Filing Number: 809079
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| Filing Accepted: 2/28/2025 |
| Last/Business Name
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BOTWINSKI
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First Name |
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BRIAN & MELANIE |
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| Street Address
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5331 LOON NEST COURT |
| City, State Zip
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APOLLO BEACH,
FL
33572
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| Email Address
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MELANIE4@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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BOTWINSKI |
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First Name |
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BRIAN & MELANIE |
| Policy # * |
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9221306005 |
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Claim #* |
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01000123010 |
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Attorney is Applicable
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| Last Name* |
KLOTZMAN
First Name *
SCOTT
Initial
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| Street Address* |
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9555 SW 175TH TERRACE, SUITE 651 |
| City, State Zip* |
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PALMETTO BAY
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FLORIDA
33157
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| Email Address * |
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PRELIT@SCOTTKLOTZMAN.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):*
AMBER LAMAR, LAURIE ULLOM, KEVIN SAULNY, AND ALL ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY FIRST PROTECTIVE INSURANCE COMPANY D/B/A FRONTLINE INSURANCE RELATED TO THIS CLAIM
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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 Denial
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Claim Delay
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Unfair Trade Practice
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Unsatisfactory Settlement Offer
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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)(2) |
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Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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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)(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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
There are no policy provision specifically at issue or in dispute, the policy provides coverage for damages resulting from Hurricane Milton, but First Protective Insurance Company D/B/A Frontline Insurance (“Insurer”) has failed to extend coverage for repairs needed for the insured property.
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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.
First Protective Insurance Company d/b/a Frontline Insurance (“Insurer”) issued an insurance policy bearing policy number 9221306005 which insured the property located at 5331 Loon Nest Court, Apollo Beach, FL 33572. The policy was in effect when the property sustained damage on or about October 9, 2024, when it was damaged by Hurricane Milton.
On or about October 9, 2024, while the subject policy was in full force and effect, the Insureds suffered a loss caused by Hurricane Milton. The claim was reported on October 11, 2024. Insurer assigned claim number 01000123010 to the loss. There was significant damage including, but not limited to, the roof, windows, interior, exterior, boat dock and lift.
On October 11, 2024, Insurer received notice of the claim for property damage resulting from Hurricane Milton. The damage was reported to Insurer which assigned Claim Number 01000123010 to the claim and began its investigation. Insurer assigned an adjuster to the claim and inspected the property.
Via written correspondence dated November 9, 2024, Insurer advised it has estimated the damages to be $10,952.81, below the policy’s $18,026.00 hurricane deductible. The November 9, 2024, under deductible letter did not cite to a single policy exclusion. Rather, the letter simply noted the replacement cost under Coverage A. Insurer failed to provide a detailed repair estimate in violation of Fla. Stat. 624.155(1)(b)(2).
The Insureds took all necessary precautions to protect their property prior to the Hurricane. Upon returning from a mandatory evacuation, they observed water damage in several areas thought the home, including but not limited to, second floor ceilings that were sagging and extensive damage to the kitchen. There was also damage to the boat dock and the lift and a repair estimate has been submitted. The Insureds immediately began remediating the damage, which was very difficult due to the high demand for restoration contractors.
Despite the obvious hurricane damage, Insurer told the Insureds that the claim would be denied since the damage was caused by flooding. There was absolutely no evidence of flood damage in their neighborhood. There was no flood damage to the insured property. The damage was from wind and rain.
The Insureds retained a Public Adjuster who provided a repair estimate and photographs of the damages, which were received by Insurer on November 21, 2024. A reinspection was then scheduled to take place on December 11, 2024. Insurer had been advised that the Insureds had incurred over $100,000.00 in out-of-pocket necessary repairs and had obtained an estimate for windows and doors totaling $147,000.00, separate and apart from the Public Adjuster’s estimate. Despite this, Insurer refused act in good faith and settle the claim. In fact, Insurer has been going out of its way to avoid making payment of the claim by making unreasonable requests on the Insureds. For example, Insurer has asked for:
1. All photographs, images, statements, text messages, emails, estimates, job quotes, invoices, receipts, and any other documentation regarding this claim you wish us to consider.
2. A list of all contractors, salespersons, or individuals working in the construction trade or in a trade related to the construction trade with whom you have discussed this loss with or who
have worked on this loss.
3. A detailed statement of damages claimed from the reported Date of Loss which separates
damage that occurred after the reported Date of Loss.
4. A detailed estimate of your anticipated repair expenses.
5. Any documentation in support of your claim you wish us to consider.
6. A completed, fully executed, signed, notarized Sworn Proof of Loss.
7. Mold Protocol and Hygienist Report
8. Loss of Use Documents, Lease Agreement for home you are renting
9. Repair Proposal for Boat Dock
10. Recorded Statement: We are requesting your recorded statement by phone and will contact you to schedule same.
The Insureds provided all required documents to Insurer such as a repair estimate, photographs, Sworn Statement in Proof of Loss, Mold Proposal, Repair proposal for dock and submitted to a recorded statement. Nevertheless, Insurer continued to delay the claim and look for reasons not to pay.
Due to the nature of the damages, the Insureds were forced to move out of their home into a rental property. This property was much smaller than their home, but they needed to move out because their property was uninhabitable during the repairs. Their daughter suffers from severe asthma and the dust put her at significant risk of a lift threatening asthma exacerbation. The Insureds submitted invoices and proof of payment for the rental home, yet Insurer has failed to reimburse them for these covered expenses.
Despite the monumental effort and expense to comply with Insurers never-ending string of requests, Insurer issued a Reservation of Rights dated November 26, 2024. This letter stated:
• It is questionable whether you protected the insured property from further damage.
• It is questionable whether you have kept an accurate record of the repair expenses.
• It is questionable whether you have cooperated with us in our investigation of your claim.
• It is questionable whether you have shown us the damaged property and the cause of loss and the condition it was in at the time of loss.
• It is questionable whether you have submitted to us, within thirty (30) days after notification of the loss, your signed, sworn proof of loss.
Additionally, Insurer alleged that the following policy exclusions MAY apply to the claim:
• It is questionable whether the loss was caused by repeated seepage or leakage of water or the presence or condensation of humidity, moisture or vapor, that occurs or develops over a period of time, whether hidden or not.
• It is questionable whether the loss was caused by wear and tear, marring, deterioration.
• It is questionable whether the loss was caused by settling, shrinking, bulging or expansion, including resultant cracking, of bulkheads, pavements, patios, footings, foundations, walls, floors, roofs or ceilings,
• It is questionable whether the loss was caused by fungi, wet or dry rot, yeast or bacteria.
Rather than adjust the claim in good faith, Insurer continued to harass the Insureds for documentation that had already been provided and/or is irrelevant.
Insurer has been provided with documents establishing that the claim is covered, despite this being apparent from the condition of the property alone. Insurer has failed to extend coverage for payments owed and has refused to attempt to settle the claim with its Insureds.
Insurer’s delay in issuing payment is causing and will cause the Insureds to sustain extra-contractual damages not covered by the property, including loss of use and enjoyment of the property and related damages, costs associated with hiring adjusters and experts, among other damages and these uninsured damages would not have occurred but for the Insurer ’s failure to timely issue payments owed. In this claim and as a business practice, Insurer fails to retain experts needed to investigate claims, ignores evidence establishing coverage and avoids covered repairs to attempt to avoid issuing payments owed pursuant to the insurance policy.
Insurer can cure these violations by attempting to settle the claim in good faith and issuing payment for the remaining contractual damages owed. As Insurer is aware, issuing payment for contractual damages owed will preclude recovery of extra-contractual damages already incurred, and that will be incurred, and the contractual damages should immediately be paid and be paid within 60 days from the date of this notice. Due to applicable Florida Statutes, and the insurance policy’s payment provisions, the payment issued should also include interest. If insurer contends there is somehow more information needed that was not already provided, it should immediately advise the Insureds’ attorney what information is needed.
Insurer has been provided with information establishing that the claim is covered but has failed to extend coverage for the claim. Insurer’s denial of the claim and refusal to issue payment is a breach of the insurance policy. This notice is being given in order to perfect the right to pursue the civil remedy authorized by this section.
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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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