Filing Number: 827611
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| Filing Accepted: 6/18/2025 |
| Last/Business Name
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LJP BUILDING, LLC
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First Name |
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| Street Address
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910 SE 14TH PLACE |
| City, State Zip
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CAPE CORAL,
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33990
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| Email Address
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LPETERSON@PTFSUPPLY.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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LJP BUILDING, LLC |
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First Name |
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| Policy # * |
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FSF16681532001 |
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Claim #* |
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KY22K2953258 |
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Attorney is Applicable
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| Last Name* |
QUINTANA
First Name *
J.C.
Initial
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| Street Address* |
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2665 S. BAYSHORE DRIVE, SUITE 220 |
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COCONUT GROVE
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FLORIDA
33133
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| Email Address * |
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JCQ@QLAWGROUP.LAW |
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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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WESTCHESTER SURPLUS LINES INSURANCE COMPANY
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| Insurer Name* |
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,
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NAIC Company Code 10172 |
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| Name of individual responsible for violation (if any):*
DOUGLAS A. RINDERER, CONNOR FERRARO, ANDREW W. JOHNSON, TRAINOR LINNE, JOHN BERGELEEN, RICHARD FRY, ANDY ANTCZAK, REBECCA VIOLA, CHAD PASTERNACK, PATRICK LOYACONA, DERREK VERLAAN, AND RITUSH PAHARI
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| Type of Insurance
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Commercial Property & Casualty
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| Reason for Notice
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Claim Delay
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Claim Denial
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Non-renewal
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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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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| 626.9541(1)(x)(2) |
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Refusal to insure, or continue to insure, any individual or risk solely because of the residence, age, or lawful occupation of the individual or the location of the risk.
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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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Based on information and belief, the entire Policy is relevant to the foregoing violations. More specifically,
the Loss Settlement Provision has been violated by Carrier.
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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.
Westchester Surplus Lines Insurance Company (hereinafter, the “Carrier”) has not attempted in good faith to settle the Insured, LJP Building, LLC’s (hereinafter, the “Claimant”) claim for Hurricane Ian damages when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward Claimant and with due regard for its interests. The Carrier has done everything possible to delay the claim and deprive Claimant from benefits due and owed under the policy of insurance. Furthermore, Carrier is required to properly investigate and adjust claims and cannot place that burden upon the insured. This was made clear by the appellate court and the Florida Supreme Court in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005)(“The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insureds…”).
On September 28, 2022, Hurricane Ian slammed into Florida’s southwest coast as one of the most powerful storms in US history. The storm was just short of being classified as a category 5 hurricane with sustained wind speeds of up to 155mph – 7mph slower than a Category 5. Data evidenced gusts across Florida of 140mph in Cape Coral, 135mph in Punta Gorda, 112mph in Pelican Bay and 110mph in La Belle. Carrier was immediately put on notice of the Claimant’s Hurricane Ian damage. Claimant obtained and produced to Carrier an estimate reflecting the cost to restore the insured property back to its pre-loss condition. In addition, Claimant documented the condition of the property during and immediately following the passage of Hurricane Ian. Thus, when the insured undertook mitigation efforts to the roof in an effort to avoid further loss or damage to the interior, Carrier was provided with photos showing the property in its damaged condition. Notwithstanding and despite Carrier’s own adjusters documenting widespread and substantial damage to the roof, vinyl backed insulation gutters, soffits, fascia, siding, signage, exterior elevations, overhead garage doors and extensive ensuing damage throughout the interiors as a result of Hurricane Ian, the Carrier only considered and adjusted for a portion of the claimed, observed and documented damages.
Throughout the claim’s handling process, Claimant and its representatives, corresponded with and followed up with the Carrier multiple times regarding the status of the claim, and reconsideration of the damages as adjusted. During its claim investigation, Carrier’s field adjuster, Doug Rinderer (“Mr. Rinderer”), inspected Plaintiff's property for hurricane damage on October 27, 2022, and documented widespread damage thereto. Despite documenting undisputed covered damage to the insured property, Carrier subsequently engaged an ESi to inspect the subject property, who inspected the insured property on November 4, 2022. On November 11, 2022, Carrier’s desk adjuster, Mr. Connor Ferraro, solicited “estimates/quotes for the repairs” from the Plaintiff. On December 29, 2022, Plaintiff engaged the services of a public adjuster, All Service Adjusting, to assist with the claim, who on December 30, 2022, produced a repair estimate totaling $404,482.40. On or about January 13, 2023, over 2 months following the inspection, ESi produced its report to Carrier. On January 23, 2023, Plaintiff provided a Sworn Statement in Proof of Loss (“SPOL”) to Carrier totaling $404,482.40 Replacement Cost Value, consistent with the repair estimate produced on December 30, 2022, by Plaintiff’s public adjuster. 11. On January 26, 2023, Carrier acknowledged receipt of Plaintiff’s SPOL, and noted that “[t]he Sworn Statement in Proof of Loss is accepted as compliance with the policy conditions; however, the amount and scope of damage claimed is not agreed with Westchester Surplus Lines Insurance Company (‘Chubb’).
As of March 2, 2023, Carrier had yet to issue a coverage position nor notify Plaintiff of its option to pay for the loss or damage pursuant to the Loss Payment provision. Instead, in an effort to buy more time and prolong the investigation, Carrier requested a third inspection of the insured property. Notwithstanding, as discovered in the deposition of the Carrier, Carrier already had the report of ESi and of its field adjuster in its possession.
On March 6, 2023, Plaintiff’s public adjuster produced a roofers proposal to Carrier in accordance with its prior request. Given Carrier’s failure to provide a coverage position, on March 22, 2023, Plaintiff filed a Notice of Intent to Initiate Litigation. On May 1, 2023, ESi conducted a re-inspection of the insured property. Despite multiple re-inspections, Carrier continued to withhold its coverage determination from Plaintiff, who on July 19, 2023, filed its second Notice of Intent to Initiate Litigation. At no point during the pendency of the subject claim, did Carrier provide a coverage determination or a reservation of rights to Plaintiff. Moreover, Carrier never produced: (i) any reservation of rights; (ii) estimate as to its adjustment of the covered loss; and (iii) coverage determination to Plaintiff. Additionally, Carrier never requested or required Plaintiff to submit estimates, proposals, or invoices in support of the claimed damage in actual cash value. Conversely, Carrier requested estimates “estimates/quotes for the repairs” from the Plaintiff – which Plaintiff produced – and “accepted” the All Service Adjusting Estimate and SPOL for Replacement Cost Value, “as compliance with the policy conditions.” Carrier has taken the position that the roof of the subject property is repairable, and has not adjusted for: any siding damage resulting from wind-borne debris; the full extent of interior water damage to drywall and drop ceilings; the full extent of damaged vinyl backed insulation; exterior signage; paint and stucco; and gutters and downspouts, amongst other items.
Additionally, despite acknowledging that the repairs made to the roof by Plaintiff were temporary in nature, Carrier’s own damages expert, Mr. Patrick Loyacona, conceded that the spray foam coating would need to be removed in order to effectuate such repairs, and such would require Plaintiff “to pay a lot of labor to remove that in order to get to your metal panels, your – standing seam.” Notably, Mr. Loyacona did not include any such repairs in his damage report. Additionally, even though Mr. Loyacona noted additional areas of vinyl backed insulation, he did not write for those in his damages report. Due to the nature and extent of damage to the roof and vinyl backed insulation, Plaintiff’s expert, who is a Florida certified general contractor and professional engineer, Mr. Brizuela, P.E. testified that the roof is not capable of repair due to and requires replacement as does the vinyl backed insulation. Additionally, given the extent of water damage to the interior of the building from Category 3 water, as defined by the IICRC, Mr. Brizuela testified the affected areas require complete replacement.
Carrier’s investigation failed to account for all of the claimed and covered damage resulting as a direct and proximate result of Hurricane Ian. Therefore, payments were not tendered as due and owed under the policy in actual cash value nor replacement cost value. Mr. Peterson testified that although he contracted with CAA prior to the damage caused by Hurricane Ian to the roof of the subject property “it became a project that went from doing a heat reduction insulation foam protection to now a heat reduction foam protection and waterproofing system.” Mr. Peterson further added “was I assuming or was I under the understanding that this foam would be a replacement for my roof that I didn’t need to do anything else, no, of course not, there was no way, but I did think that this was going to help me mitigate the issues that I had with the roof, of course, absolutely it was going to help me and it has helped me.” Mr. Beecham deferred to Mr. Peterson as to the reason why the contracted work continued after the damage to the roof, which Mr. Peterson testified was now for waterproofing purposes. Mr. Beecham further testified that the spray foam coating applied does serve as a temporary mitigation effort. Mr. Beecham testified that he has been paid in full for the spray foam coating.
In support of Plaintiff's claimed damages, Plaintiff has submitted various invoices, receipts, ledgers, checks, estimates and proposals, including but not limited to: Dre & Co, LLC repair receipt for the roof ; Paul S. Munizzi exterior paint and stucco repair proposal ; IMS Barter Network ledger showing payments after Hurricane Ian to CAA Roof Coating Systems (“CAA”) for emergency application of a spray foam coating to the surface of the roof to prevent further water leaks to the interior of the building ; Trademark Roofing proposal for replacement of the roof and water damaged vinyl backed insulation ; check number 1044 payable to Fernando Ortis for drywall repairs; ledger showing barter and cash payments to Jose and Sons for temporary repairs to the roof and fascia ; ledger showing cash payment to Kim and Andrew Plastering for stucco repairs ; ledger showing payment to Up and Down Garage Door for overhead garage door alignment ; ledger showing payments to Paul S. Munizzi for painting ; ledger showing payment to Jackson Concrete for door and block work ; ledger showing payments to Dre & Co, LLC for additional roof repairs ; ledger showing payments to Fred Wallace for electrical repairs ; and an estimate prepared by Al Brizuela, C.G.C. to restore the insured property to its pre-loss condition.
Again, despite the Carrier’s own field adjusters and consultants, acknowledging widespread and substantial damage to the subject property as a result of Hurricane Ian, the Carrier only considered and adjusted for a portion of the claimed, observed and documented damages, without asserting any applicable basis to exclude or limit coverage under the policy. Carrier has misrepresented pertinent facts concerning the investigation and insurance policy provisions relating to coverages in order to refuse Claimant’s the full benefits due and owed under the subject policy of insurance. Accordingly, Carrier has failed and refused to attempt in good faith to settle the subject claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insureds and with due regard for their interests.
Claimant has complied with all Carrier’s requests to date. Notwithstanding, Carrier has refused to reconsider its adjustment of Claimant’s irrefutable Hurricane Ian damage. Over 994 days have passed since the original date of loss, and Carrier has still refused to pay the fully covered amount owed under the policy. In fact, Carrier has failed to make any payment or issued any coverage determination. Due to Carriers’ refusal to make any payments as due and owed to Claimant under the Policy necessary to restore the insured property to its pre-loss condition, Claimant has been left with no other recourse than to perform emergency mitigation efforts to prevent further loss or damage to the property, and otherwise has been unable to make repairs and make full use of the property given the extent of repairs necessary and the Carrier’s refusal to fairly and accurately pay the actual cash value of the insured loss.
The Loss Payment provision of the subject policy provides that in the event of loss or damage to Covered Property, at Carrier’s option, it would either pay the “value of lost or damaged property” or “the cost of repairing or replacing the lost or damaged property”, the value of which would be determined pursuant to the Valuation Condition, and Carrier would “give notice of [its] intentions within 30 days after [it] receive the sworn proof of loss.” The Valuation Condition further provides that Carrier “will determine the value of Covered Property in the event of loss or damage ... at actual cash value as of the time of loss or damage.” Carrier has willfully and knowingly breach the policy of insurance and applicable Florida Statutes governing Carrier’s investigation, adjustment and settlement of the Claim.
Carrier is well aware of the full extent of the loss and has not taken any meaningful ensuing action since issuing its woefully insufficient payment to Claimant. It is clear that Carrier is: (i) not treating the Claimant with good faith claims conduct; (ii) failing to pay a claim clearly owed; (iii) not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to Claimant; (iv) failing to implement proper standards for the adjustment and investigation of claims and placing the company’s interests before the Claimant’s interests; (v) not training, supervising or managing adjusters properly so that prompt and full payments are made; (vi) refusing to pay the full amount owed to the insureds despite the fact that the damages are covered under the policy; (vii) looking for ways to delay full recovery or any recovery to the insured; and (viii) refusing to provide coverage for the claimant’s loss in a timely manner. Importantly, in an effort to coerce the Claimant, Carrier refused to renew Claimant’s policy despite knowing that Claimant would not be able to bind new insurance with an open claim.
Carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), and 626.9541(1)(i)(3)(d). Carrier’s conduct is not isolated, but appears to be an intentional pattern and business practice adopted in the handling of its claims, as experienced by the undersigned counsel’s clients in several other claims presented to Carrier.
Therefore, to cure the defects outlined in this Civil Remedy Notice, Carrier must: 1) pay the covered loss in the amount of $651,393.80, less the applicable policy deductible; 2) pay the Claimant’s attorneys’ fees and costs as they have been forced to retain counsel; 3) pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made; 4) implement proper standards for the adjustment and investigation of claims; and 5) placing the interests of its insureds before Carrier’s own interests.
A copy of this letter and filed form submitted to the FDFS has been printed out and mailed.
Please do not hesitate to contact the undersigned at (305) 419-4090 if you have any questions or concerns.
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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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