Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 809935

Filing Accepted: 3/6/2025

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Complainant

Last/Business Name *

WINSTON SHAEFFER, MARY SHAEFFER, AND ACTION JAX INC.

First Name

Street Address *

3555 STATE ROAD 13 NORTH

City, State Zip *

SAINT JOHNS, FL 32259

Email Address *

WPSHAEFFER@YAHOO.COM

Complainant Type: *

Insured

Last/Business Name*		WINSTON SHAEFFER, MARY SHAEFFER, AND ACTION JAX INC.		First Name
Policy # *		JTA5015617		Claim #*		163585

Attorney

Attorney is Applicable

Last Name*	ROSS First Name * VANESSA Initial
Street Address*		2501 S TAMIAMI TRAIL
City, State Zip*		SARASOTA , FL 34239
Email Address *		ESERVICE@ROSSLEGALFL.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		GREAT LAKES INSURANCE SE
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code

Name of individual responsible for violation (if any):* CRAIG GRAHAM, AND ALL OTHER ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY GREAT LAKES INSURANCE SE INVOLVED IN THE CLAIM.
Type of Insurance * Commercial Property & Casualty

Reason for Notice *

	Claim Denial
	Claim Delay
	Unsatisfactory Settlement Offer
	Unfair Trade Practice

* 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.
	624.155(1)(b)(3)		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.
	626.9541(1)(i)(3)(a)		Failing to adopt and implement standards for the proper investigation of claims.
	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.

Building Coverage provisions Perils Insured Against Loss Payment Loss Settlement

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

In Florida, the work of adjusting insurance claims engages the public trust. Great Lakes Insurance SE (“INSURER”) has breached the public’s trust by its adjustment of Winston Shaeffer, Mary Shaeffer, and Action Jax Inc. (“INSURED”) claim of loss. Great Lakes Insurance SE’s mailing address is Plantation Place, 30 Fenchurch Street, London EC3M 3AJ, United Kingdom. INSURER has failed to create and implement adequate guidelines for the proper investigation and evaluation of claims, claims handling, and for training and supervision of employees resulting in statutory violations as set forth above. INSURER has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the INSURED’S insurance claim for damages. INSURER has failed to promptly settle the INSURED’S insurance claim when the obligation to settle the insurance claim had become reasonably clear. To date, notwithstanding the INSURED’S pleas otherwise, INSURER has continued to refuse to acknowledge its obligation to conduct a proper investigation, and to tender the full amount of insurance monies due and owing its INSURED under the policy. This claim involves the Insured’s property located at 3555 State Road 13 North, Saint Johns, FL 32259 which sustained damage from wind on or about August 5, 2024. The Insureds immediately reported the loss to the carrier. A tree fell on the building and punctured the ceiling. The Insureds retained Floridian Public Adjusters to assist with determining the amount of damage sustained to the property. Floridian prepared an estimate in the amount of $123,246.85 ACV. Black Creek Tree Company assisted the Insured with emergency tree removal, which required a lift and grapple truck to complete totaling $6,800.00. See documentation attached hereto. Therefore, demand is hereby made as follows: Estimate $126,561.31 Less Prior Payments $0.00 Less Deductible $22,500.00 TOTAL $104,061.31 The concept of insurance is that the insurer will investigate and grant timely and prompt indemnity or security against a contingent loss. 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 in that definition is the fact that payment must be made timely and promptly so that the INSURED may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. INSURER has breached this duty. The INSURED was, and still is, forced to expend out of pocket monies to submit her insurance claim, e.g., retaining an attorney and other experts to force INSURER to honor its obligations under the insurance policy and to pay all the insurance proceeds due and owing to them. INSURER has refused and/or failed to tender all the insurance proceeds due and owing to the INSURED. INSURER’s 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 INSURED is wrongful conduct. Furthermore, the INSURED contends that INSURER’s adjusters and/or representatives financially benefit from such wrongful conduct. This notice is given in order to perfect the right to pursue the civil remedy authorized by Fla. Stat. §624.155. Therefore, to cure the defects outlined in this Civil Remedy Notice, INSURER must: (1) Create and implement adequate guidelines for the proper investigation and evaluation of claims and for the training and supervision of employees, which will avoid future statutory violations as set forth above, and prevent this from occurring in the future; (2) INSURER must 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 claims to ensure that the claims handling procedure with regard to these types of losses are adequate to prevent other Insureds from being treated unfairly and wrongfully; (3) INSURER must tender to the INSURED $104,061.31 as set forth above; and, (4) INSURER must act fairly and honestly towards its INSURED and with due regard for her interests in attempting to settle its INSURED’S claim. Attachments: PA Estimate, tree removal invoice

Comments

User Id		Date Added		Comment
eservice@rosslegalfl.com		05-01-2025		The Insured, Mary Shaeffer, Winston Shaeffer & Action Jax, Inc., hereby provides notice to the Department of Financial Services and Great Lakes Insurance SE that an amicable resolution to the issues outlined in Civil Remedy Notice filing #809935 has been resolved between the parties through settlement. Accordingly, Mary Shaeffer, Winston Shaeffer & Action Jax, Inc. hereby withdraw Civil Remedy Filing #809935 filed 03/06/2025.

Acknowledgement
*	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