Victim's Stories

Victim’s Stories THE GRAY’S Assembly District: Alicia Hyndman Co-Sponsor: Yes or No Senate District: Leroy G. Comrie Jr. Co-Sponsor: Yes or No The Gray family, including four children, suffered a fire loss to their Laurelton, New York home on March 10, 2012, The home was insured by Tri-State Consumer Insurance Company (“TSC”). The building portion of the claim was handled by TSC’s contractor, Prism, which found a replacement cost loss of $251,214 reduced to $224,790 after recoverable depreciation was calculated. At first, and without any au- thority, TSC required the Gray’s to use Prism for the repair work instead of the Gray’s contractor of choice. TSC subsequently relented on this issue. Despite the loss numbers calculated by TSC’s own contractor, the Grays were only offered $190,000 until repairs were completed at which point the recoverable depreciation of $26,000 would be issued. TSC’s president then refused to issue even this reduced check requiring the Grays to produce completely irrelevant documents such as their childrens’ birth certificates, marriage certificates and photos of a circuit breaker. A three month delay ensued during which TSC refused to communicate with the insureds about their contents claim despite the fact that payment was promised by TSC’s claim supervisor at the beginning of the three month period. Payment for contents were finally made in the sum of $62,348 despite the fact that the claim exceeded the policy limits of $224,500. During this period TSC also refused to make any additional living expense payments (which are covered by the policy) without explanation despite the family having been forced to move to a rental property because of the fire. TSC requested an Examination Under Oath (“EUO”) during which time all further payments were placed on hold, forcing Ms. Gray to sleep on the rental property floor because TSC refused to pay for furniture. She was forced to pay $1,800/month for the rental payments while still paying the mortgage on her destroyed home ‘which she did not dispute until over three years after the loss. Even then, the home she moved back to was not completely repaired due to TCS’s intransigence and the insured was forced by TSC’s antics to bring a lawsuit against them. It was uncovered during the lawsuit that: - The $190,000 payment TSC initially made was miscalculated by improperly applying the recoverable depreciation twice, thus charging the insureds a 40% holdback rather than a 20% holdback. - Instead of admitting this to the DFS which was investigating its misconduct, TSC compounded its culpable conduct by creating a different Prism estimate in order to justify it’s initial $190,000 payment. - The fraudulent revision of the Prism estimate is further evidence of TSC’s goal of minimizing claims which was confirmed by its Claims Supervisor. - Incredibly, TSC then reduced the Gray’s contents claim payment already far below what was actually damaged, an additional $21,473 and off-set that figure against the amount owed under its second, fraudulent Prism dwelling estimate. - TSC tried to dismiss the Grey’s lawsuit on the palpably frivolous ground that its insured was required to go through formal appraisal under the policy, even if one wasn’t demanded. - TSC determined whether an insured owned an item based on what neighborhood the insured lived in, thus discriminating against the Grays and others based on perceived income rather than actual observation. - TSC’s contents adjuster simply took photos and did nothing else to document each damaged item. In the Gray’s case, no inventory list was ever created by TSC. - TSC unlawfully reduced the contents claim by 50% on a purely arbitrary basis. - TSC unlawfully paid its insureds only 80% of the Actual Cash Value claim, a claim that has already been reduced by recoverable depreciation. - TSC routinely issues but then withholds delivery of its insured’s checks to allow additional time to decrease the amount payable by yet another review. The Grays will not get their day in Court until 2017, some five years after the fire. Had the Act been in force, these events would likely not have happened. If they had, the insured could still become whole. Unfortunately the Grays will never achieve that. Victim’s Stories MZM REAL ESTATE CORP. Long Beach, New York Assembly District: Vacancy Co-Sponsor: Yes or No Senate District: Todd Kaminsky Co-Sponsor: Yes or No MZM Real Estate Corp suffered a windstorm loss as a result of Superstorm Sandy on October 29, 2012 to their property located in Island Park, New York. MZM was insured by AmTrust North American through Tower Insurance Company of New York. Appraisers for both sides were appointed and the umpire was selected on February 4, 2014. The appraisal went forward. An Appraisal Award was signed by the Appraiser for the insured and the Umpire on January 30, 2015 set- ting forth the cash value of the loss and damage, and which specifically excluded any allowance for damages related to Flood or Ordinance or Law coverage. Although the award was served upon the insurer on February 2, 2015, more than the allotted time permitted by regulation has passed and the award remains unpaid. The carrier is claiming that the appraisal award is improper and lacks the specificity required, although no objection was made to the form by the carrier’s appraiser and they are refusing to pay because the insured’s time to sue passed while the Appraisal was in process. This award of almost $90,000 remains unpaid. Victim’s Stories SIMEX TRADING COMPANY New York, New York Assembly District: Richard Gottfried Co-Sponsor: Yes or No Senate District: Brad Hoylman Co-Sponsor: Yes or No Simex Trading Company is a small business operating in Brooklyn, NY. After suffering severe water damage to its stock of textiles, caused by water that poured in as a result of winter storms and ice damage on the Landlord’s roof. Due to the absence of any law or regulation Simex could enforce, its insurer, Nationwide, intentionally and with approval of management, misrepresented policy terms so as to exclude the loss, misquoting the exclusion, creatively making the loss subject to a broad exclusion, when in fact, the exclusion clearly would not apply. The insurers engineer helped to cover up the actual covered cause of loss. After nearly going bankrupt, the insureds hired counsel and sued. Only after a Federal Judge directed Nationwide’s management to testify and explain the deception did Nationwide pay the claim in full, just days after they were forced to justify their actions to the court. Despite a full recovery, Simex was not made whole, having to pay all the expenses and legal fees involved in the suit. Detailed complaints to the Department of Financial Services were twice misplaced and ultimately Nationwide never responded nor was their conduct addressed. The Act would have made Nationwide’s conduct actionable to as discourage similar future conduct and make Simex whole. Under the current law there is no way to accomplish either. Victim’s Stories OLIVER SCHEPERS Port Jefferson, New York Assembly District: Steven Englebright Co-Sponsor: Yes or No Senate District: Kenneth P. LaValle Co-Sponsor: Yes or No Oliver Schepers sustained a water loss due to a freeze-up of pipes at his home in Port Jefferson, New York on January 28, 2014. He is insured by Allstate Insurance Company. When his adjuster communicated the insured’s intent to demand Appraisal to Allstate, he was informed that checks in payment of the claim for the building replacement cost holdback would be stopped if he went forward with his demand. Essentially, if the insured did not proceed to Appraisal, then the money would be available to him for repairs, but if Appraisal was demanded then Allstate would not issue any funds as well as stop payment on funds already issued. These circumstances demonstrate Allstate’s attempt to punish the insured for disagreeing with its low estimate, and forcing him to finance repairs himself pending the completion of Appraisal. It was not until the insured threatened to take action, including the writing of separate letters to each person on Allstate’s Board of Directors as well as to the New York State Department of Financial Services, that Allstate cooperated in resolution of the claim. The Act would have discouraged such frivolous bad faith conduct when the consumer needed Allstate the most. Victim’s Stories JOSEPH ABRAMCYZK Brooklyn, New York Assembly District: Helene Weinstein Co-Sponsor: Yes or No Senate District: Simcha Felder Co-Sponsor: Yes or No Joseph Abramcyzk sustained a fire at his residence in Brooklyn, New York on June 21, 2013. His home was insured with Security Mutual Insurance Company, who refused to enter into Appraisal when demanded and would not nominate an appraiser, claiming to be uncertain of what was in dispute. In so doing, the insurer wholly disregarded its legal and contractual obligation to undertake a thorough and timely claims investigation. Additional information was not in fact necessary in order to proceed with appraisal, as confirmed by the fact that Security Mutual had already made the insured an offer on the damaged contents. It would not have been able to do so had an investigation not been completed. Security Mutual’s delay has caused the insured to suffer consequential damages. The insured has been forced to hire counsel to sue for breach of contract and to compel Appraisal. Additionally, building repairs have ceased as the contents cannot be disturbed until the appraisal team has had an opportunity to inspect the property.

Load more