Filing Number: 811219
|
| Filing Accepted: 3/14/2025 |
| Last/Business Name
*
|
|
|
FREUND
|
|
First Name |
|
HANH; DORIT |
|
| Street Address
*
|
|
1521 SW 13TH PL, |
| City, State Zip
*
|
|
BOCA RATON,
FL
33486-53
|
| Email Address
*
|
|
DORITFREUND@MSN.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
FREUND |
|
First Name |
|
HANH; DORIT |
| Policy # * |
|
SJ31151329 |
|
Claim #* |
|
SL23204528 |
|
Attorney is Applicable
|
| Last Name* |
BRAZ
First Name *
TAMARA
Initial
|
| Street Address* |
|
8865 COMMODITY CIR. STE. 12 |
| City, State Zip* |
|
ORLANDO
,
FLORIDA
32819
|
| Email Address * |
|
TBRAZ@THELAWGICALFIRM.COM |
|
|
| Insurer Type
*
|
|
Authorized Insurer
Unauthorized Insurer
|
|
|
| Insurer Name |
|
|
| Insurer Name* |
|
SLIDE INSURANCE COMPANY
|
| Insurer Name* |
|
|
| Street Address* |
|
|
| City, State Zip* |
|
,
|
|
NAIC Company Code 17227 |
|
|
| Name of individual responsible for violation (if any):*
? VERNITA WASHINGTON, SR. DESK ADJUSTER FL ON BEHALF OF SLIDE INSURANCE COMPANY; ? YAMIL G. KURI, PROFESSIONAL ENGINEER, ON BEHALF OF ROOT CAUSE CONSULTING; ? MICHAEL BLOCH, FIELD ADJUSTER ADJUSTER ON BEHALF OF COMPASS ADJUSTING SERVICES INC
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
Claim Denial
|
|
Claim Delay
|
|
Unfair Trade Practice
|
|
Other
:
Improper Investigation
|
|
Other
:
Material Misrepresentation
|
|
|
*
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.
|
| 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.
|
| 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.
|
| 626.9541(1)(i)(3)(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.
|
| 626.9541(1)(i)(4) |
|
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).
|
|
*
Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
HO 00 03 10 00
***
SECTION 1 - PROPERTY COVERAGES
A. Coverage A - Dwelling
1. We cover:
a. The dwelling on the "residence premises"
shown in the Declarations, including struc-
tures attached to the dwelling; [;]
***
HO 100 02 22
***
SECTION I – PERILS INSURED AGAINST
A. Coverage A – Dwelling And Coverage B –
Other Structures
1. We insure against risk of direct physical loss to
property described in Coverages A and B.
***
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
On or about August 3, 2023, Hanh Freund and Dorit Freund (Complainant(s)) suffered a loss to their Property, located at the address listed above due to water damage. After discovering the damage, Complainant(s) promptly reported the loss to Slide Insurance Company (“Insurer”) on or about August 11, 2023.
Throughout Insurer’s investigation, Complainant has fully cooperated with Insurer and fully performed all duties and obligations under the policy by providing all information within Complainant’s custody, possession and control.
Insurer, however, has failed to fulfill its duties under the Policy and Florida law.
Upon discovering the damages, Complainant retained American Leak Detection Of The Palm Beaches, Inc. to investigate the source and origin of water damages found in the area surrounding the kitchen.
On or about August 10, 2023, Complainant entered into a contract with Policyholder Advocates Inc (hereinafter “Public Adjuster”).
Subsequently, the same day, the Public Adjuster conducted an inspection of the property and took photographs.
On or about August 11, 2023, Insurer sent Complainants a written correspondence acknowledging the claim and stated a determination would be made upon investigation. This however was a misrepresentation. Despite all investigation and supplemental information in its possession, Insurer still did not timely provide a coverage determination.
On or about August 14, 2023, the Public Adjuster produced an estimate totaling $44,757.11 in actual cash value (“ACV”) for the damages.
On or about August 15, 2023, Insurer hired an Independent Adjuster (hereinafter “Independent Adjuster”) on behalf of Compass Adjusting Services Inc. An inspection of the property was conducted on or about August 15, 2023.
However, upon completion of such inspections and being in receipt of supplemental evidence, Insurer still failed to provide any form of status update or coverage determination.
On or about August 21, 2023, Complainants and their agents sent Insurer an executed Sworn Proof of Loss Statement. Under Fla. Stat. 627.4137, Insurer had 30 days from the SPOL to provide some form of coverage decision. Here, Insurer failed to acknowledge the SPOL in whole, and thus violated the statutory requirement.
By October 10, 2023, Insurer had violated Fla. Stat. 626.70131(7)(a), by failing to determine coverage within the 60-day period required by Florida Law. Instead, Insurer chose to retain an Engineer on or about October 18, 2023, 8 days past the violation, to conduct further inspections.
Upon information and belief, Insurer sought to retain an engineer to cause unduly delay in the claims resolution process.
On or about October 18, 2023, Insurer retained an engineer, Root Cause Consulting to inspect the subject property.
Upon completing such inspection, Insurer failed to update or produce any coverage determination.
It wasn’t until November 9, 2023, 22 days later, that Insurer sought to provide some form of claim update. Here, Insurer provided no substantive information regarding the resolution of the claim, other than the fact that investigation is still pending as it is waiting on the engineer’s report. Thus, no determination could be made.
Insurer’s letter was vague, overly broad, and entirely devoid of any meaningful reasoning for the delay.
On or about November 10, 2023, an engineer report was produced.
On or about November 15, 2023, Insurer sent a coverage determination letter resulting in a denial of the claim. In this letter, Insurer recognizes the damages made to the subject property, as confirmed by the public adjuster, however, states the damages were a result of “wear, tear and deterioration”.
Despite claiming that damages were not covered, Insurer’s correspondence failed to specify how they were calculated. Instead, Insurer merely attached a denial letter without an estimate and without context, relying on the assumption that an unqualified recipient would be unable to decipher the values or identify the omissions
This conduct is a clear misrepresentation of material information, designed to minimize the payout to Complainant. By failing to provide transparency regarding the scope and location of the damages Insurer allegedly evaluated, Insurer misled Complainant regarding the extent of the covered loss.
This deliberate misrepresentation constitutes a violation of Fla. Stat. 626.9541(1)(i)(2), which prohibits insurers from knowingly misrepresenting pertinent facts or policy provisions to reduce or deny valid claims.
Pursuant to Fla. Stat. 626.9541(1)(i)(3)(f), Insurers are required to provide a reasonable explanation for the denial of a claim. In this case, Insurer's denial was wholly inadequate and failed to meet this standard.
Upon information and belief, Insurer regularly uses this tactic to egregiously underpay rightful remedies owed to their insureds.
The claim file was open for about 96 days, during which Insurer inspected the property, without acknowledging the Public Adjuster’s estimate and without addressing the contents or undertaking any additional efforts to investigate. Insurer did not retain an Engineer until they exceeded the 60-day deadline as explained in Fla. Stat. 626.9541(1)(i)(4).
On or about December 11, 2023, Complainant retained Brownfish Inspections (hereinafter “Certified Microbial Investigator”), to investigate the source and origin of water damages.
The Certified Microbial Investigator conducted an inspection of the property and took photographs with an invoice estimating $375 for the costs on or about December 15, 2023.
On or about January 5, 2024, Complainant retained Mike The Plumber Services (hereinafter “Plumber”), to repair the broken drain line. The Plumber repaired the broken drain line and investigated other plumbing to repair if necessary with an invoice estimating $571.65 for the costs on or about January 5, 2024.
All supplemental information was promptly sent to Insurer upon possession. Insurer, however, failed to recognize any such supplemental information being in clear violation of Fla. Stat. 626.9541(1)(i)(3)(c).
By failing to consider the new evidence presented or even slightly investigate the claim, the Insurer is in clear violation of Fla. Stat. 626.9541 (1)(1)(3)(d), which prohibits insurers from denying claims without properly evaluating new information.
On or about January 19, 2024, Complainant and their agents once again, retained Mike The Plumber Services (hereinafter “Plumber”) to mitigate the damages.
Insurer, yet again, refused to review, acknowledge or respond to this supplemental information. Here, Complainants and their agents acted within their contractual duty to mitigate damages and preserve the subject property. Insurer, however, has failed to reinspect, provide coverage, or fulfill their contractual obligations by acknowledging the mitigation and repair work being done to the subject property.
Till date, Insurer has refused to acknowledge the supplemental information and provide the rightful remedies owed to Complainant.
Upon information and belief, Insurer has implemented an unreasonable company-wide policy to rely solely and heavily upon homeowners, most of whom have no background or knowledge in any of the trades involved in diagnosing a loss, to report losses with almost expert accuracy.
This policy is not in line with Insurer’s duty of a “fair and honest treatment of the claimant” as it seeks only to protect Insurer’s interests.
Based on the events described above, it is clear that Insurer conducted an improper and haste investigation to intentionally minimize its liability, contrary to the policy and Florida law’s requirements.
Moreover, Insurer has misrepresented pertinent facts and/or insurance policy provisions relating to coverages at issue, and delayed the resolution of the claim by engaging in conduct to deny or reduce recovery to the Insureds. These tactics are believed to be the general business practices of this Insurer.
Insurer can cure its bad faith conduct by: 1) accepting the Insureds’ damage claim as compensable, and agreeing to pay the claim in accordance with the policy in the amount of $66,679.00, plus interest, prior to the expiration of the cure period, 2) reviewing and responding to all communications from the Insureds and their agents, including the request for a complete copy of the Policy.
PLEASE GOVERN YOURSELF ACCORDINGLY.
|
|
*
|
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
|