Filing Number: 809409
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| Filing Accepted: 3/4/2025 |
| Last/Business Name
*
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AND DAIRELIZ RIVERA
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First Name |
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ESTEBAN RIVERA FUENTES |
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| Street Address
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248 LA PAZ DRIVE |
| City, State Zip
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KISSIMMEE,
FL
34743
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| Email Address
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INTAKE2@THEKRFIRM.COM |
| Complainant Type:
*
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Insured |
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| Last/Business Name* |
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AND DAIRELIZ RIVERA |
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First Name |
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ESTEBAN RIVERA FUENTES |
| Policy # * |
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76838-71-54 |
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Claim #* |
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7006778484-1 |
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Attorney is Applicable
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| Last Name* |
LAMBERT
First Name *
RANDY
Initial
E.
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| Street Address* |
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986 DOUGLAS AVE, STE. 102 |
| City, State Zip* |
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ALTAMONTE SPRINGS
,
FL
32714
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| Email Address * |
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RANDY@THEKRFIRM.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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TRUCK INSURANCE EXCHANGE
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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 21709 |
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| Name of individual responsible for violation (if any):*
HORACE JOHNSON, SKY LIGHT ROOFING INC., AND ALL TRUCK CLAIMS ADJUSTERS, EMPLOYEES, REPRESENTATIVES, AGENTS, VENDORS, AND/OR ENGINEERS WHO HANDLED THE 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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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Other
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Misrepresentation
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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)(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.
“We insure against accidental direct physical loss or damage to the property described in Coverages A and B, unless the loss is excluded in Section – I Exclusions.”
Truck possesses a complete copy of the subject insurance policy. The Riveras are not in possession of a complete copy of the subject policy and is requesting a copy from Truck. Thus, this CRN cannot cite subject policy language verbatim due to such.
Notwithstanding, the subject policy is an all-risks insurance policy and the applicable policy language is the provision regarding coverage of all risks for the dwelling (Language such as “We insure against direct physical loss to property…”, “We insure against risk of direct loss to property…”, among other similar policy language etc. is typically used.) and provisions regarding exclusions or limitations to this all-risks provision.
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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.
Esteban Rivera Fuentes and Daireliz Rivera (“the Riveras”) are homeowner insureds with a policy issued by Truck Insurance Exchange (“Truck”). The insured property or home is located at 248 La Paz Drive, Kissimmee, Florida 34743.
In June of 2023, a wind and rainstorm caused extensive damage to the Riveras’ home. The Riveras timely reported an insurance claim for this damage to Truck and fully cooperated with all requests for inspections. They provided all requested documentation, if any, and complied with all post loss policy conditions.
After reporting the claim, Truck retained an unqualified and biased field adjuster who has a financial relationship with Truck. This field adjuster inspected the Riveras’ home in an apparent effort to minimize Truck’s losses instead of adjusting the claim in good faith in due regard for the Riveras’ interests.
Despite Truck finding coverage for their claim, it significantly undervalued the Riveras’ claim at only $1,682.20. Because this amount is less than the subject policy’s deductible, Truck did not issue any payment to the Riveras. Due to such, the Riveras have not been able to permanently repair their home. Indeed, invoices for tarp and water mitigation services as well as an estimate for repair of all damages were prepared on behalf of the Riveras totaling $54,248.71 and were submitted to Truck; well above the amount from Truck.
Based on these facts, it is clear Truck unreasonably denied full coverage for the Riveras’ claim in bad faith through its extremely low and unreasonable undervaluation of their claim. Had Truck conducted a reasonable investigation based upon the available information, it would have been evident that affording greater coverage and issuing a substantially higher payment is warranted. Instead, it failed to adopt and implement standards for proper claim investigation as well as misrepresented pertinent policy provisions/facts rather than act fairly and/or honestly with the Riveras in due regard for their interests. Truck also delayed the claim and failed to timely respond to communications. This has become a common business practice of Truck.
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 based on determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. Truck has breached this duty by refusing to properly and timely adjust the loss.
As a result, the Riveras will have no choice but to retain the undersigned counsel to file a lawsuit against Truck.
Truck has more than enough information and is still refusing to accept coverage for this claim. This continued and repeated reckless claim delay and denial of coverage will result in a significant punitive damage award if a bad faith lawsuit is filed.
Truck can avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy for this claim and by paying the Riveras based on their $54,248.71 estimate and invoices.
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*
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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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