Filing Number:     473829

Filing Accepted:  1/28/2020

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Complainant

Last/Business Name *   TSAO   First Name   BROOKE AND BENJAMIN Street Address * 8011 PEBBLE CREEK LANE EAST City, State Zip * PONTE VEDRA, FL 32082 Email Address * Complainant Type: * Insured

Insured

Last/Business Name*   TSAO   First Name   BROOKE AND BENJAMIN Policy # * 4002-81-65-38 Claim #* 0205086540101105

Attorney

Attorney is Applicable Last Name* PAJCIC First Name * SETH Initial A Street Address* ONE INDEPENDENT DRIVE City, State Zip* JACKSONVILLE , FL 32202 Email Address * SETH@PAJCIC.COM

Violation

Insurer Type *   Authorized Insurer Unauthorized Insurer   Insurer Name Insurer Name*   GEICO GENERAL INSURANCE COMPANY Insurer Name* Street Address* City, State Zip* , NAIC Company Code 35882   Name of individual responsible for violation (if any):* NICOLE COOK, GEICO, P O BOX 9091, MACON, GA 31208-9091; PHONE: 863-619-4003 Type of Insurance * Auto

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. 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)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. 626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b). * Specific policy language that is relevant to the violation. Enter all words or phrases (one at a time) that should be used to filter. Under the Uninsured Motorists coverage we will pay damages for bodily injury sustained by an insured caused by accident which the insured is legally entitled to recover from the owner or operator of an uninsured auto arising out of the ownership, maintenance or use of that auto.   * Facts and circumstances giving rise to the violation. Enter all words or phrases (one at a time) that should be used to filter. On October 30, 2019, the Insured Brooke Tsao (belted) was driving her 2017 Honda Pilot on I-295 S. Another motorist (tortfeasor) crashed into the rear of the Brooke Tsao’s vehicle causing the Tsao vehicle to overturn and come to rest on the guardrail. Brooke Tsao suffered a right paracentral posterior disc herniation (protrusion) impinging upon the thecal sac at C4-5, central disc herniation (protrusion) with a visualized annular tear impinging upon the thecal sac at C5-6 and right paracentral posterior disc herniation (protrusion) with a visualized annular tear impinging upon the thecal sac at C6-7. The crash at issue has caused Brooke Tsao to suffer a permanent injury within a reasonable degree of medical probability. She has also incurred medical expenses in excess of $21,000. Brooke Tsao is an anesthesiologist and high wage earner. This crash has impacted her earning potential and will continue to impact her future earning ability. The tortfeasor has only $100,000 in available BI coverage which has not been tendered. Thankfully Complainant has a policy with GEICO General Insurance Company ($250,000/500,000 stacked times two vehicles) obligating it to pay UIM benefits if the Brooke Tsao is involved in a vehicle crash and the harms/losses exceed any available bodily injury coverage. Brooke Tsao’s harms and losses clearly exceed the limited, available bodily injury coverage. It should also be noted, Brooke Tsao is marred to Benjamin TSAO and he has a loss of consortium claim due to the injury to his wife. All harms/losses clearly exceed the available PIP coverage, bodily injury coverage, and the UIM coverage. Brooke Tsao has offered to resolve all claims under the UIM policy with GEICO General Insurance Company for the $500,000 in available UIM coverage. GEICO General Insurance Company has made an offer of $500.00 to settle the UIM claim. Given the clear liability crash, the severe injuries sustained by Dr. Tsao in the resulting rollover, and the ongoing economic impact these injuries have on her income, GEICO General Insurance Company’s offer of nuisance value bears no relationship to the value of the case and was made by GEICO General Insurance Company in bad-faith. GEICO General Insurance Company can cure its violations by payment of the UIM limits of $500,000 to Brooke and Benjamin TSAO.

Comments

User Id   Date Added   Comment NCOOK@GEICO.COM 03-26-2020 response sent to insureds attorney's office