Civil Remedy Notice of Insurer Violations
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Filing Number:     512113
Filing Accepted:  8/31/2020
      Print Filing
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*   PROGRESSIVE EXPRESS INSURANCE COMPANY
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.
Acknowledgement
* 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