Underwriters At Lloyd'S, London: the denial record

To cure the circumstances giving rise to the violations described in this notice, the Insurers must promptly tender $8,069,040.94 to [name redacted] minus the applicable deductible and prior payments.

The insurer declined to issue payment on the claim, based on the Insurers' determination that the repair costs were in the amount of $3,438.57, which was less than the policy deductible.

On December 6, 2022, the carrier made the unilateral determinations that the damages were covered would total to the amount of $860,887.44 for full repairs to the [name redacted] after to the application of the deductible and once the recoverable depreciation was fully recovered.

On 04/12/2022, the Insured's appraiser and the Umpire executed an Appraisal Award in the total amount of $1,192,839.23 RCV/$952,976.68 ACV in relation to the Claim, based on the Umpire's estimate.

On June 17, 2024, the public adjuster notified Underwriters of its involvement, on July 8, 2024, submitted an estimate for repairs along with photographs of the damages, and then on July 9 2024 submitted a Sworn Proof of Loss that totaled $1,124,547.66.

Their estimate totaled a Building damage to $ 657,419.78 RCV, contents damages of $2,002.24 and Loss of Use damage, including repair time in the amount of $75,000.00.

Therefore, UNDERWRITERS should tender $462,240.10 (less any prior payments, depreciation, excess policy limits, and/or deductible) in insurance benefits at this time.

Lloyd's sent the Insured a letter dated May 23, 2023 in which Lloyd's presented its below deductible estimate to the Insured in the amount of $89,157.14.

After assessing the damage and the true scope of repairs, the public adjuster prepared an estimate identifying $420,482.09 in covered damage to the dwelling, $5,745.45 in covered damage to other structures, and $18,408 for the screen enclosure special limit.

Thereafter, Underwriters notified the Insured that because the amount of the replacement cost estimate was allegedly below the deductible, there was no claim payment to be made.

The insurer has not conducted a good faith investigation of the claim and failed to arrive at a coverage determination on the claim after over four years.

Gannon determined that at least $104,597.43 worth of building repairs would be required to return the property to its pre-loss condition as a result of the windstorm loss.

LLOYD'S MADE NO PAYMENT AS THE ESTIMATE FELL BELOW THE POLICY'S DEDUCTIBLE OF $75,000.00.

Through C.A.R.E., the Insureds submitted an itemized estimate of damages, dated November 18, 2024, totaling $250,703.16 in replacement cost value, reflecting the necessary expenses to restore the Insured Property to its pre-loss condition, including current prices of materials, labor, and permits in

Subsequently, the insured submitted a loss package in the amount of $244,152.25 needed to restore the property back to its pre-loss condition to the carrier.

Subsequently, on March 25, 2024, the Insured obtained an itemized estimate of damages totaling $159,589.24 an amount that more accurately reflects the true scope and nature of the loss.

However, the Insurer wrongfully determined that it would only require $16,169.20 to restore the insured property to its pre-loss condition, which failed to exceed the policy deductible.

Subsequently, the insureds prepared a loss package in the amount of $219,186.98 needed to restore the property back to its pre-loss condition.

Following the loss, the insured retained RS Builders to perform mitigation repairs, where the insured incurred at least $67,561.94 in temporary repairs.

Moreover, AVIVA determined that at least $194,908.87 worth of repairs would be required to return the property to its pre-loss condition as a result of the flood loss.

On or about January 23, 2023, the Insurers issued a coverage determination letter, making an advance on the building settlement for the loss to the Property in the amount of $100,000.00.

Upon information and belief, Carrier deliberately kept its coverage estimate dated December 1, 2022 under the $20,000.00 deductible to avoid paying out any money on the claim.

Moreover, AVIVA determined that at least $47,153.36 worth of repairs would be required to return the property to its pre-loss condition as a result of the flood loss.

Subsequently, the claimant prepared a loss package in the amount of $ 167,938.18 needed to restore the property back to its pre-loss condition.

Therefore, demand is hereby made as follows: Estimate $167,382.05 Less Prior Payments $20,116.77 Less Deductible $37,207.40 TOTAL $135,162.37 The concept of insurance is that the insurer will investigate and grant timely and prompt indemnity or security against a contingent loss.

Storm One prepared an estimate in the amount of $114,697.[address redacted]ease find a copy of Storm One's estimate along with photos taken of the loss.

As the Insurer has failed to make a timely determination, it has violated this code.

Specifically, the Insured, with assistance from their public adjuster, submitted an estimate for $91,296.56, which was a fair and reasonable assessment for the repair/replacement of damages.

Thereafter, the insurer offered in total (including recoverable depreciation) the amount of $61,874.04.

Therefore, UNDERWRITERS should tender $1,577,343.75 (less any prior payments, depreciation, excess policy limits, and/or deductible) in insurance benefits at this time.

Subsequently, the insureds prepared a loss package in the amount of $45,475.00 needed to restore the property back to its pre-loss condition.

Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $45,372.20 (after application of the deductible) 2.) Pay the statutory interest on the amount of unpaid damages from the date the loss was reported to the date pa

This is demonstrably false: the Insured provided access, documentation, ongoing photos, roofing contact information, mitigation invoices, and responsive communications while the [name redacted] failed to respond substantively to the March 18, 2025 demand or pay approved mitigation costs totaling now

The water bills then progressively dropped in July ($2,743.00) and August ($868.56).

The field adjuster created an estimate dated January 26, 2021, for $2,362.29, which failed to exceed the policy deductible.

During the course of Underwriters' investigation, the Insured made her property available for inspection, provided facts and information about the loss, and complied with Underwriters' adjustment of the claim.

On December 18, 2024, the Public Adjuster representing the insured submitted a signed Sworn Proof of Loss, an estimate, and a written appraisal demand to the insurer.

Carrier inspected the property and acknowledged coverage for the loss but underpaid the claim by only issuing a payment of $1,317.82 after application of the $7,500 windstorm deductible.

The insurer, in bad faith, has raised defenses to paying the full value of the claim that the insurer knows are inapplicable to the subject loss and which the insurer's own experts do not agree with based upon a plain reading of the expert's reports.

The letter also incorrectly stated that the Insurers remained liable for only $18,598,332 of that $25 million because they had paid their proportionate share of $5 million pursuant to the non-cash agreement and $1,401,668 had already been paid toward code-related rebuilding.

The insured disputes the entirety of the denial letter of July 5, 2024, including the co-insurance penalty being applied and including the insuror's allegation that the requested repairs were somehow "excessive".

The Carrier performed a cursory inspection of the Insured Property and failed to retain unbiased experts necessary to scope the entirety of the Loss and covered repairs necessary to restore the Insured Property to its pre-loss condition.

The Carrier performed a cursory inspection of the Insured Property and failed to retain unbiased experts necessary to scope the entirety of the Loss and covered repairs necessary to restore the Insured Property to its pre-loss condition.

Ironshore's and Oil Casualty's exposures for this claim arise when the total payments to all insureds exceed $25,000,000.

Following this inspection, Lloyd's failed to timely communicate a coverage determination or request any additional documents necessary for concluding its investigation.

The Carrier performed a cursory inspection of the Insured Property and failed to retain unbiased experts necessary to trigger the cause of the Loss and covered repairs necessary to restore the Insured Property to its pre-loss condition.

The Insured promptly reported the loss to Insurer, mitigated the damages, complied with all applicable post-loss obligations, and retained a public adjuster to assist through this difficult time.