Filing Number: 810662
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| Filing Accepted: 3/11/2025 |
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PLANAVSKY
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First Name |
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DEREK |
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341 CARYOTA CT |
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NEW SMYRNA BEACH,
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32168
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DEREK.P@SAWLUTIONSLLC.COM |
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Third Party |
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EMERSON INTERNATIONAL, INC |
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PHPK2408944 |
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Claim #* |
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PHRA23041575398 |
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Attorney is Applicable
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 Authorized Insurer
 Unauthorized Insurer
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PHILADELPHIA INDEMNITY INSURANCE COMPANY
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NAIC Company Code 18058 |
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| Name of individual responsible for violation (if any):*
LICENSE #: W740417 CHRISTINA HERKOPEREC, AINS: FAST TRACK CLAIMS EXAMINER; LICENSE #: A190981 MELODY NESTOR: SENIOR CLAIMS EXAMINER/ CLAIMS EXAMINER; LICENSE #: W317345 DANIELLE JOSEPH: (FORMER) CLAIMS ASSISTANT TO MELODY NESTOR; LICENSE #: A1855
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Commercial Property & Casualty
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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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Bad Faith Insurance Practices (Florida Statutes §624.155)
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Other
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Failure to Act in Good Faith (F.S. §624.155(1)(b)(1))
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Other
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Insurance Fraud (Florida Statute §817.234)
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Other
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Consumer Protection & Regulatory Violations (Florida Deceptive and Unfair Trade Practices Act §501.2
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Other
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Improper Disclosure of Policy Information (Florida Statute §627.4137)
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Other
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Failure to Comply with Privacy Regulations (F.S. 624.26)
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Other
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Violation of F.S. §627.4265 (Settlement Offers & Valuation)
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Other
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Violation of the Implied Covenant of Good Faith & Fair Dealing:
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Other
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Violation of §626.9743(5)(a)
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Other
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Violation of Dodd-Frank Wall Street Reform and Consumer Protection Act:
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Other
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Violation of Federal Consumer Protection Laws
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Other
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Violation of Good Faith and Fair Dealing (Common Law)
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Other
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Violation of Florida Statute 627.70131 – Insurer's Duty to Acknowledge and Pay Claims
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Other
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Violation of NAIC Model Unfair Claims Settlement Practices Act
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Other
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Violation of Federal Trade Commission Act (FTC Act)
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Other
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Violation of Florida Administrative Code – Claims Handling Standards (69B-220.201)
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Other
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Violation of Florida Statute 626.9743(5)(a)
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Other
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VIOLATION OF POLICY/BREACH OF CONTRACT
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Other
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Misrepresenting Facts, Misleading, PIIC False Reporting to DFS: Service Request Number: 1-1170879238
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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)(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)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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Denying claims without conducting reasonable investigations based upon available information.
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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)(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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Altering or amending an insurance adjuster’s report without:
(I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and
(II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or
(III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
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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.
Violations by Philadelphia Insurance Company (PIIC):
A. Bad Faith Insurance Practices (Florida Statutes §624.155):
Failure to Act in Good Faith (F.S. §624.155(1)(b)(1)): – Not attempting in good faith to settle claims when, under all circumstances, it could and should have done so.
Offered a significantly undervalued settlement, not reflecting market value.
Delayed payment over one year despite acknowledging liability.
Refused fair vehicle evaluation and provided valuation by falsely reporting inaccurate information (DOL, mileage, features, etc.) to third party valuation company. PIIC stated on several occasions they were unable to provide a past date evaluation to reflect the date of loss and refused a past date valuation from independent KBB valuation, procured by Claimant. Valuation reflects value as of September 5th, 2023, when PIIC filed with CCC.
PIIC falsely reported inaccurate information regarding the valuation to the DFS, regarding complaint[SR#:1-1170879238]. As stated in the DFS findings, "PIIC advised that the original estimate had April 24, 2023, date of loss, and the CCC ran the total loss with that date. Therefore, the reports were generated with the April 24, 2023, loss date. The company advised if they were to change the date of loss to March 11, 2023, this would cause the valuations of comparable vehicles to re-run on the date of their request. Concluding this is the reason they kept the date of 04/24/2023 to have a fair market value from their September request."
The CCC report is based on the date reported to them, September 5th, 2023 (PIIC Reporting Date). PIIC later changed the date on the CCC report to 4/24/23, causing confusion and misrepresentation to the date used for the valuation, as the vehicle sale dates included in the report are dated June 27th, 2023- September 5th, 2023, further impacting the valuation.
The mileage on all documents provided is listed as the mileage at the end of June, 2023, as 92,218, instead of the mileage at the date of loss. Due to this inaccuracy and false reporting, the average mileage of the 11 vehicles listed as comparable is 92,651.90, further impacting the valuation.
A letter of non representation was received by PIIC and Melody Nestor on 9/05/23. Melody Nester conducted a valuation report from CCC on 9/05/23. Melody Nestor provides notice PIIC accepted liability for property damage via phone on 9/19/23. Prior to receiving letter of non representation, PIIC was "investigating" "disputed facts," 4/24/24 to 9/05/23.
The first CCC report is based off the base model without additional premium features/ options. The second report did not reflect the aftermarket tow hitch.
PIIC’s failure to promptly settle the claim, accurately reflect the vehicle’s actual cash value at the date of loss, communicate effectively, and continuous delays, limited the options available for the Claimant to be able to have safe and reliable transportation, compelling to purchase of an additional vehicle in Claimants personal name. This resulted in significant financial hardship, including negative impacts on personal credit, unnecessary loan payments, insurance premiums, and associated fees. Negative impacts to personal credit scores resulting from maintaining multiple vehicle loans simultaneously.
PIIC's repeated deflection to Claimants own insurance carrier, despite knowing that PIIC’s policyholder was at fault, suggests an effort to offload the claim onto Geico to delay payments, avoid liability, or force Claimant into an unfavorable settlement. PIIC and Melody Nestor sent multiple communications, mitigation letters, and continuous responses to requests for a fair valuation, to provide an accurate offer letter, or to stop delaying with potential misuse of legal language, such as "duty to mitigate your damages" and "You have the option of filing through your personal auto insurance carrier and the duty to mitigate your damages.", at such a frequency between August 2023 and May, 2024, it would strongly suggest it was a deliberate strategy to manipulate the claims process(also violating §626.9541(1)(i)(2), §626.9541(1)(i)(3)(c), and §626.9541(1)(i)(3)(d). Claimant made best efforts to the general obligation to prevent further unnecessary damages, such as using outdoor tape to cover cracked glass and visible vulnerabilities for over 14 months. However, Claimant is not a professional vehicle repair specialist with the required tools, equipment, or know how to correctly fix damage and waterproof vehicle.
Refusal to Cover Out-of-Pocket Costs: Claimant explicitly chose to go through PIIC’s liability insurance to avoid personal expenses, yet Christina Herkoperec and Melody Nestor ignored this decision and continued pushing for you to go through claimant's insurer,Geico. If Claimant had filed through Geico, Claimant would have been forced to: Pay the deductible upfront. Cover the three-week rental out-of-pocket before seeking reimbursement through PIIC. Possibly face additional increased insurance premiums as a result of the claim. PIIC refused a rental and refused to pay for a rental during tear down and refused to pay for the total cost of tear down PIIC requested to better assess damage(a year after the DOL).
PIIC uses a company that lacks the ability to provide an accurate valuation based on a previous date, or an actual date of loss, to provide official valuation reports, potentially broad negative impacts on payouts to claimants, acting in the best interest of the insurer. This would further support PIIC intentional delays in claim.
PIIC Initially accepted liability (on 9/19/2023), but then repeatedly stating a release waiver was required, "Any offers of settlement are contingent on a signed release. We will send said release once we have a settlement agreement.", particularly after the claimant started bring notice to violations of Florida Statutes, after requesting corrections of errors were consistently ignored. This indicates PIIC may not have been acting in good faith to settle the claim. Conditioning a settlement on a signed release without addressing errors or corrections constitutes an attempt to pressure the claimant into an unfair or premature settlement?, waiving claimants rights to pursue further.
Delaying Settlement Despite Clear Obligation (F.S. §624.155(1)(b)(3)):
PIIC delayed paying undisputed portions of the claim intentionally, resulting in prolonged hardship for the claimant.
B. Unfair Claim Settlement Practices (Florida Statutes §626.9541):
Material Misrepresentation (F.S. §626.9541(1)(i)(2)):
Despite having the correct date of loss on all initial documentation, PIIC continuously reported the incorrect date of loss to third parties and on claims documents, reflecting a later date after HB 837 made changes to the statute of limitations.
Incorrectly reported loss date to CCC as 4/24/23 instead of actual 3/11/23, affecting valuation.
Incorrectly reported loss date to Independent adjuster assigned to provide assesment as 4/24/23 instead of actual 3/11/23, affecting valuation.
Incorrectly reported loss date to the lender, Infiniti Financial Services as 4/24/23 (on 10/02/23), 1/24/24 (on 1/31/24), and 4/24/23 (on 5/17/24) instead of actual 3/11/23, affecting valuation.
Incorrectly reported vehicle mileage (92,218 instead of actual mileage at loss date), reducing vehicle's valuation.
Unauthorized contact to Claimants insurance carrier, Geico, unnecessarily, reporting inaccurate information on 5/5/23, after explicitly being informed the claimant wished to handle the claim through PIIC and not the claimants insurer to avoid out of pocket expenses, which may have resulted in: unauthorized disclosure of information; privacy violation; misrepresentation; disclosure of incorrect, misleading or false information; and impact on insurance coverage and premiums, negatively impacting the claimant. This action triggered a sequence of events (admitted by Geico) resulting in: a coverage reevaluation, policy changes and cancellation, a new policy issued without notice or prior written explanation, including a "new policy mandatory deposit of 25% for the policy term and an insurance premium increase of over 100% the rate at the time of the date of loss, despite being a loyal policy holder for over 12 years with satisfactory payment history.
Ignored repeated requests for correction, effectively misrepresenting the actual market value of your vehicle.
PIIC, through Melody Nestor, repeatedly insisted Claimant's vehicle's damage closely approached an 80% total loss threshold, potentially using this threshold to pressure claimant into accepting a lower settlement. Specifically, PIIC presented a valuation of 15,592.00 and $17,962.00 against repair estimates of $13,600.13, stating they were nearing the total loss threshold, despite claimant rights clearly outlined under Florida Statute 626.9743(5)(a) and 319.30(3)(a)(2), which state explicitly, vehicle repairs that do not exceed 100% of the value give the claimant the right to decide between repair or total loss?. PIIC's insistence on applying an 80% threshold is a misrepresentation and tactic to avoid higher repair costs and liability.
Vehicle repairs that do not exceed 100% of the value give the claimant (you) the right to decide between repair or total loss?Legislature Reference-2….
PIIC's insistence on applying an 80% threshold is a misrepresentation and tactic to avoid higher repair costs and liability.
Falsely reporting the Claimants vehicle as a total loss to the Lender without the cost of repair meeting an 80% threshold or exceeding 100% of PIIC's claimed value, violating Claimants rights under Florida Statute 626.9743(5)(a) and 319.30(3)(a)(2).
CCC valuation reports are generated based on incorrect dates (using the date the insurer provided rather than the actual loss date), incorrect mileage, and omitted additional premium vehicle features, impacting the valuation negatively?
Denying Claims Without Proper Investigation (F.S. §626.9541(1)(i)(3)(d)):
PIIC failed to conduct a timely and adequate investigation (over 150 days delay post-claim filing).
PIIC claimed to conduct their investigation for months with no updates, despite the Insured admitting fault, cameras directly in front of the place of incident, a witness, a police report, and a gate repair service request that included comprehensive documentation and photos of the damage and gate support beams not attached to a support, provided by the Claimant to the Insured at the time of the incident, which was then forwarded to PIIC to open the claim. Ignored the claimant's evidence, ignored requests for what specifically were the "disputed facts", and refused the KBB valuation.
No onsite inspection conducted immediately after the incident or at the claimant's request.
PIIC did not perform an evaluation reflecting the actual date of loss, which is essential for accurately assessing the vehicle's value at that time?. The insurer ignored available evidence supporting the correct valuation, such as the Kelley Blue Book (KBB) report provided independently by you at your own cost. PIIC uses CCC valuation reports that are generated based on incorrect dates (using the date the insurer provided rather than the actual loss date)
Failing to Acknowledge/Act Promptly (F.S. §626.9541(1)(i)(3)(c)):
Repeated delays and ignoring of communications by phone and email throughout the claim process.
PIIC representatives ignored calls, emails, and voicemail follow-ups consistently. Despite the Claimants previous counsel communicating PIIC may contact the Claimant directly, Christina Herkoperec refused requests for status updates, failed to acknowledge demand letters, and further delayed the claim process with continuously requesting documents and information previously given, multiple times.
Despite receiving a letter of non-representation from Claimants previous counsel on September 5th, 2023, Melody Nestor refused to speak with the Claimant or return calls on several occasions, including hanging on on the Claimant on 9/19/23, not returning voicemails left on 10/18/23 and 10/26/23 and a response email to Danielle Joseph requesting corrections to be made to the offer letter on 10/12/23.
Melody Nestor continued to fail to acknowledge or act promptly by not keeping updated or accurate records, resulting in a phone call to PIIC on 10/31/23, wherein a representative noted the reason no one was responding to the claimant was because it is noted on the account that the Claimant had an attorney and that no one could speak to anyone but the attorney, to which the Claimant stated no longer having an attorney, to which her response was, "well I can't change it." This was then followed by no communication until January of 2024, with a receipt of a letter stating the claim would close in 10 days.
Melody Nestor, Thomas Morton(direct supervisor), and other representatives displayed consistent failure to acknowledge emails, requests for documentation and information, status updates, corrections to incorrect information, a fair valuation, follow through, and repeatedly provided partial responses or documentation, such as responding to a request for all claim and policy documents with providing a 562 page redacted policy, redacting important coverage limits, such as loss of use(page 328), while ignoring requests for other claim files.
Failing to Provide Reasonable Written Explanation (F.S. §626.9541(1)(i)(3)(f)):
No written explanation provided for the initial undervalued settlement offer or for subsequent valuations after corrections were requested.
Failing to affirm coverage until September 19th, 2023, via phone.
Denying requests for explanations of changes, failure to make corrections, request for clarification, not providing valuation reports or assessments until months after conducted, refusing to provide explanations, or repetitively copy and pasting a response phrase without addressing the request or providing explanation.
Melody Nestor stating "KBB does not reflect market value" is not a sufficient explanation under the law. PIIC did not provide supporting documentation of a fair valuation, reflecting accurate vehicle information, as the valuation is based off value as of 9/05/23, not the date of loss, 3/11/23, with higher mileage and not reflecting all additional features(also violating §626.9541(1)(i)(2), §624.155(1)(b)(1), §626.9541(1)(i)(3)(c), §626.9541(1)(i)(3)(d), §626.9541(1)(i)(3)(j)). Melody Nestor responded to requests for a fair and accurate valuation with "we have provided a fair offer", with such a frequency, strongly suggesting malicious refusal to provide explanation.
Altering Insurance Adjuster’s Report (F.S. §626.9541(1)(i)(3)(j)):
Adjuster's reports altered without explanations or retaining original versions, including changes to valuation dates, mileage, claimant’s name spelling, and vehicle driveability status.
Failure to Pay Undisputed Amounts Promptly (F.S. §626.9541(1)(i)(4)):
Waited over a year to issue payment after determining the claim valid, ignoring statutory timelines.
Processed payment to the lender and delayed payment for remaining undisputed amount, claiming remaining payment is contingent on Claimant signing a release waiver. Stated a release was required for payment multiple times, after PIIC accepted liability and to pay for damages, including on June 26th, 2024, Melody Nestor stating, "Any offers of settlement are contingent on a signed release."
PIIC failed to pay undisputed amounts within 60 days. It waited over a year to settle, demonstrating unreasonable delays in making settlement offers and payments, relying on inaccurate CCC reports which failed to reflect the actual date of loss (3/11/2023)?Requests-Received-20250…
Failure to Acknowledge Communications (F.S. §626.9541(1)(i)(3)(c)):
Repeated failure by PIIC to respond promptly or acknowledge critical communications regarding the claim's status and valuation corrections by multiple people within PIIC.
Insurance Fraud (Florida Statute §817.234):
Deliberate and intentional misreporting critical information, such as the date of loss, mileage, features, or vehicle status, to third parties (CCC valuation firm, Infiniti financial services) influencing settlement terms negatively for claimant and constituting insurance fraud.
Continuous reporting of inaccurate information on official claims documents, continued after Claimant expressed concern with violation of F.S. 817.234 to both Melody Nestor and Thomas Morton.
Possible intentional alteration of adjuster’s valuation reports and claim documents.
Knowingly preparing reports (such as a CCC valuation or loss settlement reports) that contains false, misleading, or incomplete information for misleading another party can constitute insurance fraud. Inaccurate dates, mileage, and vehicle conditions, despite correction requests.
Consumer Protection & Regulatory Violations (Florida Deceptive and Unfair Trade Practices Act §501.204):
Engaged in misleading claim settlement practices.
Provided false statements and misrepresented facts, inducing claimant to accept a lower settlement offer.
Conditioning settlement offers on a waiver and misrepresenting valuation methods could be seen as deceptive acts designed to pressure claimants into accepting inadequate compensation without addressing legitimate issues raised by the claimant?
PIIC’s misleading settlement practices and reliance on inaccurate valuations to offer a lower settlement might constitute deceptive practices. CCC is only able to provide a valuation based on when the report is generated.
Improper Disclosure of Policy Information (Florida Statute §627.4137):
Failed to provide full policy documents, limits, and coverage information despite repeated requests.
Failed to answer coverage requests, such as rental coverage, loss of wages (requested on 9.19.23) and loss of use more than 30 days(requested continuously over a year period).
Failure to Comply with Privacy Regulations (F.S. 624.26):
Disclosed unrelated third-party personal insurance information (Ocean Lakes Family Campground claim information sent mistakenly), potentially violating confidentiality requirements.
C. Additional Identified Violations and Misconduct by PIIC:
Violation of F.S. §627.4265 (Settlement Offers & Valuation):
Failed to provide accurate vehicle value at the correct date of loss (March 11, 2023), significantly reducing the amount owed to claimant. CCC, a company that provides valuation reports, should possess the ability to provide an accurate valuation based on a previous date or actual date of loss, or the company should not be recognized as a provider for a fair valuation, as this violates PIIC policy definition of date of loss, as well as potentially violates other laws and regulations.
Violation of the Implied Covenant of Good Faith & Fair Dealing: PIIC delayed providing essential claim information, necessary policy documents, and vehicle valuation.
Florida Administrative Code – Claims Handling Standards (69B-220.201)
PIIC failed to adhere to ethical obligations for adjusters handling claims.
Act with fairness and honesty: Forcing a claimant to take unnecessary actions or avoid handling a legitimate claim properly is unethical and violates these ethical obligations. PIIC failed to provide honest and accurate information on claim documents, reporting inaccurate information to third parties with negative impacts on the Claimant. PIIC attempted to require the claimant to have a tear down of the damaged vehicle for a secondary assessment, requiring Claimant to pay for any additional cost over 4 hours of labor for the tear down, costs of a rental and costs of reconstruction of vehicle to condition prior to tear down. PIIC did not handle the claim in a fairly, forcing the claimant to represent his business and services in a damaged vehicle, and drive an unsafe, water permeable, vehicle with a smashed windshield for over 494 days after the claim was filed. PIIC may have prioritized investigating their liability due to Insured filing claim 44 days after incident, instead of acting in the best ineterest of the Claimant.
Promptly investigate and adjust claims: PIIC delayed their investigation and instead pushed the claimant to use alternative methods (such as their own insurance), provided low ball offers, refused corrections and reasonable requests violating these ethical requirements.
Federal Trade Commission Act (FTC Act): PIIC used deceptive practices to compel unnecessary actions from the claimant(requiring waiver, compelling a tear down to delay settlement, requiring out of pocket expenses, forcing claimant to drive an unsafe vehicle that could be ticketed by law enforcement due to broken windshield causing visual impairment, as well as other events listed throughout.
Truth in Advertising Standards: PIIC misrepresented policy coverage and mislead the claimant about obligations under the policy.
NAIC Model Unfair Claims Settlement Practices Act:
Compelling insureds to initiate litigation to recover amounts due: PIIC continuously compelled the claimant to file through their own insurance to repair damages and go through subrogation to recover additional costs.
Failing to provide a reasonable explanation for claim denials: PIIC avoided handling the claim, ignored requests, failed to provide a lawful explanation of unfair valuation, and required a waiver until the claimant contacted the DFS.
Florida Statute 627.70131 – Insurer's Duty to Acknowledge and Pay Claims: PIIC investigated the claim for 148 days before accepting liability on 9/19/23, compelling the claimant to take unnecessary actions with waterproofing the vehicle, not being able to drive or work when it rained. PIIC did not process a payment until July 16th, 2024, 493 days until after the date of loss.
Violation of §626.9743(5)(a): Insurers cannot declare a vehicle a total loss without the owner’s agreement if repairs do not exceed 100% of the actual cash value immediately before the loss. By not offering an accurate valuation reflecting the pre-loss date and instead using later dates and depreciated values, PIIC restricted Claimants statutory rights as the vehicle owner to make an informed decision?.
Good Faith and Fair Dealing (Common Law): Implied duty of good faith and fair dealing. PIIC mishandled the claim and acted in a manner that was coercive and obstructive, forcing the claimant to involve multiple superiors and later, the DFS in an attempt to have the claim handled properly.
Federal Consumer Protection Laws
Dodd-Frank Wall Street Reform and Consumer Protection Act: PIIC's actions involve deceptive practices, including using a company that lacks the ability to provide accurate valuations. PIIC could be in violation of broader consumer protection regulations that aim to protect claimants from these unfair practices.
Intentional Infliction of Emotional Distress: Unreasonable delays, non-responsive communications, and prolonged claim settlement process caused excessive stress and emotional burden.
Multiple senior PIIC personnel consistently copied and aware but failed to rectify significant claim-handling errors.
Refused certified Kelley Blue Book valuation (correctly dated March 11, 2023), insisting instead on lower September 2023 valuation benefiting their financial interests.
PIIC provided false information to DFS regarding valuation timing.
Issued unauthorized payment to lienholder without claimant authorization as coercive tactic.
Required unjustified release waivers for undisputed claim payments.
Ignored direct claimant communications despite formal non-representation notifications.
Backdated and altered documents post-complaint filing.
Undervalued "loss of use" compensation despite documented loss duration.
Ignored lost wages coverage clarification requests.
PIIC prioritized internal liability investigation over prompt action in claimant’s interest.
VIOLATION OF POLICY/BREACH OF CONTRACT
PIIC has committed multiple violations of its policy terms, including:
Failure to pay within policy-mandated timeframes
Incorrect valuation of property
Refusal to acknowledge correct loss details
Unlawful waiver requirement
Failure to compensate for loss of use
Unjustified claim delays and misrepresentation
Denial of proper dispute resolution options
Commercial General Liability Coverage Form (CG 00 01 04 13) – Breaches Identified
Failure to Settle Property Damage Claims as Required
Policy Section Violated: CG 00 01 04 13, Page 15 of 16, Definition of "Property Damage"
Violation: The insurer failed to provide timely settlement and compensation for the property damage sustained by the insured. Property damage includes loss of use of tangible property, which is deemed to occur at the time of the occurrence that caused it. The insurer failed to compensate for the full loss of use, violating its contractual obligation to pay for property damage promptly.
Incorrect Valuation of Property in Violation of Policy Terms
Policy Section Violated: CG 00 01 04 13, Loss Conditions (Valuation), Page 278
Violation: The insurer used an incorrect post-incident date to undervalue the claim, despite the policy stating valuation should be based on the actual cash value at the time of the loss. The policy explicitly states that property will be valued at the time of the loss, but PIIC used a later date (9/05/23 instead of 3/11/23), impacting the assessment of damages.
Delay in Payment of Claims Beyond the 30-Day Requirement
Policy Section Violated: CG 00 01 04 13, Loss Conditions, Page 320
Violation: The policy requires that payment be made within 30 days after receiving a sworn proof of loss. PIIC delayed payment for over 449 days after the claim was filed and 493 days from the date of loss, despite acknowledging liability. Failure to process payment within 30 days of claim documentation submission. Unreasonable delay in claim investigation and processing.
Attempt to Coerce the Insured into Signing a Waiver
Policy Section Violated: CG 00 01 04 13, Page 316, Waiver of Recovery Clause
Violation: The insurer attempted to require the claimant to sign a waiver to receive payment, even though the policy does not contain any provision requiring a waiver for payment. The waiver of recovery section applies to PIIC waiving their rights to recovery, not the insured waiving their own rights to future claims. This constitutes an unfair settlement practice and bad faith handling.
Breach of Good Faith Claim Handling and Failure to Communicate Timely
Policy Section Violated: CG 00 01 04 13, General Conditions for Handling Claims, Page 305
Violation: The insurer refused to communicate directly with the policyholder despite multiple requests and failed to respond to key inquiries, violating its obligation to handle claims in good faith. The policyholder is entitled to timely responses and clear communication regarding claim decisions. The insurer ignored correction requests regarding the date of loss, valuation, and misrepresented policyholder name, creating delays and confusion.
Commercial General Liability Coverage (CG 33 80 02 10) – Breaches Identified
Refusal to Offer Arbitration Despite Policy Allowing for Dispute Resolution
Policy Section Violated: CG 33 80 02 10, Florida Changes – Binding Arbitration
Violation: PIIC failed to offer arbitration despite policy provisions allowing disputes to be resolved through arbitration. Instead, they prolonged the claims process without offering a clear path to resolution. The claimant has the right to request arbitration to resolve disputes. The insurer's lack of response to dispute resolution requests violates the policy.
Additional Policy Breaches and Violations of Insurance Law
Breach of Policy’s "Insured Contract" Clause by Failing to Provide Fair Coverage
Policy Section Violated: CG 00 01 04 13, Page 9, Definition of "Insured Contract"
Violation: The insurer failed to uphold contractual obligations, misrepresented coverage, and forced the insured into unnecessary delays.
Fraudulent and Misleading Claims Processing in Violation of Coverage Terms
Violation Details: PIIC provided false claim data to third parties (e.g., incorrect loss date and vehicle valuation), resulting in financial harm to the insured.
Failure to Uphold "Legal Action Against Us" Policy Terms by Hindering Resolution
Policy Section Violated: CG 00 01 04 13, Page 3, Legal Action Against Us Clause
Violation: PIIC created unnecessary barriers to legal recourse by delaying claim resolutions and misrepresenting policy obligations.
Misrepresenting Facts, Misleading, PIIC False Reporting to DFS: Service Request Number: 1-1170879238
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Facts and circumstances giving rise to the violation.
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Background & Incident Overview:
On March 11, 2023, at approximately 8 pm, a parking garage gate malfunctioned at Sanctuary Apartments (managed by Greystar) located at 486 Centerpointe Cir. Altamonte Springs, FL 32701, damaging the claimant's vehicle, 2017 INFINITI QX60. Building Management notified by both the Community Officer. Claimant notified building management by filing a service request for repair of the gate with Building Management via resident portal, including: incident details, pictures of the gate and cause of malfunction, pictures of the vehicle damage, picture of police report, and request for insurance provider information. . Police dispatched to conduct report. Police dispatched to conduct report. Despite prompt notifications to Greystar, there were numerous delays and complications in handling the claim. Sanctuary initially acknowledged fault and indicated they would handle the claim privately, but delayed providing insurance details and claim information for over a month, finally doing and filing their claim with PIIC on April 24, 2023, 44 days after the incident occurred?.
Police Report: Altamonte Springs Police Department HSMV Report Number 25094330 | Agency Case Number 2023TA003014 dated 3.11.23
Witness: Sean Patrick Mernane
Facts and Circumstances Giving Rise to the Insurer’s Violations:
Unjustified Delay: The insurer delayed resolving this claim for over a year despite accepting liability.
Fraudulent Valuation: The insurer improperly valued the Complainant’s vehicle six months after the date of loss, which resulted in an undervaluation, incorrect mileage, date of loss, features.
Failure to Pay Fair Compensation: Despite the excessive delay, the insurer only offered 30 days of loss of use, failing to compensate for the 15 months of actual loss.
Coercion & Unlawful Waiver Attempt: The insurer attempted to force the Complainant to sign a waiver, relinquishing legal rights in exchange for payment of damages after they accepted liability.
Unsafe Driving Conditions: The insurer deliberately delayed repairs, forcing the Complainant to drive with a smashed windshield for over a year, jeopardizing safety, restricting ability to drive and work when it rained, and further vehicle damage due to the damage rendering the vehicle no longer waterproof.
False & Misleading Reports: The insurer provided incorrect information to third parties, including the vehicle valuation company and the lienholder, causing financial and legal harm to the Complainant.
Philadelphia Indemnity Insurance Company engaged in numerous violations of Florida Insurance Statutes, Unfair Claims Practices, and breached their contractual obligations.
Identified Violations:
A. Bad Faith Insurance Practices (F.S. §624.155)
Failure to Act in Good Faith (§624.155(1)(b)(1)):
Offered significantly undervalued settlement.
Delayed payment over a year after acknowledging liability.
Manipulated vehicle valuation (incorrect date, mileage, features) to undervalue the claim.
Ignored independent Kelley Blue Book valuation provided by Claimant.
Misrepresented valuation details to the Florida Department of Financial Services (DFS).
Delaying Settlement (§624.155(1)(b)(3)):
Deliberately prolonged payment of undisputed claim amounts, creating significant hardship.
Breach of Implied Covenant of Good Faith & Fair Dealing:
Attempted to coerce claimant into signing waivers.
Ignored repeated requests for accurate valuation and timely communications.
Unfair Claim Settlement Practices (F.S. §626.9541):
Material Misrepresentation (§626.9541(1)(i)(2)):
Continuously reported incorrect dates and mileage affecting valuation.
Unauthorized contact and misrepresentation to Claimant’s insurer (Geico), causing unnecessary financial and policy-related harm.
Failure to Acknowledge Communications (§626.9541(1)(i)(3)(c)):
Repeated lack of timely communication, ignoring emails, calls, and formal letters.
Failing to Provide Reasonable Explanation (§626.9541(1)(i)(3)(f)):
Provided inadequate or no justification for valuation discrepancies and delays.
Alteration of Insurance Adjuster’s Report (§626.9541(1)(i)(3)(j)):
Adjuster reports altered without proper notification or documentation.
Failure to Pay Undisputed Amounts Promptly (§626.9541(1)(i)(4)):
Delayed payment significantly beyond statutory timelines despite clear liability.
Additional Violations & Misconduct:
Insurance Fraud (§817.234):
Intentional misrepresentation of claim details (date, mileage, vehicle status) to third parties.
Consumer Protection Violations (FDUTPA §501.204):
Deceptive valuation methods, settlement coercion, and misleading practices.
Violation of Privacy (§624.26):
Improper disclosure of claimant’s personal insurance details to third parties.
Violation of Insurer’s Duty to Acknowledge and Pay Claims (§627.70131):
Delayed investigation and acknowledgment of claim over 150 days.
Breach of Contract/Policy Terms (CG 00 01 04 13):
Incorrect valuation contrary to policy terms (valuation date and features).
Delays exceeding 30-day payment requirement.
Unauthorized waiver requirements and coercion.
Refusal to offer arbitration despite policy terms allowing dispute resolution.
Consequences Suffered by Claimant:
Financial Losses:
Initial lost earnings: $13,887.40
Continued loss of earnings due to vehicle condition: $59,250
Loss of use damages still owed: $46,300
Vehicle payments and interest: $9,743.58
Additional expenses (moving, storage, fees): $6,472.16
Unnecessary expenses incurred from misrepresentation and delays.
Non-financial Damages:
Emotional distress and embarrassment
Potential increased insurance premiums due to improper handling
Requested Remedies:
To avoid further legal action, PIIC must:
Issue full vehicle valuation as of the actual loss date (March 11, 2023).
Fully compensate for 15-month loss of use damages.
Reimburse all additional incurred expenses and financial damages.
Provide a written apology acknowledging wrongful conduct.
Cease unfair claims handling practices immediately.
Notice of Preservation of Evidence:
PIIC is formally notified to preserve all digital records and documents, including emails, internal communications, adjustments, and valuations, including all alterations.
Request for Immediate Investigation:
Given PIIC’s systematic violations and harmful conduct, immediate regulatory investigation is requested from:
Florida Department of Financial Services (DFS)
Florida Attorney General’s Office
Florida Department of Consumer Services
Consumer Financial Protection Bureau (CFPB)
Notification of Intent to Pursue Civil Litigation:
Claimant intends to initiate civil litigation for bad faith insurance practices, consumer protection violations, and breach of contractual obligations unless immediate corrective action is taken. Claimant seeks compensatory, consequential, and punitive damages, statutory interest, penalties, and attorney’s fees as provided by Florida Statute §624.155.
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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
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DFS-10-363
Rev. 10/14/2008
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