Filing Number: 809258
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| Filing Accepted: 3/3/2025 |
| Last/Business Name
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ALDEN
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First Name |
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JONATHAN |
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| Street Address
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38 S. BLUE ANGEL PKWY, NUMBER 248 |
| City, State Zip
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PENASACOLA,
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36502
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| Email Address
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JONATHAN@PROPERTYCLAIMCOUNSELORS.COM |
| Complainant Type:
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Third Party |
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| Last/Business Name* |
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LANGMAID |
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First Name |
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SHERYL AND PETER |
| Policy # * |
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SJ61025276 |
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Claim #* |
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SL22205509 |
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Attorney is Applicable
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| Last Name* |
ALDEN
First Name *
JONATHAN
Initial
R
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| Street Address* |
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38 S. BLUE ANGEL PKWY, NUMBER 248 |
| City, State Zip* |
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PENASACOLA
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FL
32506
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| Email Address * |
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JONATHAN@PROPERTYCLAIMCOUNSELORS.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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SLIDE 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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NAIC Company Code 17227 |
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| Name of individual responsible for violation (if any):*
DESK ADJUSTER CLAYTON GREEN W560118, IA BRANT HAMBLY W437416
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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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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)(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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
HOMEOWNERS 6 – UNIT-OWNERS FORM OUTLINE OF YOUR HOMEOWNERS POLICY
AGREEMENT We will provide the insurance described in this policy in return for the premium and compliance with all applicable provisions of this policy.
SECTION I – PROPERTY COVERAGES A. Coverage A – Dwelling 1. We cover: a. The alterations, appliances, fixtures, and improvements which are part of the building contained within the "residence premises";
(Alterations does not modify appliances, fixtures and improvements. The desk adjuster misapplies this policy language in an attempt to underpay the INSURED).
B. Coverage C – Personal Property 1. Covered Property We cover personal property owned or used by an "insured" while it is anywhere in the world. After a loss and at your request, we will cover personal property owned by: a. Others while the property is on the part of the "residence premises" occupied by an "insured"; or b. A guest or a "residence employee", while the property is in any residence occupied by an "insured".
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Page 1 of 1 PERSONAL PROPERTY REPLACEMENT COST LOSS SETTLEMENT
A. Eligible Property B. Covered losses to the following property are settled at replacement cost at the time of the loss:
1. Coverage C; and 2. If covered in this policy: a. Awnings; b. Outdoor antennas; c. Outdoor equipment d. Carpeting; and e. Household appliances; Whether or not attached to buildings.
D. Coverage D. – Loss of Use.
1. Additional Living Expense. If a loss covered under Section I makes that part of the “residence premises” where you reside not fit to live in or if loss to the building containing the property makes the “residence premises” not fit to live in; we cover any necessary increase in living expenses incurred by you so that your household can maintain its normal standard of living.
Payment will be for the shortest time required to repair or replace the damage or, if you permanently relocate, the shortest time required for your household to settle elsewhere. In any event, the payment(s) will be limited to 24 consecutive months from the date of the covered loss.
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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 INSURER, Slide Insurance, violated the following statutes while adjusting this claim.
F.S. 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.
Slide Insurance excluded covered damages in an attempt to underpay its insured. They have an obligation to pay for covered peril related damages. In this claim, they have failed to pay for Coverage A related damages, Coverage C related damages, and Coverage D related damages. Slide relies on an inadequate Field Adjuster report to settle this claim, even after Public Adjuster presented photographic evidence of additional damages. Desk Adjuster Green insists on photographs of labels on personal property to verify what brand it was. The Field Adjuster had an opportunity to document personal contents branding at the time of his inspection and did not or in the alternative, did document it and Slide is ignoring it in an attempt to delay paying its contractual obligations in bad faith.
Slide has also acted in bad faith by assigning a Desk Adjuster, Mr. Green, who does not have the authority to settle this claim at its full value. It is believed that Mr. Green is merely relaying information from management and has no real authority to settle this claim. It is believed that an undisclosed person is actually adjusting this claim.
Mr. Green also insists that three months of Alternative Living Expenses is excessive after a Category 5 Hurricane made landfall at the loss location. The property is a condominium and part of a Homeowners Association (HOA). The HOA is insured by a different insurance company to cover losses to the building. Slide insures the interior.
Contractors, building material, and insurance company money was scarce at that time and it delayed repairing the building roof. Insurers had 90 days to make a coverage decision and additional time to make payment. That means that the roof could easily not even been started for 100 days.
Mr. Green also questions the amount of money to rent a similar apartment in the same complex. The Policyholder was a year-round resident and did not have another place to stay. She paid the fair market price to live in the same community. She presented an invoice for the expenses.
In any case, Coverage D is limited to $4,200.00. Delaying payment of this amount by demanding Insured proves that she needed longer than 3 months is nothing more than an attempt to delay this claim and is done in bad faith.
F.S. 626.9541 (1)(i)(2) 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.
Slide misrepresented the extent of damage to the interior. They did this when they failed to honor the original field adjuster’s assessment of damages. It is believed that either they or their third-party adjuster cherry picked damages off of the initial estimate. They then misrepresented the extent of damage in their first coverage determination. The damage is so obvious that there could be no other explanation.
Slide failed to document personal contents damage, or if they did, they are not disclosing their evaluation. The ceiling collapsed onto personal contents and there could be no disagreement that it was damaged. Slide’s estimate does not address even one penny of contents. The omission is a material misrepresentation.
F.S. 626.9541 (1)(i)(3) Committing or performing with such frequency as to indicate a general business practice any of the following:
a. Failing to adopt and implement standards for the proper investigation of claims;
It is obvious that a well-trained person who was trying to indemnify a policyholder could have made it happen with the information that is readily available. Desk adjuster Mr. Green could have settled the contents/personal and property and Loss of Use by now, but he refuses. This is either because he is improperly trained or he his trained to underpay INSURED intentionally, or management forbids him by giving him settlement authority well below what a good faith effort to settle requires.
f. 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.
Mr. Green has failed to provide a reasonable explanation in writing why he has not paid for personal property and for storm-related damage including flooring and cabinetry. It is not reasonable to insist on photographic documentation of personal contents branding over two years after the loss, when Slide had an opportunity to document this on the field inspection.
g. Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
Slide only insisted on documentation of personal contents when the Policyholder hired a Public Adjuster.
The facts supporting the above violations follow.
This complaint is made on behalf of Peter Langmaid and Sheryle R. Langmaid ("INSURED"). In consideration for the premium paid to it by INSURED, Saint Johns Insurance Company (INSURER) issued Insurance Policy number SJ61025276. At some point in time prior to the date of loss, Slide Insurance acquired Saint Johns Insurance Policies when Saint Johns became insolvent. On or around September 28, 2022, while the Policy was in full force and effect, the INSURED suffered a loss at the insured property located at 2000 Marianne Key Rd Unit 11A, Punta Gorda, FL 33955 ("the Property"). The loss caused direct physical damage to the Property. The loss was sudden and accidental, and therefore, a covered peril under the policy.
The INSURED notified the Insurer of the loss due to Hurricane Ian on or about September 30th, 2022, with a date of loss of September 28, 2022, and INSURER assigned claim number SL22205509 to the INSURED'S loss.
On October 8, 2022, INSURER dispatched Independent Field Adjuster Brant Hambly, Florida Adjuster License number W437416. We never met Mr. Hambly, but we believe that between the date of inspection and when INSURED received their estimate, someone deleted estimate line items with the intent of reducing valid coverage. This has happened in the past with Saint Johns Insurance Polices that were acquired by Slide Insurance.
After sending their coverage decision, INSURER closed the claim in hopes that the INSURED would not pursue additional money and if they did, it would fall on a closed claim.
Feeling betrayed and cheated by Slide Insurance, INSURED sought the help of a Public Adjuster.
On October 19, 2024, INSURED elected to obtain representation from Property Claim Counselors, LLC (PUBLIC ADJUSTER) to protect their interests. PUBLIC ADJUSTER conducted a thorough investigation, including preparing a repair estimate totaling $102,929.35 including Personal Contents in the amount of $12,495.63, food loss in the amount of $720.09, and Additional Living Expenses in the amount of $9,153.00.
At some point Mr. Clayton Green was assigned to the claim as a Desk Adjuster. His adjuster license is W560118. It should be noted that Mr. Green previously worked as an adjuster for United Property and Casualty Insurance (UPC), who went insolvent, and who also had a terrible reputation of grossly amending field adjuster estimates downward in an attempt to defraud policyholders of rightful contractual benefits.
We believe this is the same situation as this claim but do not know who is responsible. We believe management at Slide Insurance removed covered damage in order to protect Slide’s financial interest.
All of the above was done in bad faith.
INSURER has as a general business practice, failed to properly adopt and implement standards for the proper investigation of claims by hiring adjusters/engineers who present one-sided reports for the sole purpose of denying claims. As a business practice, INSURER does not retain adjusters/engineers whose reports suggest indemnifying INSURED for covered damages. When INSURER is not presented with independent and objective reports, it has no choice but to deny coverage. Because of this, INSURER is in violation of F.S. 626.954(1)(i)(3)(a) by failing to implement and adopt standards for the proper investigation of claims.
INSURER has denied claims without conducting reasonable investigations of claims based upon available information by seeking out adjusters/engineers who will only report to them facts that are contrary to indemnifying their INSURED. Because of this, INSURER is in violation of F.S. 626.9541(1)(i)(3)(d) in that it denied claims without considering all the facts.
INSURER’S delay does not follow policy guidelines (see conditions section of policy) and does not show a desire to return the Property to a pre-loss condition as detailed and required under the Policy. INSURER has also specifically ignored aspects of the INSURED'S claim for which coverage exists. The entire purpose of insurance is to indemnify the INSURED of a covered loss. Despite this, INSURER has failed to issue adequate payment to INSURED. INSURER’S delay in this matter subjects the insured property to further damage. The INSURED'S damages will continue to exacerbate so long as INSURER refuses to provide full indemnification for the covered loss.
The INSURED has provided INSURER with all information available with respect to the loss. To date, INSURER has failed and/or refused to provide INSURED with all the insurance benefits due and owing, despite knowing that INSURED has sustained covered damages to their insured property. Despite the INSURED'S repeated pleas, INSURER has not tendered the full amount needed to repair the Property or issued all payments to the INSURED due under the Policy. Instead, INSURER is apparently attempting to ignore further coverage with an end goal of denying the claim.
As INSURER must admit, it is implied within every insurance policy a fiduciary duty, a duty of good faith and fair dealings. In an insurance contract, each party is prevented from interfering with the other's right to benefit from the contract. The obligations of good faith and fair dealings encompass qualities of decency and humanity inherent in its responsibilities as a fiduciary. INSURER is bound to conduct itself with the utmost good faith for the benefit of the INSURED. However, INSURER has failed to comply with the obligations in connection with this claim and has never looked at the claim or the contract for insurance with good faith and fair dealing. Instead, INSURER has looked for ways not to pay the claim in full and these actions have been to the detriment of INSURED.
The adjusters assigned to this claim have a duty to adjust and treat all claims equally. Since the beginning of this claim, the representatives on behalf of INSURER have approached this investigation in a manner prejudicial to the INSURED. INSURER is using either untrained or improperly trained adjusters in connection with this claim. INSURER should have been adjusting the loss with the INSURED, but instead, it was looking for ways not to pay the claim in full. If INSURER manages all the claims in the manner in which INSURED’S claim was adjusted, then it is improperly handling all claims.
INSURERS’ conduct has been reckless and unfair to the INSURED. This is evidenced by the lack of a determination of coverage for the INSURED'S claim, the failure of INSURER to evaluate the claim in total, and the failure of INSURER to acknowledge or respond to multiple inquiries regarding the INSURED'S claim.
INSURER has refused and/or failed to comply with the Policy's cooperation and/or "Loss Payment" provision. Under the Policy, INSURER was to timely tender insurance benefits to the INSURED. INSURER has failed and/or refused to timely tender all owed insurance benefits. This is a breach of the Policy.
INSURER has refused and/or failed to cooperate and/or "Adjust the Loss" by cooperating with the INSURED during the claims adjustment process in compliance with the Policy's "Loss Payment" provision. This is a breach of the Policy.
INSURER has a contractual obligation to make a perfunctory investigation, not ignoring evidence that would support the INSURED'S claim. This is a breach of the Policy.
INSURER has a contractual obligation not to look the other way when confronted with facts revealing the possibility of additional coverage and resisting reasonable interpretations of its policy. This is a breach of The Policy.
The concept of insurance is that insurance is the insurer's granting of timely and prompt indemnity or security against a contingent loss. Florida Statute 5624.02 defines "insurance" as a contract whereby one undertakes to indemnify another or pay or allow 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 damage and to put them back into the position they were in prior to the loss as quickly as possible. INSURER has breached this duty.
INSURER has refused and/or failed to tender all insurance proceeds to the INSURED upon demand. INSURER refusal and/or failure to settle the insurance claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards the INSUREDS is wrongful conduct. Furthermore, the INSURED contends that INSURER’s adjusters and/or representatives financially benefit by such wrongful conduct.
In Florida, the work of adjusting insurance claims engages the Public Trust. INSURER has breached this duty by its adjustment of its INSURED'S claim of loss.
INSURER’s handling and adjustment of its INSURED'S claim of loss and the conduct of the adjusters, supervisors, management and individuals associated with or retained by INSURER in this claim to date evidence that INSURER 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. INSURER has also failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the INSUREDS' insurance claim for damages. To date, notwithstanding the INSURED'S pleas for assistance, INSURER has refused to pay the full amount of its INSURED'S claim.
Therefore, INSURER has violated some of the most basic adjustment principles in its adjustment of the INSURED'S claim, including:
1) failure to pay claim in full;
2) failure to promptly investigate claim;
3) failure to properly investigate claim;
4) failure to adjust loss;
5) failure to act in due diligence and good faith to resolve claim;
6) placing financial interest of INSURER before that of policy holders and claimants;
7) failure to properly train, evaluate and manage adjusters;
8) looking for ways to deny coverage, pay less, delay payment and otherwise "low ball" or "stone wall" claim;
9) 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.
Therefore, to cure the defects outlined in this Civil Remedy Notice, INSURER must:
Create and implement adequate guidelines for proper investigation and evaluation as to claims handling and for the training and supervision of employees, which will avoid future statutory violations as set forth above, and to avoid this from occurring in the future;
Create and implement adequate guidelines for the proper investigation and evaluation of these types of claims, and for the training and supervision of employees with regard to these types of claims to ensure INSURER’S claims handling procedures with regard to these types of losses are adequate to stop further Insureds from being treated unfairly and wrongfully;
Assist the INSURED in mitigating their damages;
Immediately tender all undisputed insurance proceeds to INSURED;
Tender all amounts due and owing the INSURED in accordance with the estimate submitted by PUBLIC ADJUSTER totaling $102,929.35 plus attorney’s fees and all other fees associated with pursuing his rightful benefits.
Act fairly and honestly towards the INSURED and with due regard for their best interests in attempting to settle the INSURED'S claim, including by providing the INSURED with copies of reports, declarations pages, certified copies of policies, or estimates being relied upon to support the coverage determination;
Immediately tender all insurance benefits due and owing to the INSURED under the Policy pursuant to the relevant policy provisions provided therein that would reasonably place the INSURED back to their pre-loss condition, including, but not limited to all interest due and owing under applicable Florida Statutes.
Reimburse the INSURED for costs associated with having to hire their own representation on their claim.
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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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