Filing Number:     512113

Filing Accepted:  8/31/2020

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Complainant

Last/Business Name *   TIPIANA   First Name   MARCIA Street Address * 2681 N. FLAMINGO ROAD, APT. TH7S City, State Zip * SUNRISE, FL 33323 Email Address * MARR.GT@GMAIL.COM Complainant Type: * Insured

Insured

Last/Business Name*   TIPIANA   First Name   MARCIA Policy # * 06250110-0 Claim #* 185216822

Attorney

Attorney is Applicable Last Name* FISCHER First Name * JOHN Initial P Street Address* 4601 SHERIDAN STREET, SUITE 320 City, State Zip* HOLLYWOOD , FL 33021 Email Address * JOHN@FRTRIALLAWYERS.COM

Violation

Insurer Type *   Authorized Insurer Unauthorized Insurer   Insurer Name Insurer Name*   PROGRESSIVE EXPRESS INSURANCE COMPANY Insurer Name* Street Address* City, State Zip* , NAIC Company Code 10193   Name of individual responsible for violation (if any):* Type of Insurance * Auto

Reason for Notice * Unsatisfactory Settlement Offer * 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. * Specific policy language that is relevant to the violation. Enter all words or phrases (one at a time) that should be used to filter. THE COMPLAINANT WAS PROVIDED WITH THE TRANSPORTATION NETWORK COMPANY COMMERCIAL AUTO POLICY INSURANCE COVERAGE SUMMARY, THE FLORIDA POLICY ENDORSEMENT, AND THE CANCELLATION REFUND ENDORSEMENT. THE SPECIFIC LANGUAGE IN THOSE DOCUMENTS IS AS FOLLOWS: "UNINSURED MOTORIST COVERAGE PROVIDES FOR PAYMENT FOR DAMAGES, OTHER THAN PUNITIVE OR EXEMPLARY DAMAGES, THAT AN INSURED IS LEGALLY ENTITLED TO RECOVER FROM THE OWNER OR OPERATOR OF AN UNINSURED AUTO BECAUSE OF BODILY INJURY SUSTAINED BY AN INSURED, CAUSED BY AN ACCIDENT OCCURRING WHILE THE TNC DRIVER IS ENGAGED IN PROVIDING A PREARRANGED SERVICE, AND ARISING OUT OF THE OWNERSHIP, MAINTENANCE, OR USE OF AN UNINSURED AUTO. ADDITIONALLY, THE ENTIRE POLICY LANGUAGE IS TOO VOLUMINOUS TO CITE SPECIFICALLY AND IN DETAIL. ALL PORTIONS PERTAINING TO UNINSURED AND UNDER-INSURED MOTORIST APPLY. PROGRESSIVE EXPRESS INSURANCE COMPANY HAS FAILED TO TENDER ITS UNINSURED MOTORIST POLICY LIMITS WHEN, UNDER THE CIRCUMSTANCES, A REASONABLE INSURANCE COMPANY WOULD DO SO.   * Facts and circumstances giving rise to the violation. Enter all words or phrases (one at a time) that should be used to filter. THE INSURED CLAIMANT SUSTAINED, INTER ALIA, SIGNIFICANT, PERMANENT SPINAL AND BRAIN INJURIES, AS A RESULT OF A MOTOR VEHICLE COLLISION WHICH WAS CAUSED BY AN UNINSURED/UNDERINSURED MOTORIST. THIS WAS IN ADDITION TO A FRACTURED NECK, FIVE FRACTURED RIBS, FRACTURED SCAPULA AND COLLAPSED LUNG. THE CLAIMANT HAS RECEIVED EXTENSIVE MEDICAL CARE AND TREATMENT THROUGH THE DATE OF THIS NOTICE, INCLUDING A MULTIPLE DAY HOSPITALIZATION FOLLOWING THE CRASH, AND IT IS REASONABLY CERTAIN THAT SHE WILL REQUIRE ADDITIONAL MEDICAL CARE AND TREATMENT, INCLUDING SURGERY TO HER CERVICAL SPINE, IN THE FUTURE. PAST ECONOMIC DAMAGES CURRENTLY KNOWN ARE APPROXIMATELY $83,632.07. THERE IS NO DISPUTE TO LIABILITY, CAUSATION, AND PERMANENCY. MS. GONZALEZ RECEIVED A PERMANENT INJURY IMPAIRMENT RATING OF 10% TO THE BODY AS A WHOLE FROM HER TREATING PHYSICIAN, DR. REMY. ADDITIONALLY, THE DEFENSE’S ORTHOPEDIC EXPERT, DR. ROLANDO GARCIA, HAS ALSO OPINED THAT MS. GONZALEZ HAS A PERMANENT IMPAIRENT RATING OF 5% AS A RESULT OF ONLY THE RIB AND SCAPULA INJURIES. WITH RESPECT TO THE BRIAN INJURY, THE INSURED CLAIMANT ALSO HAD POSITIVE FINDINGS ON A DTI MRI PERFORMED BY DR. ANDREW WALKER AND DEMONSTRABLE COGNITIVE DEFICITS WITH A NEUROPSYCHOLOGICAL EXAMINATION PERFORMED BY DR. RICHARD HAMILTON. THE INSURER APPROVED THE CLAIMANT'S SETTLEMENT WITH THE UNINSURED/UNDERINSURED MOTORIST, AND WAIVED ITS RIGHTS OF SUBROGATION. THE CLAIMANT ASKED THE INSURER TO SETTLE HER UNINSURED/UNDERINSURED MOTORIST CLAIM FOR THE AVAILABLE POLICY LIMITS OF $1,000,000.00. DESPITE ALL THE AVAILABLE INFORMATION THAT IT HAS, THE INSURER REJECTED THAT SETTLEMENT OPPORTUNITY AND MADE A NOMINAL SETTLEMENT OFFER OF $500,000, GIVEN THE EIGHT FIGURE VALUATION OF THIS CASE.

Comments

User Id   Date Added   Comment kdanque1@progressive.com 09-28-2020 This will acknowledge that Progressive Express Insurance Company is in receipt of a Civil Remedy Notice of Insurer Violation regarding the above captioned matter. We deny all allegations set forth in this complaint. There is a dispute regarding the value of the claim. Our efforts continue to seek an amicable resolution.