Filing Number: 812069
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| Filing Accepted: 3/20/2025 |
| Last/Business Name
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SCHAIBLE
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First Name |
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EVELYN |
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| Street Address
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100 BOCILLA DRIVE |
| City, State Zip
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PLACIDA,
FL
33946
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| Email Address
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RS@WEKLAW.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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SCHAIBLE |
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First Name |
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EVELYN |
| Policy # * |
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441578 |
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Claim #* |
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925101 |
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Attorney is Applicable
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| Last Name* |
SUGATHAPALA
First Name *
RUWAN
Initial
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| Street Address* |
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800 EAST BROWARD BLVD., SUITE 500 |
| City, State Zip* |
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FORT LAUDERDALE
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FLORIDA
33301
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| Email Address * |
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RS@WEKLAW.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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HOMEOWNERS CHOICE PROPERTY & CASUALTY INSURANCE COMPANY, INC.
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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 12944 |
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| Name of individual responsible for violation (if any):*
CHRISTOPHER BARNETT, STEPHANIE GROVER BROCK, DAISY PRINCESA
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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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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)(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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
I. Loss Payment
We will adjust all losses with you.
PERIL INSURED AGAINST
1. We insure for direct physical loss to the
property described in Coverages A, B and
C caused only by the peril of windstorm or
hail unless the loss is excluded in
EXCLUSIONS.
2. With respect to paragraph 1. above,
coverage for loss caused by a Peril Insured
Against includes loss to:
a. Watercraft of all types and their trailers,
furnishings, equipment, and outboard
engines or motors, only while inside a
fully enclosed building.
b. The inside of a building or the property
we cover contained in a building caused
by:
(1)Rain;
(2)Snow;
(3)Sleet;
(4)Hail;
(5)Sand; or
(6)Dust;
if the direct force of the windstorm or
hail first damages the building, causing
an opening through which the rain,
snow, sleet, hail, sand or dust enters
and causes damage.
d. We will initially pay at least the actual
cash value of the insured loss, less any
applicable deductible. We will then pay
any remaining amounts necessary to
perform such repairs as work is
performed and expenses are incurred,
subject to 2.a. and 2.b. above.
D. Coverage D – Loss of Use
The limit of liability for Coverage D is the
total limit for the coverages in 1. Additional
Living Expense, 2. Fair Rental Value and 3.
Civil Authority Prohibits Use below.
1. Additional Living Expense
a. If a loss covered under PROPERTY
COVERAGES makes that part of the
“residence premises” where you
reside 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.
b. 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.
c. In either event, the payment(s) will
be limited to 24 consecutive
months from the date of the
covered loss.
E. Additional Coverages
1. Debris Removal
a. We will pay the reasonable expense
you incur for the removal of:
(1)Debris of covered property if a
Peril Insured Against that applies
to the damaged property causes
the loss; or
b. We will also pay the reasonable
expense you incur, up to $1,000, for
the removal from the “residence
premises” of:
(1)Your tree(s) felled by a Peril
Insured Against;
2. Reasonable Repairs
a. We will pay the reasonable cost
incurred by you for the necessary
measures taken solely to protect
covered property that is damaged
by a Peril Insured
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PERSONAL PROPERTY REPLACEMENT COST
LOSS SETTLEMENT
A. Eligible Property
1. Covered losses to the following property
are settled at replacement cost at the time
of the loss:
a. Coverage C; and
b. If covered in this policy:
(1)Outdoor antennas and outdoor
equipment; and
(2)Household appliances;
whether or not attached to buildings.
2. This method of loss settlement will also
apply to the following articles or classes of
property if they are separately described
and specifically insured in this policy and
not subject to agreed value loss
settlement:
a. Jewelry;
b. Furs and garments;
(1)Trimmed with fur; or
(2)Consisting principally of fur;
c. Cameras, projection machines, films
and related articles of equipment;
d. Musical equipment and related articles
of equipment;
e. Silverware, silver-plated ware, goldware,
gold-plated ware and pewterware,
but excluding:
(1)Pens or pencils;
(2)Flasks;
(3)Smoking implements; or
(4)Jewelry; and
f. Golfer's equipment meaning golf clubs,
golf clothing and golf equipment.
Personal Property Replacement Cost loss
settlement will not apply to other classes of
property separately described and specifically
insured.
B. Ineligible Property
Property listed below is not eligible for
replacement cost loss settlement.
Any loss will be settled at actual cash value
at the time of loss but not more than the
amount required to repair or replace.
1. Antiques, fine arts, paintings and similar
articles of rarity or antiquity which cannot
be replaced.
2. Memorabilia, souvenirs, collector’s items
and similar articles whose age or history
contribute to their value.
3. Articles not maintained in good or workable
condition.
4. Articles that are:
a. Outdated or obsolete; and
b. Are stored or not being used.
C. Replacement Cost Loss Settlement
Condition
The following loss settlement condition
applies to all property described in A. above:
1. We will pay no more than the least of the
following amounts:
a. Replacement cost at the time of loss
without deduction for depreciation;
b. The full cost of repair at the time of loss;
c. The limit of liability that applies to
Coverage C, if applicable;
d. Any applicable special limits of liability
stated in this policy; or
e. For loss to any item described in A.2.a.-
f. above, the limit of liability that applies
to the item.
2. We will settle the loss as follows:
a. If the “residence premises” is not a
mobile home, we will settle the loss as
noted in Paragraph C.1. above whether
or not actual repair or replacement is
complete.
b. If the “residence premises” is a mobile
home, paragraphs b.(1) and b.(2)
below are made a part of this policy:
(1)If the cost to repair or replace the
property described in A. above is
more than $500, we will pay no
more than the actual cash value of
the loss until the actual repair or
replacement is complete.
(2)You may make a claim for loss on
an actual cash value basis and then
make claim for any additional
liability in accordance with this
endorsement provided you notify us
of your intent to do so within 180
days after the date of loss.
All other provisions of this policy apply
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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.
This Civil Remedy Notice of Insurer Violation (hereinafter “CRN”) is being submitted on behalf of Evelyn Schaible (hereinafter the "Insured") as against her insurance company, Homeowner’s Choice Property & Casualty Insurance Company, Inc.
As of the submission of this CRN, and as shall be demonstrated in further detail below, the insurance company has violated multiple bad-faith statutes by not attempting, in good faith, to settle the insured’s claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly towards the insured and with due regard for their interests. The commission of these violations has been known to Homeowner’s Choice dating back to at least October of 2022 and even now, with the information known to Homeowner’s Choice, instead of immediately seeking to cure these violations, instead continues to draw out litigation and take unnecessary discovery in a drawn-out legal battle to the detriment of its Insured.
The specific facts are as follows:
Evelyn Schaible (the "Insured") purchased an insurance policy ("Policy") from Homeowner’s Choice Property & Casualty Insurance Company, Inc. ("Homeowner’s Choice"), with effective coverage on the date of the loss, on or about September 28, 2022, and policy number HCPC-HW2-441578-9 to insure her home located at 100 Bocilla Drive, Placida, Florida 33946 (the "Property").
On or about September 28, 2022, the aforementioned Property suffered severe damage as the result of the devastating Hurricane Ian, which caused damages to the Property, including but not limited to the exterior and interior of the property. The Insured promptly reported their claim to Homeowner’s Choice. Homeowner’s Choice acknowledged receipt of the claim by generating claim number 925101.
Homeowner's Choice performed a woefully inadequate adjustment of the Insured's claim, retaining out of state adjusters from various third party administrators, including Wardlaw Claims and Griston Claims. The adjustment of the Insured's claim is representative of a number of other, similar claims in and around the west coast of Florida, including Lee, Charlotte, and Collier counties.
Homeowner's Choice performed three rushed, incomplete inspections on 10/12/22, 11/23/22, and over a year later on 11/9/23, by third party hired adjusters respectively identified as Chase McCauley, Josh Lodwick, and Kai Guliksen. On each of these three inspections, new damage that had existed since the passage of Hurricane Ian were identified, resulting in 2 estimates of damage for the Property pursuant to Coverage A of the Policy. The initial estimate purports to be authored by Josh Lodwick; however, Mr. Lodwick solely included one line-item to the initial estimate. To date, Homeowner's Choice has attempted to veil or conceal the true author of the initial estimate. Subsequently, upon inspection by Kai Guliksen, Homeowner's Choice prepared it's second estimate, now over 1 year removed from the hurricane, purported to be prepared by Daisy Princesa, one of the claims examiners involved with the Insured's claim but who had never inspected the Property. This second estimate failed to fully indemnify the Insured for her sustained damage and only adjusted for Coverage A of the Policy.
In the time that the claim was pending, the Insured made repeated efforts to communicate and submit documents for Homeowner's Choice to evaluate and consider in the adjustment of this loss. This included providing Homeowner's Choice with information about the unique access issue of this Property, located on an island area only accessible by ferry. In addition, the Insured submitted documentation pertaining to repairs, as well as contractor estimates, and other information attempting to communicate to her insurance company that the value of the loss was far greater than the estimate(s) from Homeowner's Choice. The Insured verbally communicated on repeated instances with claims examiner Christopher Barnett and Daisy Princesa, among others, in an effort to supply documentation for her repairs. The Insured provided information to Mr. Barnett and Homeowner's Choice (or its agents) communicating the commencement of repairs, the dangerous conditions and received no response. The Insured's efforts and communications span from April 2023 through approximately October 2023 when she was finally forced to retain the services of Capital Claims, a public adjuster, to assist her in efforts to get responses.
Once the public adjuster was involved, it appears Homeowner's Choice realized that the Insured had representation and could not be misled and thus advised it would perform a re-inspection, a year after the storm and after repairs had taken place necessary to restore and protect the Property. The Insured, through her representative, provided a line-item detailed breakdown of the areas of damage, as well as documenting the incurred costs of repairs. Homeowner's Choice ultimately did not provide any meaningful response to these submissions and simply relied upon the supplemental estimate prepared by Daisy Princesa.
Not once has Homeowner's Choice given consideration to Loss of Use, Mold, Contents, and failed to properly account for repair records and other documents supporting the Insured's claim
The Insured additionally supplied numerous, detailed personal property inventory forms applicable to Coverage C of her Policy for numerous personal items and property damaged from Hurricane Ian.
Upon information and belief, Homeowner's Choice, despite assuming risk of the Insured's Property as well as countless other Floridians, was unable and unequipped to manage and adjust the numerous hurricane Ian claims it received following September 2022.
Indeed, it is believed that Homeowner's Choice undertook a systematic approach to avoid liability and skirt its indemnification obligations by continuously representing in letters that its payments and coverage determinations were not final. Yet here, as evidenced by the efforts of the Insured, all of her submissions to Homeowner's Choice to have the claim supplemented were ignored.
Homeowner's Choice to date has not once provided a coverage determination as to the Insured's Personal Property claim submission - this means there were not only no payment but no explanation of a coverage position whatsoever, despite receiving multiple inventory forms with notations, claim information, and photographs/receipts. Upon information and belief known to counsel for the Insured, Homeowner's Choice has a widespread of failing to pay contents coverage to Hurricane Ian victims who duly purchased said coverage. Moreover, Homeowner's Choice failed to release recoverable depreciation, although the valuation of this was also improper and done with a view toward minimizing its own liability by applying depreciation incorrectly and to non-depreciable items. In addition, the Insured, concerned about the impact on her health, tested for mold and supplied this documentation to Homeowners Choice as well. Again, this was ignored and otherwise not responded to by operation of a coverage decision, supplemental determination and/or payment.
Due to the delays, mismanagement, failure to acknowledge or respond, and other failures of Homeowner's Choice, the Insured sustained considerable damage beyond that caused by Hurricane Ian to her Property, including being subjected to dangerous conditions such as mold, being forced to find alternative quarters out of pocket, prematurely cashing out investments in order to effectuate necessary repairs, and missed work as a Pharmacist. The extensive travel and logistics to perform needed work forced her to incur barge and travel fees as well and the considerable stress of the aftermath of the storm and Homeowner's Choice's conduct has impacted her mental health and stability.
Homeowner’s Choice was woefully understaffed and under equipped to handle the processing of claims such as that of the Insureds following Hurricane Ian. The facts as alleged herein are known to have occurred on a wide-scale basis to many Homeowner’s Choice insureds in and around the West Coast of Florida.
The Property sustained damage that is attributed to the insurance company’s lacking investigation, low-ball evaluation of damage, and delay in timely processing the claim, including moisture and mold damage that pose a threat to the health and safety of the Insured. The Insured in fact asked about what repairs were needed to be done based on the complex and complicated insurance estimate(s) prepared using industry-accepted Xactimate software. In fact, the Insured asked the insurance company about specific line-item breakdowns to properly determine what steps should be taken only to be told this is confidential information.
Homeowner’s Choice’s blatantly insufficient coverage decision has resulted in further damages to the Insured by preventing them from returning their Property to its pre-loss condition, rather than participating in the settlement process in good faith.
As a direct consequence of Homeowner’s Choice’s failure to adjust this loss in good faith and pay what it owed under the policy, the Insured IS continuing to sustain considerable hardship. Homeowner’s Choice continues to this day to engage in bad faith and is aware of the fact that their own agent admits to there being covered damage that Homeowner Choice is unwilling to pay for.
Homeowner’s Choice has violated Florida Statute § 624.155(1)(b)(1) by continuously not attempting in good faith to settle this claim when it should have done so if it had acted fairly and honestly towards its Insured. Homeowner’s Choice has also violated Florida Statute § 624.155(1)(b)(3) by failing to promptly settle this obviously covered claim to influence settlement in its favor. Despite being presented all of the indisputable evidence of the amount of damage sustained by this Property, it is a disgrace that the Insured have been treated in this manner by their insurance company after sustaining an obviously covered loss, submitting to every demand of Homeowner’s Choice, and making a good faith effort to resolve in an attempt to amicably come to a fair resolution. Homeowner’s Choice violated Florida Statutes § 626.9541(1)(i)(2) and § 626.9541(1)(i)(3)(b) by making material misrepresentations to the Insured for the purpose and with the intent to settle the claim on less favorable terms than those provided and contemplated by the policy. While Homeowner’s Choice was made aware, and even admits to knowing, of this information for the purpose of obtaining the money contractually owed to the Insured, Homeowner’s Choice wantonly disregards these facts, knowing all too well the additional damage and hardship that is being placed on the Insured by its actions. Homeowner’s Choice violated § 626.9541(1)(i)(3)(a) when it failed to adopt and implement standards for the proper investigations of claims. Under no circumstances is there an excuse for the lack of care and utter disregard for the investigations in this case. Homeowner’s Choice and their representatives are willfully blind and grossly underqualified to handle a loss such as the one sustained by the Insured. In addition, after being placed on notice as to the blatant underpayment of the Insured’ claim, Homeowner’s Choice has yet to rectify their actions and do right by the Insured by paying the money they are contractually owed. There still has yet to be significant action taken by Homeowner’s Choice to this date, despite Homeowner’s Choice being presented with the incongruencies in their farcical rationale for underpaying the Insureds.
As demonstrated above, Homeowner’s Choice has known of covered damage it did not pay or properly adjust, resolving to pay only a fraction of covered loss.
The Insured has undergone considerable stress that has impacted her health as a consequence of the ensuing events following Hurricane Ian and Homeowner’s Choice’s failure to properly and appropriately adjust the claim. The Insured was diagnosed with Spasmotic Dysphonia that was diagnosed by Dr Victoria Gau at Sarasota Memorial Hospital and undergoes voice therapy. She has additionally had to cash out investments prematurely in order to absorb the cost of the loss.
Homeowner’s Choice violated § 626.9541(1)(i)(3)(g) by failing to promptly notify the Insured of any additional information necessary for processing the claim. The Insured have more than complied with each and every request and there has still been no action by Homeowner’s Choice. In the event Homeowner’s Choice is in need of additional information, they have failed to promptly notify the Insured in a timely manner. This pattern of behavior is perpetuated by Homeowner’s Choice and their representatives undeterred by the Ethical Requirements that are imposed by law on all Adjusters. Fla. Admin. Code Ann. R. (3) explicitly states the adjustment of insurance claims engage the trust of the public, and therefore, an adjuster has a duty of fair and honest treatment of the Insured throughout the insurance claim process. Several duties and responsibilities to the Insured were violated in the handling of this claim, which are specifically listed responsibilities of an Adjuster in the Florida Administrative Code. These breached duties and responsibilities include adjusters from Homeowner’s Choice approaching the investigation and settlement in a manner prejudicial to the Insured, failing to allow a fair settlement with the Insured, and acting with due diligence in achieving a proper disposition of the claim. In contrast to the legislative intent motivating the enumeration of an Adjuster’s responsibilities outlined in the Administrative Code, the Insured were not afforded the professional duties entrusted on Homeowner’s Choice by the public. To date, Homeowner’s Choice has failed to adequately compensate the Insured for the damage that occurred on September 28, 2022. As a direct result of Homeowner’s Choice’s delay, the Insured were forced to seek the help of legal counsel to assist them. Due to the amount of time that has passed since the date of loss, this acknowledgement is evidence that Homeowner’s Choice knowingly and intentionally are delaying the claims process in order to further disadvantage the Insured. The financial detriment caused to the Insured is a direct result of Homeowner’s Choice’s reckless delay of the claim process. The Insured are dutiful customers who made it a priority to pay their insurance premiums to ensure that in such an event as this devastating incident, their home would be covered. The Insured timely filed their claim and fulfilled all of their post-loss obligations. All requested information and documentation has been turned over to Homeowner’s Choice and their representatives promptly by the Insured. However, Homeowner’s Choice failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim, failed to inform the Insured how they may remedy any deficiencies in their claim, and failed to provide them with qualified representatives to ensure the claim was initially adjusted, evaluated, and estimated properly. To deny the Insured the benefit of their bargain after they satisfied all of their obligations is morally and ethically reprehensible. Upon belief, the aforementioned actions complained of, among others, were made by Homeowner’s Choice so often as to constitute a general business practice, evidencing a motive to enhance Homeowner’s Choice’s profits, and designed to cause a detrimental effect to its policy holders. Homeowner’s Choice was aware that the Insured’ damages were covered and took advantage of its Insured in an attempt to force them into an irreparably disadvantaged position, which they hope will force the Insured to settle for less coverage than they are contractually entitled to under the policy.
The facts and circumstances set forth herein confirm Homeowner’s Choice 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)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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)(e) 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.
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)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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.
This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should Homeowner’s Choice fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, Homeowner’s Choice must:
1. Immediately tender the policy benefits after offset of prior payments for Coverage A in the amount of $800,000, as well as the policy liability for C of $166,287.63, and for Loss of Use Cov. D in the amount of $57,210.
2. Agree to reimburse the Insured’ reasonable attorneys’ fees and costs for having to become involved to resolve the claim;
3. Although the Insured have made a demand herein and have previously provided Homeowner’s Choice with all the necessary estimates, invoices, receipts, etc. in support thereof, the Insured is still willing to consider and to potentially accept any reasonable counter-offer made by Homeowner’s Choice.
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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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