41
Fla. L. Weekly D2736bop of Form
Fla. L. Weekly D2736bop of Form
Insurance
— Homeowners — Sinkhole loss — Bad faith — Trial court erred when it
entered summary judgment in favor of insurer on first-party bad-faith complaint
on ground that, by accepting insurer’s proposal for settlement on underlying
breach of contract claim for amount less than policy limits, insureds had
failed to obtain a determination of liability or the extent of their damages —
Insurer’s payment of settlement amount constituted a favorable resolution for
insureds and further served as a determination of liability and extent of
insureds’ damages, and fact that settlement was in amount less than policy
limits or amount initially demanded by insureds does not change result
— Homeowners — Sinkhole loss — Bad faith — Trial court erred when it
entered summary judgment in favor of insurer on first-party bad-faith complaint
on ground that, by accepting insurer’s proposal for settlement on underlying
breach of contract claim for amount less than policy limits, insureds had
failed to obtain a determination of liability or the extent of their damages —
Insurer’s payment of settlement amount constituted a favorable resolution for
insureds and further served as a determination of liability and extent of
insureds’ damages, and fact that settlement was in amount less than policy
limits or amount initially demanded by insureds does not change result
SANDRA
BARTON AND GREGORY BARTON, Appellants, v. CAPITOL PREFERRED INSURANCE COMPANY,
INC., Appellee. 5th District. Case No. 5D15-1587. Opinion filed December 9,
2016. Appeal from the Circuit Court for Marion County, Lisa D. Herndon, Judge.
Counsel: James J. Dye, Orlando, and Nicholas A. Shannin and Pamela R. Masters,
of Shannin Law Firm, P.A., Orlando, for Appellants. Brandon S. Vesely and
Nicole M. Ziegler, of Keane, Reese, Vesely & Gerdes, P.A., St. Petersburg,
for Appellee.
BARTON AND GREGORY BARTON, Appellants, v. CAPITOL PREFERRED INSURANCE COMPANY,
INC., Appellee. 5th District. Case No. 5D15-1587. Opinion filed December 9,
2016. Appeal from the Circuit Court for Marion County, Lisa D. Herndon, Judge.
Counsel: James J. Dye, Orlando, and Nicholas A. Shannin and Pamela R. Masters,
of Shannin Law Firm, P.A., Orlando, for Appellants. Brandon S. Vesely and
Nicole M. Ziegler, of Keane, Reese, Vesely & Gerdes, P.A., St. Petersburg,
for Appellee.
(EVANDER,
J.) Sandra and Gregory Barton appeal the final summary judgment entered in
favor of Capitol Preferred Insurance Company, Inc., on the Bartons’ first-party
bad-faith complaint. In granting Capitol’s motion for summary judgment, the
trial court found that by accepting Capitol’s proposal for settlement on their
underlying breach of contract claim for an amount less than the policy limits,
the Bartons had failed to obtain a determination of liability or the extent of
their damages. We disagree and, accordingly, reverse.
J.) Sandra and Gregory Barton appeal the final summary judgment entered in
favor of Capitol Preferred Insurance Company, Inc., on the Bartons’ first-party
bad-faith complaint. In granting Capitol’s motion for summary judgment, the
trial court found that by accepting Capitol’s proposal for settlement on their
underlying breach of contract claim for an amount less than the policy limits,
the Bartons had failed to obtain a determination of liability or the extent of
their damages. We disagree and, accordingly, reverse.
Capitol
provided homeowners’ insurance to the Bartons from April 28, 2003, through
12:01 a.m., April 28, 2011. The homeowners’ policy included sinkhole coverage
up to policy limits of $312,000. Capitol did not renew the Bartons’ policy
after April 28, 2011, and the Bartons then obtained homeowners insurance with
Universal Property and Casualty Insurance Company, effective from April 28,
2011 through April 28, 2012. Within two weeks of obtaining insurance with
Universal, the Bartons noticed damage to the walls and floor of their home.
They filed a claim for sinkhole-related damages with Universal. Universal
denied the claim, determining that the damage occurred prior to the effective
date of its policy. Thereafter, by letter dated October 7, 2011, the Bartons,
through their attorney, submitted a claim and request for sinkhole testing to
Capitol, pursuant to section 627.707, Florida Statutes (2011).1 The Bartons did not provide a date of
loss in their claim. Capitol denied the claim by letter dated October 17, 2011.
In its letter, Capitol identified the date of loss as “Unknown” and stated that
it could not process any claim payments because the policy was not renewed on
April 28, 2011. The letter also stated, “However, if you believe you have
documentation which confirms that the incident occurred within the policy
effective period, please forward it to this office for review.”
provided homeowners’ insurance to the Bartons from April 28, 2003, through
12:01 a.m., April 28, 2011. The homeowners’ policy included sinkhole coverage
up to policy limits of $312,000. Capitol did not renew the Bartons’ policy
after April 28, 2011, and the Bartons then obtained homeowners insurance with
Universal Property and Casualty Insurance Company, effective from April 28,
2011 through April 28, 2012. Within two weeks of obtaining insurance with
Universal, the Bartons noticed damage to the walls and floor of their home.
They filed a claim for sinkhole-related damages with Universal. Universal
denied the claim, determining that the damage occurred prior to the effective
date of its policy. Thereafter, by letter dated October 7, 2011, the Bartons,
through their attorney, submitted a claim and request for sinkhole testing to
Capitol, pursuant to section 627.707, Florida Statutes (2011).1 The Bartons did not provide a date of
loss in their claim. Capitol denied the claim by letter dated October 17, 2011.
In its letter, Capitol identified the date of loss as “Unknown” and stated that
it could not process any claim payments because the policy was not renewed on
April 28, 2011. The letter also stated, “However, if you believe you have
documentation which confirms that the incident occurred within the policy
effective period, please forward it to this office for review.”
The
Bartons filed a breach of contract action against both Capitol and Universal in
August 2012. Subsequently, Universal retained Ground Down Engineering (“GDE”)
to perform sinkhole testing. GDE issued a report on January 8, 2013,
determining that “the cracks and separations within and on the exterior of the
Barton residence are likely the result of soil movement associated with
sinkhole activity.” GDE estimated the cost of repairs would be between $129,220
and $146,220. The Bartons settled their breach of contract action with
Universal for an undisclosed amount, but continued to pursue their action
against Capitol.
Bartons filed a breach of contract action against both Capitol and Universal in
August 2012. Subsequently, Universal retained Ground Down Engineering (“GDE”)
to perform sinkhole testing. GDE issued a report on January 8, 2013,
determining that “the cracks and separations within and on the exterior of the
Barton residence are likely the result of soil movement associated with
sinkhole activity.” GDE estimated the cost of repairs would be between $129,220
and $146,220. The Bartons settled their breach of contract action with
Universal for an undisclosed amount, but continued to pursue their action
against Capitol.
In
March 2013, pursuant to section 624.155, Florida Statutes (2013),2 the Bartons filed a “Civil Remedy
Notice of Insurer Violation” with the Florida Department of Insurance. Section
624.155 of the Florida Insurance Code,3 requires insureds to file a civil
remedy notice with the Department of Insurance (with a copy served on the
insurer) as a condition precedent to bringing a bad-faith claim against an
insurer. See § 624.155(1)(b), Fla. Stat. (2013). The notice must set
forth the specific statutory provision the insurer allegedly violated, the facts
giving rise to the violation, the relevant policy language, and a statement
that the notice is given to perfect the right to pursue the civil remedy
authorized by the statute. § 624.155(3)(b), Fla. Stat. (2013). If the insurer
pays the damages or corrects the violation within sixty days of the filing of
the notice, then the insureds are precluded from filing a bad-faith claim. §
624.155(3)(a), (d), Fla. Stat. (2013).
March 2013, pursuant to section 624.155, Florida Statutes (2013),2 the Bartons filed a “Civil Remedy
Notice of Insurer Violation” with the Florida Department of Insurance. Section
624.155 of the Florida Insurance Code,3 requires insureds to file a civil
remedy notice with the Department of Insurance (with a copy served on the
insurer) as a condition precedent to bringing a bad-faith claim against an
insurer. See § 624.155(1)(b), Fla. Stat. (2013). The notice must set
forth the specific statutory provision the insurer allegedly violated, the facts
giving rise to the violation, the relevant policy language, and a statement
that the notice is given to perfect the right to pursue the civil remedy
authorized by the statute. § 624.155(3)(b), Fla. Stat. (2013). If the insurer
pays the damages or corrects the violation within sixty days of the filing of
the notice, then the insureds are precluded from filing a bad-faith claim. §
624.155(3)(a), (d), Fla. Stat. (2013).
In
their civil remedy notice, the Bartons alleged that rather than perform a
“complete, thorough and statutorily compliant sinkhole/subsidence
investigation,” Capitol merely summarily denied the sinkhole claim, thereby
placing its interests ahead of those of its insureds. The civil remedy notice
further alleged that Capitol wrongly denied a valid claim.
their civil remedy notice, the Bartons alleged that rather than perform a
“complete, thorough and statutorily compliant sinkhole/subsidence
investigation,” Capitol merely summarily denied the sinkhole claim, thereby
placing its interests ahead of those of its insureds. The civil remedy notice
further alleged that Capitol wrongly denied a valid claim.
On
April 5, 2013, Capitol responded to the civil remedy notice by denying all
allegations. Approximately six months later, Capitol served the Bartons with a
proposed settlement, pursuant to section 768.79, Florida Statutes (2013),
offering to settle the Bartons’ claim for $65,000. Significantly, the proposal
did not require the Bartons to execute a release or to expressly waive their
right to pursue a bad-faith action against Capitol. The Bartons timely accepted
Capitol’s proposal for settlement. Shortly thereafter, Capitol paid the Bartons
$65,000, and the Bartons dismissed their breach of contract complaint.
April 5, 2013, Capitol responded to the civil remedy notice by denying all
allegations. Approximately six months later, Capitol served the Bartons with a
proposed settlement, pursuant to section 768.79, Florida Statutes (2013),
offering to settle the Bartons’ claim for $65,000. Significantly, the proposal
did not require the Bartons to execute a release or to expressly waive their
right to pursue a bad-faith action against Capitol. The Bartons timely accepted
Capitol’s proposal for settlement. Shortly thereafter, Capitol paid the Bartons
$65,000, and the Bartons dismissed their breach of contract complaint.
After
settling the underlying action, the Bartons filed a first-party bad-faith
action against Capitol, alleging that in handling the Bartons’ sinkhole claim,
Capitol violated sections 624.155(1)(b) and 626.9541(1)(i)3,4 Florida Statutes (2013), by, inter
alia, failing to properly investigate the Bartons’ claim and failing to act
in good faith to settle that claim. Capitol filed an answer and affirmative
defenses denying liability.5
settling the underlying action, the Bartons filed a first-party bad-faith
action against Capitol, alleging that in handling the Bartons’ sinkhole claim,
Capitol violated sections 624.155(1)(b) and 626.9541(1)(i)3,4 Florida Statutes (2013), by, inter
alia, failing to properly investigate the Bartons’ claim and failing to act
in good faith to settle that claim. Capitol filed an answer and affirmative
defenses denying liability.5
Capitol
filed a motion for summary judgment in December 2014. It alleged that it was
entitled to judgment as a matter of law on the Bartons’ bad-faith claim because
the Bartons failed to establish the necessary prerequisites to maintain such a
claim against Capitol. Specifically, Capitol alleged that the Bartons failed to
prove that: (1) the underlying breach of contract case had been resolved in
their favor; and (2) there had been a determination of the “actual extent of
[their] loss.” In support of summary judgment, Capitol submitted an affidavit
from one of its claims supervisors, who averred that as a claims supervisor she
oversaw all claims, evaluated liability, and made coverage decisions. According
to her affidavit, Capitol never admitted liability for the Bartons’ claim and
the proposal for settlement was made in an effort to dispose of litigation
costs. The claims supervisor further averred that there had not been a determination
of liability against Capitol, nor had there been a determination of the extent
of the Bartons’ alleged damages.
filed a motion for summary judgment in December 2014. It alleged that it was
entitled to judgment as a matter of law on the Bartons’ bad-faith claim because
the Bartons failed to establish the necessary prerequisites to maintain such a
claim against Capitol. Specifically, Capitol alleged that the Bartons failed to
prove that: (1) the underlying breach of contract case had been resolved in
their favor; and (2) there had been a determination of the “actual extent of
[their] loss.” In support of summary judgment, Capitol submitted an affidavit
from one of its claims supervisors, who averred that as a claims supervisor she
oversaw all claims, evaluated liability, and made coverage decisions. According
to her affidavit, Capitol never admitted liability for the Bartons’ claim and
the proposal for settlement was made in an effort to dispose of litigation
costs. The claims supervisor further averred that there had not been a determination
of liability against Capitol, nor had there been a determination of the extent
of the Bartons’ alleged damages.
The
Bartons filed a response in opposition to Capitol’s motion for summary
judgment. They alleged that although a release was discussed, the parties
ultimately agreed to a settlement without a release. Additionally, the Bartons’
posited that Capitol’s payment of $65,000 on the policy was a confession of
judgment and constituted a determination of liability and damages. In support
of their response, the Bartons filed the affidavits of the Bartons and their
attorney. The trial court granted Capitol’s motion for summary judgment,
stating that “a proposal for settlement does not equate to a determination of
liability and the extent of damages.” The Bartons timely appealed the final
summary judgment granted in favor of Capitol.
Bartons filed a response in opposition to Capitol’s motion for summary
judgment. They alleged that although a release was discussed, the parties
ultimately agreed to a settlement without a release. Additionally, the Bartons’
posited that Capitol’s payment of $65,000 on the policy was a confession of
judgment and constituted a determination of liability and damages. In support
of their response, the Bartons filed the affidavits of the Bartons and their
attorney. The trial court granted Capitol’s motion for summary judgment,
stating that “a proposal for settlement does not equate to a determination of
liability and the extent of damages.” The Bartons timely appealed the final
summary judgment granted in favor of Capitol.
A
cause of action for an insurer’s failure to settle its insured’s claim in good
faith does not accrue until and unless the insured’s underlying first-party
action for insurance benefits is resolved favorably to the insured. Blanchard
v. State Farm Mut. Auto. Ins. Co., 575 So. 2d 1289, 1291 (Fla. 1991).
Furthermore, a bad-faith action is premature until there is a determination of
liability and extent of damages owed on the first-party insurance contract. Vest
v. Travelers Ins. Co., 753 So. 2d 1270, 1276 (Fla. 2000). However, the
Florida Supreme Court has specifically stated that the insured is not obligated
to obtain the determination of liability and the full extent of his or her
damages through a trial, but may do so by other means — such as a settlement:
cause of action for an insurer’s failure to settle its insured’s claim in good
faith does not accrue until and unless the insured’s underlying first-party
action for insurance benefits is resolved favorably to the insured. Blanchard
v. State Farm Mut. Auto. Ins. Co., 575 So. 2d 1289, 1291 (Fla. 1991).
Furthermore, a bad-faith action is premature until there is a determination of
liability and extent of damages owed on the first-party insurance contract. Vest
v. Travelers Ins. Co., 753 So. 2d 1270, 1276 (Fla. 2000). However, the
Florida Supreme Court has specifically stated that the insured is not obligated
to obtain the determination of liability and the full extent of his or her
damages through a trial, but may do so by other means — such as a settlement:
Certainly, the insured is not
obligated to obtain the determination of liability and the full extent
of his or her damages through a trial and may utilize other means of doing so,
such as an agreed settlement, arbitration, or stipulation before initiating a
bad faith cause of action.
obligated to obtain the determination of liability and the full extent
of his or her damages through a trial and may utilize other means of doing so,
such as an agreed settlement, arbitration, or stipulation before initiating a
bad faith cause of action.
Fridman
v. Safeco Ins. Co. of Ill., 185 So. 3d 1214, 1224 (Fla. 2016).
v. Safeco Ins. Co. of Ill., 185 So. 3d 1214, 1224 (Fla. 2016).
Here,
Capitol’s payment of $65,000 constituted a favorable resolution for the
Bartons. Cf. Ivey v. Allstate Ins. Co., 774 So. 2d 679, 684-85 (Fla.
2000) (holding that Allstate’s voluntary payment of additional monies after
insured brought action to recover personal injury protection benefits operated
as confession of judgment, thereby entitling insured to recover attorney’s
fees). The settlement further served as a determination of liability and extent
of the Bartons’ damages. See Fridman, 185 So. 3d at 1224 (stating that
settlement may serve as determination of liability and full extent of insured’s
damages); Brookins v. Goodson, 640 So. 2d 110, 112 (Fla. 4th DCA 1994), disapproved
on other grounds, State Farm Mut. Auto. Ins. Co. v. Laforet, 658 So.
2d 55, 62 (Fla. 1995) (holding that insurer’s payment of policy limits pursuant
to settlement of underinsured motorist claim established that insured had valid
claim for underinsured motorist benefits for purpose of first-party bad-faith
action against insurer).
Capitol’s payment of $65,000 constituted a favorable resolution for the
Bartons. Cf. Ivey v. Allstate Ins. Co., 774 So. 2d 679, 684-85 (Fla.
2000) (holding that Allstate’s voluntary payment of additional monies after
insured brought action to recover personal injury protection benefits operated
as confession of judgment, thereby entitling insured to recover attorney’s
fees). The settlement further served as a determination of liability and extent
of the Bartons’ damages. See Fridman, 185 So. 3d at 1224 (stating that
settlement may serve as determination of liability and full extent of insured’s
damages); Brookins v. Goodson, 640 So. 2d 110, 112 (Fla. 4th DCA 1994), disapproved
on other grounds, State Farm Mut. Auto. Ins. Co. v. Laforet, 658 So.
2d 55, 62 (Fla. 1995) (holding that insurer’s payment of policy limits pursuant
to settlement of underinsured motorist claim established that insured had valid
claim for underinsured motorist benefits for purpose of first-party bad-faith
action against insurer).
Capitol
suggests that because it settled for an amount less than policy limits or the
amount initially demanded by the Bartons, that there has been no determination
of liability or extent of damages. We reject that argument. Section 624.155
authorizes an insured to bring a first-party bad-faith action where the insured
has been damaged by the insurer’s failure to comply with certain enumerated
statutory provisions. The statute does not condition the right to bring an
action on the insured’s recovery of the policy limits or an amount equal to or
greater than its initial demand in the underlying action.
suggests that because it settled for an amount less than policy limits or the
amount initially demanded by the Bartons, that there has been no determination
of liability or extent of damages. We reject that argument. Section 624.155
authorizes an insured to bring a first-party bad-faith action where the insured
has been damaged by the insurer’s failure to comply with certain enumerated
statutory provisions. The statute does not condition the right to bring an
action on the insured’s recovery of the policy limits or an amount equal to or
greater than its initial demand in the underlying action.
REVERSED
AND REMANDED. (LAWSON, C.J., and SCHUMANN, B.B., Associate Judge, concur.)
AND REMANDED. (LAWSON, C.J., and SCHUMANN, B.B., Associate Judge, concur.)
__________________
1Section
627.707 sets forth an insurer’s obligation to investigate sinkhole claims.
Among other things, once an insurer receives a sinkhole claim for a covered
building, the insurer must inspect the premises for structural damage that may
have resulted from sinkhole activity and engage a professional engineer or
geologist to conduct testing if the cause of damage cannot be ascertained or is
consistent with sinkhole activity. § 627.707(1)-(2), Fla. Stat. (2011).
627.707 sets forth an insurer’s obligation to investigate sinkhole claims.
Among other things, once an insurer receives a sinkhole claim for a covered
building, the insurer must inspect the premises for structural damage that may
have resulted from sinkhole activity and engage a professional engineer or
geologist to conduct testing if the cause of damage cannot be ascertained or is
consistent with sinkhole activity. § 627.707(1)-(2), Fla. Stat. (2011).
2Section
624.155, Florida Statutes (2013), provides, in pertinent part:
624.155, Florida Statutes (2013), provides, in pertinent part:
624.155 Civil remedy.
—
—
(1) Any person may bring a
civil action against an insurer when such person is damaged:
civil action against an insurer when such person is damaged:
. . . .
(3)(a) As a condition
precedent to bringing an action under this section, the department and the
authorized insurer must have been given 60 days’ written notice of the
violation. If the department returns a notice for lack of specificity, the
60-day time period shall not begin until a proper notice is filed.
precedent to bringing an action under this section, the department and the
authorized insurer must have been given 60 days’ written notice of the
violation. If the department returns a notice for lack of specificity, the
60-day time period shall not begin until a proper notice is filed.
(b) The notice shall be on a
form provided by the department and shall state with specificity the following
information, and such other information as the department may require:
form provided by the department and shall state with specificity the following
information, and such other information as the department may require:
1. The statutory provision,
including the specific language of the statute, which the authorized insurer
allegedly violated.
including the specific language of the statute, which the authorized insurer
allegedly violated.
2. The facts and
circumstances giving rise to the violation.
circumstances giving rise to the violation.
3. The name of any individual
involved in the violation.
involved in the violation.
4. Reference to specific
policy language that is relevant to the violation, if any. If the person
bringing the civil action is a third party claimant, she or he shall not be
required to reference the specific policy language if the authorized insurer
has not provided a copy of the policy to the third party claimant pursuant to
written request.
policy language that is relevant to the violation, if any. If the person
bringing the civil action is a third party claimant, she or he shall not be
required to reference the specific policy language if the authorized insurer
has not provided a copy of the policy to the third party claimant pursuant to
written request.
5. A statement that the
notice is given in order to perfect the right to pursue the civil remedy
authorized by this section.
notice is given in order to perfect the right to pursue the civil remedy
authorized by this section.
. . . .
(d) No action shall lie if,
within 60 days after filing notice, the damages are paid or the circumstances
giving rise to the violation are corrected.
within 60 days after filing notice, the damages are paid or the circumstances
giving rise to the violation are corrected.
(e) The authorized insurer
that is the recipient of a notice filed pursuant to this section shall report
to the department on the disposition of the alleged violation.
that is the recipient of a notice filed pursuant to this section shall report
to the department on the disposition of the alleged violation.
. . . .
(4) Upon adverse adjudication
at trial or upon appeal, the authorized insurer shall be liable for damages,
together with court costs and reasonable attorney’s fees incurred by the
plaintiff.
at trial or upon appeal, the authorized insurer shall be liable for damages,
together with court costs and reasonable attorney’s fees incurred by the
plaintiff.
. . . .
(8) The civil remedy
specified in this section does not preempt any other remedy or cause of action
provided for pursuant to any other statute or pursuant to the common law of
this state. Any person may obtain a judgment under either the common-law remedy
of bad faith or this statutory remedy, but shall not be entitled to a judgment
under both remedies. This section shall not be construed to create a common-law
cause of action. The damages recoverable pursuant to this section shall include
those damages which are a reasonably foreseeable result of a specified
violation of this section by the authorized insurer and may include an award or
judgment in an amount that exceeds the policy limits.
specified in this section does not preempt any other remedy or cause of action
provided for pursuant to any other statute or pursuant to the common law of
this state. Any person may obtain a judgment under either the common-law remedy
of bad faith or this statutory remedy, but shall not be entitled to a judgment
under both remedies. This section shall not be construed to create a common-law
cause of action. The damages recoverable pursuant to this section shall include
those damages which are a reasonably foreseeable result of a specified
violation of this section by the authorized insurer and may include an award or
judgment in an amount that exceeds the policy limits.
3The
Florida Insurance Code is found at chapters 624-632, 634-636, 641-642, 648, and
651 of the Florida Statutes (2013).
Florida Insurance Code is found at chapters 624-632, 634-636, 641-642, 648, and
651 of the Florida Statutes (2013).
4Section
626.9541(1)(i)3., Florida Statutes (2013), provides:
626.9541(1)(i)3., Florida Statutes (2013), provides:
626.9541 Unfair methods of
competition and unfair or deceptive acts or practices defined.
—
competition and unfair or deceptive acts or practices defined.
—
(1) Unfair methods of
competition and unfair or deceptive acts. — The following are defined as
unfair methods of competition and unfair or deceptive acts or practices:
competition and unfair or deceptive acts. — The following are defined as
unfair methods of competition and unfair or deceptive acts or practices:
. . . .
(i) Unfair claim
settlement practices. —
settlement practices. —
. . . .
3. Committing or performing
with such frequency as to indicate a general business practice any of the
following:
with such frequency as to indicate a general business practice any of the
following:
a. Failing to adopt and
implement standards for the proper investigation of claims;
implement standards for the proper investigation of claims;
b. Misrepresenting pertinent
facts or insurance policy provisions relating to coverages at issue;
facts or insurance policy provisions relating to coverages at issue;
c. Failing to acknowledge and
act promptly upon communications with respect to claims;
act promptly upon communications with respect to claims;
d. Denying claims without
conducting reasonable investigations based upon available information;
conducting reasonable investigations based upon available information;
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;
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;
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;
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;
g. Failing to promptly notify
the insured of any additional information necessary for the processing of a
claim; or
the insured of any additional information necessary for the processing of a
claim; or
h. Failing to clearly explain
the nature of the requested information and the reasons why such information is
necessary.
the nature of the requested information and the reasons why such information is
necessary.
i. Failing to pay personal
injury protection insurance claims within the time periods required by s.
627.736(4)(b). The office may order the insurer to pay restitution to a
policyholder, medical provider, or other claimant, including interest at a rate
consistent with the amount set forth in s. 55.03(1), for the time period within
which an insurer fails to pay claims as required by law. Restitution is in
addition to any other penalties allowed by law, including, but not limited to,
the suspension of the insurer’s certificate of authority.
injury protection insurance claims within the time periods required by s.
627.736(4)(b). The office may order the insurer to pay restitution to a
policyholder, medical provider, or other claimant, including interest at a rate
consistent with the amount set forth in s. 55.03(1), for the time period within
which an insurer fails to pay claims as required by law. Restitution is in
addition to any other penalties allowed by law, including, but not limited to,
the suspension of the insurer’s certificate of authority.
5Capitol
also filed a counterclaim alleging that the Bartons had breached the settlement
agreement by filing a bad-faith claim.
also filed a counterclaim alleging that the Bartons had breached the settlement
agreement by filing a bad-faith claim.
* *
*
*