Filing Number: 809013
|
| Filing Accepted: 2/28/2025 |
| Last/Business Name
*
|
|
|
| Street Address
*
|
|
15862 SW 78TH ST |
| City, State Zip
*
|
|
MIAMI,
FL
33193
|
| Email Address
*
|
|
JIMCLIGMAN@GMAIL.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
BAEZ |
|
First Name |
|
MILARGOS |
| Policy # * |
|
PFL345379-01 |
|
Claim #* |
|
CFL17538122 |
|
Attorney is Applicable
|
| Last Name* |
LIGMAN
First Name *
JAMES
Initial
|
| Street Address* |
|
1342 COLONIAL BLVD SUITE C22 |
| City, State Zip* |
|
FORT MYERS
,
FL
33907
|
| Email Address * |
|
JIMCLIGMAN@GMAIL.COM |
|
|
| Insurer Type
*
|
|
 Authorized Insurer
 Unauthorized Insurer
|
|
|
| Insurer Name |
|
|
| Insurer Name* |
|
PEOPLE'S TRUST INSURANCE COMPANY
|
| Insurer Name* |
|
|
| Street Address* |
|
|
| City, State Zip* |
|
,
|
|
NAIC Company Code 13125 |
|
|
| Name of individual responsible for violation (if any):*
PEOPLES TRUST INS. CO., DYLAN ASBURY, LEE COOPER OF CNC, SHEZAR MUMTAZ, EVER TEJADA, RAPID RESPONSE TEAM, ARIELLE MOLINET PETERS, LAUREN MADDOX
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
|
Claim Delay
|
|
|
*
Statutory provision(s) which the insurer allegedly violated.
|
|
|
|
| 624.155(1)(b)(1) |
|
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.
|
|
| 626.9541(1)(i)(3)(a) |
|
Failing to adopt and implement standards for the proper investigation of claims.
|
|
| 626.9541(1)(i)(3)(b) |
|
Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
|
|
| 626.9541(1)(i)(3)(c) |
|
Failing to acknowledge and act promptly upon communications with respect to claims.
|
|
| 626.9541(1)(i)(3)(d) |
|
Denying claims without conducting reasonable investigations based upon available information.
|
|
*
Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Policy Language
THIS ENDORSEMENT CHANGES YOUR POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT DOES NOT APPLY TO SINKHOLE CLAIMS.
In consideration of the premium credit shown on “your” Declarations Page, “you” agree to the following:
THIS ENDORSEMENT ALLOWS US AT OUR OPTION TO SELECT RAPID RESPONSE TEAM, LLC™ TO MAKE COVERED REPAIRS TO YOUR DWELLING OR OTHER STRUCTURES.
“You” agree that in the event of a covered loss to “your” dwelling or other structures on the “residence premises,” other than a sinkhole loss “we” at our option may select Rapid Response Team, LLC™ to repair “your” damaged property as provided by the policy and its endorsements.
This endorsement does not reduce the applicable deductible under the policy. “You” will be responsible for paying the amount of the deductible to Rapid Response Team, LLC™.
In addition, the following provisions of the policy and its endorsements where applicable, are changed:
SECTION I – PROPERTY COVERAGES
E. Additional Coverages
2. Reasonable Repairs is deleted and replaced by the following for losses other than sinkhole:
a. If a peril causing a loss and related damage are covered (other than sinkhole loss) and repairs are necessary to protect covered property from further damage, “you” must notify us before authorizing or commencing repairs so “we”, at our option, may select Rapid Response Team, LLC™ to make the covered Reasonable Repairs.
b. If “you” do not notify “us” and allow “us”, at our option, to select Rapid Response Team, LLC™ for the covered Reasonable Repairs, “our” obligation for repairs made to protect the covered property from further damage is limited to the lesser of the following:
(1) The reasonable cost “you” incur for necessary repairs made solely to protect the property from further damage; or
(2) The amount “we” would have paid to Rapid Response Team, LLC™ for necessary repairs made solely to protect the covered property from further damage.
This coverage does not increase the limit of liability that applies to the covered property.
SECTION I – CONDITIONS
C. Duties After Loss
5. a. and b. are deleted and replaced by the following for losses other than sinkhole:
5. Protect the property from further damage. If repairs to the property are required, or if the services of a contractor are required to protect the property from further damage, “you” must:
a. Notify “us” before authorizing or commencing the repairs or the services so “we”, at our option, may select Rapid Response Team, LLC™ to make covered repairs or perform the services; and
b. Keep an accurate record of repair expenses;
If “you” do not notify “us” prior to authorizing or commencing the Reasonable Repairs as described in SECTION I – PROPERTY COVERAGE E. Additional Coverages, or the repairs or services as described in the SECTION I – CONDITIONS – D. Loss Settlement and allow “us” at our option to select Rapid Response Team, LLC™ for such Reasonable Repairs, or such repairs or services, “our” obligation for the Reasonable Repairs, or the repairs or services is limited to the lesser of the following:
a. The reasonable cost “you” incur for necessary Reasonable Repairs, or for repairs or services; or
b. The amount “ we” would have paid to Rapid Response Team, LLC™ selected by “us” for necessary Reasonable Repairs, repairs or services.
D. Loss Settlement, 2. d. the following is revised:
d. If “we” do not elect to repair, “we” will initially pay at least the actual cash value of the incurred loss less any applicable deductible. “We” will then pay the necessary amounts actually spent to repair or replace the damaged building as work is performed and expenses are incurred. If a total loss of the covered dwelling occurs, if “we” do not elect to repair, we shall pay the replacement cost coverage without reservation of any depreciation in value, subject to policy limits.
J. Our Option 3. is deleted and replaced with the following:
3. “We” will provide written notice to “you” no later than thirty (30) days after “our” inspection of the reported loss, unless factors beyond “our” control reasonably prevent “us” from doing so.
K. Loss Payment, the following is added:
4. When we have exercised our option to repair “your” damaged property pursuant to this Preferred Contractor Endorsement, we will repair the damaged property with material of like kind and quality without deduction for depreciation. Such repair is in lieu of issuing any loss payment that would otherwise be due under the policy.
S. Appraisal, the following is added to the policy: Where “we” elect to repair: 1. If “you” and “we” fail to agree on the amount of loss, which includes the scope of repairs, either may demand an appraisal as to the amount of loss and the scope of repairs. In this event, each party will choose a competent appraiser within 20 days after receiving a written request from the other. The two appraisers will choose an umpire. If they cannot agree upon an umpire within 15 days, “you” or “we” may request that the choice be made by a judge of a court of record in the state where the "residence premises" is located. The appraisers will separately set the amount of loss and scope of repairs. If the appraisers submit a written report of an agreement to “us”, the amount of loss and scope of repairs agreed upon will be the amount of loss and scope of repairs. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will set the amount of loss and the scope of repairs. Each party will pay its own appraiser, and bear the other expenses of the appraisal and umpire equally.
2. The scope of repairs shall establish the work to be performed and completed by Rapid Response Team, LLC™. Such repair is in lieu of issuing any loss payment to “you” that otherwise would be due under the policy. The amount of loss shall establish only the initial amount paid to Rapid Response Team, LLC™ by “us”, and any additional amounts required to complete repairs shall be PTI PROD-000103 3 PTIC E023 1115 Includes copyrighted material of Insurance Services Office, Inc. with its permission “our” responsibility and will be paid to Rapid Response Team, LLC™ without regard to policy limits or the amount of initial payments.
3. If we demanded mediation under Condition G. Mediation of Section I – Conditions and either party rejects the mediation results, “you” are not required to submit to, or participate in, any appraisal of the loss as a precondition to an action against us.
T. Our Duties After Loss, the following section is added to the policy:
Our duties after loss pertaining to commencement and performance of repairs are as follows:
1. “We” will instruct Rapid Response Team, LLC™ to furnish “you” with written documentation of current licensure as required by any applicable local, municipal, county, state, federal or governmental authority’s ordinances, statutes or regulations.
2. “We” will instruct Rapid Response Team, LLC™ to furnish “you” with written documentation of current workers’ compensation insurance and commercial general liability coverage with policy limits of no less than $1,000,000, or in a greater amount as may be required by any applicable municipal, county, state or federal ordinances, statutes or regulations. “We” may, at our option, assist Rapid Response Team, LLC™ by providing the documentation.
All of the provisions of your policy that are not affected by this endorsement remain unchanged.
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Facts and Circumstances:
1) Failure to promptly investigate claim;
2) Failure to adjust loss;
3) Failure to act in due diligence and good faith to resolve claim; 4) Placing financial interest of insurer before that of policy holders and claimants:
5) Failure to properly train, evaluate and manage adjusters;
6) Looking for ways to deny coverage, pay less, delay payment and otherwise “low ball” or “stone wall” claim;
7) The reasons for this may be attributed to improper training, supervision, and/or motivation of adjusters and claims supervisors to promptly and fairly investigate, adjust and pay full benefits available to all beneficiaries. The insurer may have failed to adopt proper standards of investigation and adjustment of losses, or is otherwise not implementing those standards because full payment and prompt payment for the loss is not occurring.
On 9/10/17, the insured, Milagros Baez’s home was severely impacted by Hurricane Irma. At all times relevant to this civil remedy notice, People’s Trust Insurance Company (PTI), insured the Baez property. The loss was reported to PTI on 10/4/17. On October 24, 2017 the insureds attorney requested a certified policy. Adjuster, Dylan Asbury, responded that same day and said a policy would be sent and stated that a PTI claims adjuster would be contacting the Ligman firm to arrange an inspection. Mr. Lee Cooper, Field Adjuster for CNC claims adjusting, was not able to inspect the property until 11/21/17. Mr. Cooper advised that they were extremely backed up. It took the insurer over 4 weeks to inspect the property from the initial reporting of the loss.
After Mr. Cooper’s inspection, PTI allegedly invoked the option to repair on 12/3/17. PTI’s adjuster, Daniel Haidt, was the adjuster responsible for invoking the option to repair. It took PTI over 3 months to invoke the option to repair which was very unreasonable. Along with the 12/3/17 letter, invoking the option to repair, PTI sent their estimate prepared by Lee Cooper in the amount of $75,989.05 and requested a Proof of Loss. The insured was in the process of having an estimate prepared and requested Mr. Haidt to grant them an extension of time to respond to the POL. Mr. Heidt verbally rejected the request. On 1/5/18, the Ligman firm sent a letter requesting an extension of time to respond to the POL or a declaratory action would be filed. Yet another actor for PTI became involved, Lauren Maddox, Esq., who agreed to the extension. The insured swore out a POL using Lee Coopers estimate as the insured had not yet received her proposed estimate.
On 4/30/18, the insured forwarded their estimate for damages in the amount of $92,912.86. On 4/30/18, PTI demanded appraisal due to the difference in amount and scope of the competing estimates. The parties went to appraisal but the issue was not resolved until 9/23/18. The Umpire, Sean Lewis, awarded the insured $92,912.86. The award was $16,923.81 greater than what PTI and their field adjuster estimated. Clearly, PTI was low balling the insured. Due to PTI’s low ball estimate, the appraisal process had to occur. Had PTI been fair in their adjustment of the damages, the repair process could have been started much sooner. PTI has attempted to push the blame for delay onto an elderly lady. However, due to PTI’s practices and procedures, late inspection, and low ball estimate, it took over one year from the date of reporting the claim until the appraisal award was issued. This delay is directly due to PTI’s practice and procedures. Delay as long as possible, frustrate an elderly insured and earn interest on money not paid.
From the appraisal award of $92,912.86, PTI paid RRT $88,215.48 to do all of the repairs. It appears that PTI kept $4,000.38 from the appraisal award. It is unclear why. RRT hired Vizcaya to do the roof. The appraisal award allotted $70,379.90 for roof replacement. RRT sent a payment to Vizcaya in the amount of $35,000 to do the roof. It would appear that RRT made a profit of $35,379.90. If that is not bad enough, Vizcaya purchased inferior roof tiles from Mediterranean Roof tiles in the amount of $6,802.19, however, the appraisal award allotted $36,330.32 for the cost of the tiles. This results in a windfall to Vizcaya and a screw job to the insured.
After the appraisal award was issued, the long process of inspections by multiple contractors, permitting documents, and HOA approval began. Work on the Baez home did not begin until 7/5/19. PTI has attempted to blame an elderly insured for a delay in the repair process, however, closer inspection reveals that there were numerous steps that had to be accomplished before the work could be started. The insured had to select a tile color and this had to be approved by the HOA and the architectural board of her community. PTI put most of the process burden upon the insured, making her do the leg work that should have been done by PTI.
PTI elected the option to repair. As part of their repair process, PTI was supposed to replace the tile roof, repair interior damages, replace the garage door and repair the insureds wood fence. PTI did not begin repairs of anything other than the roof, They could have started the interior repairs by tearing out water damaged materials, replacing the garage door and replacing the wood fence. On 7/5/19 tear off of the roof began. On 8/2/19, El ROI Construction began installing the roof tile. At this point, the roof was dried in and interior repairs could have begun. On 8/7/19, the insured halted repairs. She was upset that they were causing damage to her pool, pavers, pool pump and AC, and her yard. However, her primary complaint was due to the fact that the roofer had pulled up numerous tiles after they were installed and was using a tile color that she did not approve of and the HOA did not approve. The tile the insured selected was 44 1GOCS623ONN Terr. After the roofer pulled up the tiles, he began to replace them with a substituted tile, 44 1GOC56225BU SPCL. The tile color did not match.
. The insured voiced her concerns to Vizcaya, El ROI and Rapid Response Team. There was a meeting at the property, however, nothing was done to address the insureds concerns and the insured was told that the mismatching colored tile would fade over time.
PTI never sent anyone directly from the insurance company to inspect. Instead, they relied upon the opinions of the same people the insured complained about. Instead of inspecting the property and addressing her concerns, PTI sent two threatening letters stating that she was in breach of contract and if she did not allow the repairs to commence, PTI would sue her. PTI never addressed the other repairs which were not even started. Ms. Baez never told PTI or any of their minions that they could not do the other repairs. She was simply unhappy with the work the roofer was doing and she dared to voice her concern.
The insured filed suit for breach of contract and failure of the insurer to restore the property to its pre loss condition. PTI filed a counter suit for Breach. PTI has put up a monumental defense and has not come close to making any reasonable offers. Early on, and throughout the litigation, the insured requested that PTI provide a new roofer to do the roof work, however, PTI rejected that compromise and continued to pound on an elderly insured.
The insured had to hire a Certified GC / Roofer and Engineer. These experts support Ms. Baez contention that the roof was not done properly.
PTI hired RRT who hired Vizcaya who hired El ROI. None of these actors have a Roofing License which is required by the GC or the installer of the tile roof.
FS 489 Section 113 (2)(3) – A contractor shall subcontract all electrical, mechanical, plumbing, roofing, sheet metal, swimming pool, and air-conditioning work, unless such contractor holds a state certificate or registration in the respective trade category.
FS 489 Section 113(3)(b) A general, building, or residential contractor shall not be required to subcontract the installation, or repair made under warranty, of wood shingles, wood shakes, or asphalt or fiberglass shingle roofing materials on a new building of his or her own construction.
It is understandable that the roofer did not know what he was doing due to his failure to obtain proper certification.
The insured was fined by Miami Dade County for having an expired permit. In order to stop the accumulation of fines, the insured had to hire a roofer to do temporary repairs so that the permit could be closed. The insured had to come out of pocket in the amount $11,700 to make temporary repairs in order to close the roofing permit. Passing a permit inspection and having a roof structurally and aesthetically installed are apples and oranges. The insured did what she had to do, however, it is anticipated that the roof will leak within the next several years as the stick down underlayment was exposed to sunlight, for a lengthy period of time, where PTI’s roofer had pulled up over 100 tiles.
PTI has used unethical tactics in defending this suit and asserting a counter claim. PTI has asserted that the insureds case should be thrown out as the insured did not provide notice to the contractor with regard to complaints. F.S. 558 is intended for a direct relation ship between a home owner and a contractor. The insured never signed any contracts, never paid or promised to pay any contractors, the insured was not provided with proper disclosures and the project was not completed, all of which eliminate the use of Ch 588 in this litigation. PTI knows that this affirmative defense is a duck, yet continues to assert it in their option to repair contract disputes in an attempt to scare their insureds.
Additionally, PTI filed a Motion for Summary Judgment which was denied by the Court. In essence, the Court said that the insured could pursue a breach of contract for failure of the insurer to do a proper job and pursue damages for work the insured did not start.
The insurer owes a heightened standard to elderly insureds. Ms. Baez was over 70 years old when PTI began their bulling campaign and barrage of threats. PTI treated Ms. Baez like garbage. Throughout this entire process, PTI has acted as if they owe no duty or responsibility to the insured. Their corporate representative and desk adjuster are indifferent and try to pass the buck along to RRT, Vizcaya and El ROI. They take the position of washing their hands of all responsibility on the basis that they issued a check.
For PTI to purge their bad faith actions they need to do one of the following:
Option I
-Retain a new roofer who is properly certified to tear off the existing roof and install a new tile roof;
-Perform the remaining repairs per the umpires estimate;
-Pay the insured for the cost of temporary roof repairs;
-Pay the insured for the cost of MDC fines;
-Pay the insured statutory interest from the date of loss up to the day payment of interest is made and
-Pay the insureds reasonable attorney fees and costs to be determined by agreement or the Court.
Option II.
-Pay the insured the amount of the umpire’s award with adjustment for inflation;
-Pay the insured for the cost of temporary roof repairs;
-Pay the insured for the cost of MDC fines;
-Pay the insured statutory interest from the date loss up to the day payment of interest is made and
-Pay the insureds reasonable attorney fees and costs to be determined by agreement or the Court.
Defendant has all documents to support this claim for bad faith
|
|
|
*
|
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.
|
DFS-10-363
Rev. 10/14/2008
|