Filing Number: 822508
|
| Filing Accepted: 5/20/2025 |
| Last/Business Name
*
|
|
|
TIMBERLAKE CONDOMINIUM NO. 3 ASSOCIATION, INC.
|
|
First Name |
|
|
|
| Street Address
*
|
|
17810 SAN CARLOS BLVD. |
| City, State Zip
*
|
|
FORT MYERS BEACH,
FL
33931
|
| Email Address
*
|
|
MAGGIE@RALRESORTS.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
TIMBERLAKE CONDOMINIUM NO. 3 ASSOCIATION, INC. |
|
First Name |
|
|
| Policy # * |
|
09-7590172586-S-00 |
|
Claim #* |
|
ICAT-2022-V-0000030208 |
|
Attorney is Applicable
|
| Last Name* |
MEJEUR
First Name *
JORDAN
Initial
|
| Street Address* |
|
350 N. LAKE DESTINY RD. |
| City, State Zip* |
|
MAITLAND
,
FL
32751
|
| Email Address * |
|
JMEJEUR@ITSABOUTJUSTICE.LAW |
|
|
| Insurer Type
*
|
|
 Authorized Insurer
 Unauthorized Insurer
|
|
|
| Insurer Name |
|
|
| Insurer Name* |
|
NATIONAL FIRE & MARINE INSURANCE COMPANY
|
| Insurer Name* |
|
|
| Street Address* |
|
|
| City, State Zip* |
|
,
|
|
NAIC Company Code 20079 |
|
|
| Name of individual responsible for violation (if any):*
EDGAR THOMAS, BRENT KELLY, KELLY TAYLOR, SEAN BAXTER, CRAIG HANES, AND DAVID VANDEROSTYNE
|
| 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)(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)(b) |
|
Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
|
|
| 626.9541(1)(i)(3)(d) |
|
Denying claims without conducting reasonable investigations based upon available information.
|
|
| 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.
A. Coverage
We will pay for direct physical loss of or damage to Covered Property at the premises described in the Declarations caused by or resulting from any Covered Cause of Loss.
1. Covered Property
Covered Property, as used in this Coverage Part, means the type of property described in this section, A.1., and limited in A.2., Property Not Covered, if a Limit of Insurance is shown in the Declarations for that type of property.
a. Building, meaning the building or structure described in the Declarations, including:
(1) Completed additions;
(2) Fixtures, including outdoor fixtures;
(3) Permanently installed:
(a) Machinery and
(b) Equipment;
(4) Personal property owned by you that is used to maintain or service the building or structure or its premises, including:
(a) Fire-extinguishing equipment;
(b) Outdoor furniture;
(c) Floor coverings; and
(d) Appliances used for refrigerating, ventilating, cooking, dishwashing or laundering;
(5) If not covered by other insurance:
(a) Additions under construction, alterations and repairs to the building or structure;
(b) Materials, equipment, supplies and temporary structures, on or within 100 feet of the described premises, used for making additions, alterations or repairs to the building or structure.
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
This is the second Civil Remedy Notice filed in this claim. It does not supersede the first Civil Remedy Notice, as both are filed independently, and each carry their own weight.
To those reading this Civil Remedy Notice in a future proceeding who are unfamiliar with the CRN process, please be advised that the information contained in here is based upon website input fields wholly created and controlled by the department of financial services and cannot be modified by an end user. The address fields of this CRN portal on the website do not allow you to put multiple addresses for multiple loss locations in a policy. As such the address stated above is per the policy directly where the policy states "NAMED INSURED" with the address as listed above. The loss locations per the insurance and this specific claim are as follows: 6490, 6492, 6494, 6496, 6498 Royal Woods Dr. Fort Myers, FL 33908. Furthermore, the input field for "TYPE OF INSURANCE" does not provide "COMMERCIAL RESIDENTIAL" as an option, which is what the policy at hand is. As such, Commercial is selected.
On or about September 28, 2022, the Insured, Timberlake Condominium No. 3 Association, Inc., suffered significant damage to their five condominium buildings as a result of Hurricane Ian. The five condominium buildings are insured by RenaissanceRe Specialty U.S. Ltd. via commercial residential property insurance policy number 09-7590172586-S-00, under contract number B1776BP201112N, National Fire and Marine Insurance Company via commercial residential property insurance policy number HCP007519 under contract number 42-IPA-178852-01, and Underwriters at Lloyd’s, London via commercial residential property insurance policy number 09-7590175286-S-00 under contract number B1776BP201112N. All three insurers are collectively referred as “insurers” herein.
Prior to the loss, insurers sold their policy in exchange for paid premiums to cover the five condominium buildings located at Timberlake Condominium No. 3 Association, Inc. Said policy was in full force and effect when Hurricane Ian ravaged the buildings and the policy afforded coverage for the Hurricane damage. Mass destruction occurred throughout Fort Myers and the surrounding area within and around Timberlake’s property.
Hurricane Ian was one of the strongest hurricanes in record history to hit Fort Myers Beach, Florida, which is where Timberlake Condominium No. 3 Association, Inc. properties are located. Timberlake Condominium No. 3 Association sustained significant damages to each and every building including but not limited to shingle roofing systems, exteriors, fences, carports, windows, gutters, downspouts, fenestrations, stucco, paint, doors and sliders, ceilings, handrails, lights, and interiors of the property as result of Hurricane Ian’s punishing wind speeds and rains.
Insurers were notified of the loss by the Insured and assigned claim number ICAT-2022-V-0000030208. To date, Timberlake Condominium No. 3 Association, Inc. has substantially complied with all of the insurers’ requests, has made the property available for inspection by the insurers and their chosen agents and representatives, and provided documents regarding the damages.
Insurers in response to the loss first decided to hire an outfit named “iCat” to handle the claim.
iCat then decided to hire an outfit named “Field Pros Direct.” Field Pros Direct purportedly sent out an adjuster to the property to perform an adjustment.
Timberlake has never seen any document from Field Pros Direct and through deposition of iCat adjuster Kelly Taylor, we all learned that the insurers retainer of Field Pros Direct was a complete waste of time and money.
iCat later then hired an outfit named “MKA International, Inc.” to adjust the claim. They sent out a guy named Sean Baxter to perform all aspects of creating the estimate and adjusting the numbers on the claim. Baxter generated an estimate totaling over $200K, adjusting for things including but not limited to roof damage, window and fenestration damage, stucco and paint damage.
While the initial adjustment admitted to the fact that covered hurricane damage existed, it was woefully short of the actual, obvious, and objective damages and their estimated cost to restore the Timberlake property to pre-loss condition. As such, Timberlake was forced to retain the services of expert adjusters and engineers through a local and reputable company called “Orbis Consulting, Inc.”
Orbis performed a thorough inspection of the property and generated a forensic engineer report opining on the condition of the roofing systems and other damaged areas. Timberlake also retained a company called Moisture Intrusion Solutions “MIS” to perform window testing and assessment for hurricane damaged windows. Prior to the hurricane the windows at Timberlake did not have widespread leaking and other issues such as penetrated gaskets and damaged frames which now exist. MIS confirmed through testing a substantial sample size of windows at Timberlake that the windows have been damaged from Hurricane Ian. The Orbis loss assessment is $1.9M and after the fenestration investigations from MIS, the Orbis loss assessment is $3.4M.
All of this information was submitted to the insurers. The insurers requested another inspection of the windows and fenestrations hiring an outfit called "BSC." BSC did identify that some of windows and fenestrations have received damage, however BSC ignored the objective and obvious damage to the windows throughout the property. BSC upon information and belief also failed to perform any proper testing of any of the windows despite knowing or should have known of the air and water intrusion from the hurricane compromised windows and fenestrations. The insurers have never sent payment for these additional damages or issued an updated adjustment determination. The first corporate representative to be deposed in this case we learned that they have no idea why the insurers have failed to perform these actions.
We also later learned through deposition of Sean Baxter that his estimate is littered with errors, that it was one of his first commercial hurricane adjustments, and that Mr. Baxter never obtained a Florida adjuster’s license. We also learned that the insurers had Mr. Baxter perform an assessment of MKA’s engineer report and generate a comparison of the Timberlake expert estimate despite not being qualified to assess engineer reports. Mr. Baxter deleted some line items off of his original +$200K estimate and then adjusted a new estimate for under $170K based off of an engineer report he wasn’t qualified to assess. Insurers later received the Timberlake engineer report but never sent it to Mr. Baxter to compare, although he probably would not have been qualified to assess the Timberlake engineer report either.
It is safe to say that nobody involved on this claim from the insurers were qualified, and Mr. Baxter is not even remotely qualified to be adjusting this claim and the insurers despite this have sank their entire adjustment of the claim on Mr. Baxter’s estimates.
The insurers’ actions on this claim are in violation of many things including but not limited to their own policy provisions, Florida Statutes, and the Florida Adjuster Ethical Requirements Administrative Code 69B-220.201(3) Code of Ethics (c) and (d).
It is obvious that a complete and thorough investigation of this loss by licensed adjusters and competent individuals did not occur.
It is clear that the insurers have implemented a pattern and practice of not properly investigating claims and generating woefully undervalued adjustments to prejudice their insureds who have been subject to one of the worst hurricanes in Florida’s history.
It is clear that the insurers have blatantly violated the adjuster’s code of ethics as well as Florida statutes 624.155 and 626.9541.
It has become a general business practice of insurers to not implement proper claims handling procedures, to hire unqualified incompetent unlicensed “adjusters” and consultants to ignore objective evidence of hurricane damage and delay a claim resolution, and to not settle claims in good faith when under all circumstances it could and should have. As is the case here, it is a pattern and practice for insurers to fail and otherwise refuse to adjust and handle their claims in good faith.
Accordingly, to cure this Civil Remedy Notice, insurers must author a letter accepting coverage for the roof replacements and all damaged fenestrations at the Timberlake insured location. Thereafter, the amounts can be resolved through cordial, good faith and amicable discussion amongst counsel, and if that does not work, the amounts can be resolved through an appraisal of the entire claim. Said letter must be sent to Timberlake Condominium No. 3 Association’s counsel, Cohen Law Group, at 350 N. Lake Destiny Road, Maitland, Florida 32751.
|
|
|
*
|
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
|