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.
A. Coverage - We will pay for direct physical loss of or damage to Covered Property at the premises described in the Declarations caused by or resulting from any Covered Cause of Loss.
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4. Additional Coverages
a. Debris Removal – [W]e will pay your expense to remove debris of Covered Property and other debris that is on the described premises, when such debris is caused by or results from a Covered Cause of Loss that occurs during the policy period.
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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:
Frontline Insurance Unlimited (“FRONTLINE”) 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 FRONTLINE; 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) FRONTLINE 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. FRONTLINE has breached this duty by its adjustment of the insured’s claim of loss. FRONTLINE 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. FRONTLINE 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 FRONTLINE of their insurance claim, FRONTLINE has failed and refused to acknowledge the covered loss and pay all amounts due and owing to the insured under the policy of insurance. Despite the insured’s pleas otherwise, FRONTLINE 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, FRONTLINE issued the subject insurance policy which provided coverage for the insured property for “sudden and accidental physical loss to covered property described in Coverages A and B.” As such, the subject Policy contains coverage for all direct physical losses to the insured property unless the loss is specifically and unambiguously excluded from coverage by the Policy. On or about October 10, 2024, the insured property suffered a windstorm loss (Hurricane Milton) and the insured immediately submitted a claim to FRONTLINE for extensive windstorm damage i.e., storm, wind, rain, and water intrusion damages 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 FRONTLINE 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.
Since being presented the Insured’s claim, FRONTLINE, has failed to issue a coverage determination within 90 days of the Insured reporting the loss to FRONTLINE. Additionally, FRONTLINE did not promptly inspect the property, waiting at least 60 days to perform an inspection. Ultimately, FRONTLINE has failed and refused to properly investigate and settle the insured’s claim in good faith. The insured has requested that FRONTLINE conduct an investigation, admit coverage, and pay damages; FRONTLINE has failed and refused to do so. In short, FRONTLINE 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).Therefore, FRONTLINE breached the Policy.
Given the extensive nature of the physical damage, the insured retained a loss consultant, AVIVA Insurance Adjusters (“AVIVA”), to perform an investigation and damage evaluation in accordance with industry standards and Florida law. Based on its investigation, AVIVA determined that a windstorm on or about October 10, 2024 (Hurricane Milton) including storm, rain, and wind caused damage to the exterior of the insured property (particularly the roof warranting replacement), creating openings which allowed water to intrude into the interior causing further damage. Moreover, AVIVA determined, taking into account the estimate below, that at least $823,596.42 worth of mitigation, remediation, and repairs would be required to return the property to its pre-loss condition as a result of the loss. Additionally, the insured has incurred costs of $281,529.56 for mitigation and remediation, including tarping of the structure and water and mold remediation. Moreover, the insured has incurred costs of $1,595.00 for repairing the fence. The Insured sent correspondence to FRONTLINE enclosing supporting documentation. To date, FRONTLINE failed and refused to promptly investigate the claim, delaying its investigation by at least 60 days. Additionally, FRONTLINE has failed to issue a coverage determination within 90 days. Therefore, FRONTLINE breached the Policy.
In summary, FRONTLINE chose to delay coverage for the insured’s loss. To date, FRONTLINE continues to deny the insured and its insured’s full indemnity for the claim. While FRONTLINE refuses to honor, or even acknowledge, this claim, a jury in Pasco County will likely find FRONTLINE failed to promptly investigate the claim and timely issue a coverage determination in violation of the policy and Florida law.
As of today, FRONTLINE 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. Indeed, from the time of receiving the claim, FRONTLINE has purposely and maliciously delayed in adjusting the subject claim in an effort to either avoid paying the claim altogether.
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 FRONTLINE 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, FRONTLINE is putting the insured property at risk. As responsible property owners, the insured purchased insurance to protect the property, paid all of the premiums, and have 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, FRONTLINE turned its back and delayed coverage that the insured is rightfully owed.
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. FRONTLINE breached this duty.
The actions taken by FRONTLINE 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.
FRONTLINE’S actions amount to but are not limited to the following:
1. Claim delay
2. Unfair trade practice
3. Unfair claim settlement practices
4. Failure to act on claim
5. Failure to maintain proper complaint handling procedures
6. Misrepresenting the insurance policy provisions to the insured
7. Misrepresenting Florida statutory provisions to the insured
8. Failure to acknowledge and act promptly upon communications with respect to claims
9. Denying claims without conducting reasonable investigations based upon available information
10. 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.
11. 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.
12. Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
13. Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
14. 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, FRONTLINE must:
(1): Admit full coverage for the insured’s loss;
(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:
Frontline Insurance Unlimited
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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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