AUTO GLASS AMERICA LLC Plaintiff vs. GEICO GENERAL INSURANCE COMPANY Defendant, CONO17003311, 03-21-2018_Notice of Filing (Fla. Broward Cty. Ct. Mar. 21, 2018) (2024)

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`
`
`
`FLORIDA
`DEPARTMENT OF
`FINANCIAL SERVICES
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`
`
`Filing Number:
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`381726
`
`Filing Accepted:
`
`3/46/2018
`
`tee
`mei
`telecast
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`HOG PR OTITAL
`Etid VO
` yevlew,
`
`
`
`f The submitter hereby states that this notice is given in orderto perfect the rights of the person(s)
`damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.
`
`Name:
`Street Address:
`
`AUTO GLASS AMERICA, LLC
`8553 EAST SAN ALBERTO DRIVE
`
`City, State Zip:
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`SCOTTSDALE, AR 85258
`
`Email Address:
`
`Complainant Type:
`
`Insured
`
`SYLVIA VELEZ
`
`4290428871
`
`796257
`
`Name:
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`EMILIO STILLO
`
`Street Address:
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`7320 GRIFFIN ROAD, SUITE 203
`
`City, State Zip:
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`DAVIE, FLORIDA 33314
`
`Email Address:
`
`
`
`Insurer Type:
`Authorized Insurer
`
`Name:
`GEICO GENERAL INSURANCE COMPANY
`
` ee
`
`
`
`
`Street Address:
`
`City, State Zip:
`
`;
`
`Please identify the person or persons representing the insurer who are most responsible for/knowledgeable of the
`facts giving rise to the allegationsin this notice.
`
`
`
`SUSANNA EBERLING
`
`Auto
`Type of Insurance:
`
`
`DFS-10-363
`Rev. 11/2007
`
`

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`
`FLORIDA
`DEPARTMENT OF
`FINANCIAL SERVICES
`
`
`Filing Number:
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`381726
`
`
`
`Reasonsfor Notice:
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`Claim Denial
`
`626.9541(1}(i}(2)
`
`
`“erectingernieneinrett
`PURSUANTTO SECTION 624.155, F.S. please indicate all statutory provisions alleged to have been violated.
`624.155(1}(b)}(4}
`Not attempting in goodfaith to settle claims when, under all the circ*mstances,
`it could and should have done so, hadit acted fairly and honestly toward its
`insured and with due regard for heror his interests.
`A material misrepresentation made to an insured or any other person having
`an interest in the proceeds payable under such contract or policy, for the
`purposeand with the intent of effecting settlement of such claims, loss, or
`damage under such contract or policy on less favorable terms than those
`provided in, and contemplated by, such contract or policy.
`626.9541(1}(i}(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to
`coverages at issue.
`
`eettterninwenniitnugteenneweentte
`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 languageif the authorized insurer
`has not provided a copy of the policy to the third party claimant pursuant to written request.
`
`
`
`DFS-10-363
`Rev. 11/2007
`
`

`

`Sylvia Velez had a policy containing comprehensive and collision coverage which was in full force and
`effect on January 3rd, 2017. Sylvia Velez incurred windshield damage requiring replacement of the
`windshield such that it wouldbe unsafe to drive with such damage Sylvia Velez assigned her rights under
`the policy to AutoGlass America LLC. Auto Glass America LLC replaced the windshield and submitted an
`invoice to GEICO in the amountof $419.69. GEICO only paid $0.00. GEICO provided no explanation of
`benefits of any kind as to why the full amountof the claim was not paid. GEICO maintains a general
`business practice of not sending Explanations of Benefits as to why glass claims are not paid in full.
`GEICO uses a direct competitor of Auto Glass America LLC, Safelite, who in conjunction with GEICO use
`data to artificially lower reimbursem*nts.
`.
`,
`
`Geico issues a policy which promises to pay for each loss to repair or replace glass under the
`comprehensive and/orcollision provisions. The policy contains a Limit of Liability provision which states:
`The limit of ourliability for loss will not exceed the prevailing competitive price to repair or replace the
`property at the time of loss. Although you have the right to choose any repair facility or location, the limit
`ofliability for repair or replacement of such property is the prevailing competitive price which is the price
`we can secure from a competent and conveniently located repair facility. At your request, wewill identify a
`repair facility that will perform the repairs or replacementat the prevailing competitive price.
`instead of determining if the repair facility is competent, conveniently located and whetherit could secure
`the same price quoted by the repairfacility to the insured, GEICO has a general business practice to
`predetermine amounts paid in accordance with pricing agreements betweenits third party administrator
`Safelite and other repair facilities(in-network facilities). It must be noted that Safelite is a direct competitor
`of the complainant herein. This is not disclosed to the policyholder. GEICO claims that whateverprice it can
`secure from a competent and conveniently located repair facility is the prevailing competitive price. Despite
`the fact that GEICO eliminates the competitive element by claiming it can use any price it can secure and
`define it as the prevailing competitive price, GEICO fails to accountforthe fact that the charge from any
`repair facility that is competent, conveniently located and can be secured by GEICO would also constitute
`the prevailing competitive price.
`
`GEICO has instead engaged in an unfair claims practice act in the following manner: Long before the
`issuanceof this policy Geico made a decision to engagein the practice of utilizing data intentionally
`designedtoartificially skew reimbursem*ntsfor glass repairs in a manner that bore no rationale
`relationship to the actual “prevailing competitive price’. GEICO knew whenthis policy was issued the exact
`amountit would not pay in excess offor glass repair/replacement(upon information and belief no more than
`49% of NAGS) since GEICO had decided to use Safelite Solution LLC data and referral network’s previously
`agreed uponrates to constitute the shops from which GEICO could “secure the price.” Instead of
`adequately and clearly notifying its insureds in the policy that Geico will pay the “lowest priceit can
`secure” or adequately explaining the methodologyit used to determine the “price we can secure” GEICO
`misrepresents thatit* insured have the freedom to use any repair facility it chooses and will pay the claim
`so long as the facility is competent, conveniently located and charges a price that GEICO can secure.
`
`Consequently GEICO misrepresents insurance policy provisions, does not adopt and implement standards
`for the proper investigation of glass claims, denies glass claims without conducting reasonable
`investigations, and fails to provide any explanation, let alone a reasonable explanation, in writing to the
`insured of the basis in the insurance policy, in relation to the facts or applicable law, for the denial of a
`claim or for then offer of a compromise settlement.
`
`GEICOtells its insureds, after the work is performed thatit will pay no more and the insured is left holding
`the bag. Theseacts are in violation of Florida Statutes 624.155, 626.9541(1}(i)(2)(3-a,b,d,f), are willful, wanton
`malicious in nature and in reckless disregard for the rights of its insureds. They also occur with such
`frequency as to indicate a general business practice. Afterlitigation is initiated GEICO continues to engage
`in bad faith by misrepresenting which shops they “can secure the price” from. GEICO can remedy the
`claim by paying the overdue amountwith interest, costs and any associated attorney’s fees.
`
`To enable the insurer to investigate and resolve your claim, describe the facts and circ*mstances giving rise to the
`insurer's violation as you understand them atthis time.
`
`
`
`DFS-10-363
`Rev. 11/2007
`
`

`

`Syivia Velez had a policy containing comprehensive and collision coverage which wasin full force and
`effect on January 3rd, 2017. Syivia Velez incurred windshield damage requiring replacementof the
`windshield such that it would be unsafe to drive with such damage Sylvia Velez assigned herrights under
`the policy to Auto Glass AmericaLLC. Auto Glass America LLC replaced the windshieid and submitted an
`invoice to GEICO in the amount of $419.69. GEICO only paid $0.00. GEICO provided no explanation of
`benefits of any kind as to why the full amount of the claim was not paid. GEICO maintains a general
`business practice of not sending Explanations of Benefits as to why glass claims are not paid in full.
`GEICO uses a direct competitor of Auto Glass America LLC, Safelite, who in conjunction with GEICO use
`data to artificially lower reimbursem*nts.
`.
`.
`
`Geico issues a policy which promises to pay for each loss to repair or replace glass underthe
`comprehensive and/or collision provisions. The policy contains a Limit of Liability provision which states:
`
`The limit of our llability for loss will not exceed the prevailing competitive price to repair or replace the
`property at the time of loss. Although you have the right to choose any repair facility or location, the fimit
`of liability for repair or replacement of such property is the prevailing competitive price whichis the price
`we Can secure from a competent and conveniently located repair facility. At your request, we will identify a
`repair facility that will perform the repairs or replacementat the prevailing competitive price.
`
`instead of determiningif the repair facility is competent, conveniently located and whetherit could secure
`the sameprice quoted by the repair facility to the insured, GEICO has a general business practice to
`predetermine amounts paid in accordance with pricing agreements between its third party administrator
`Safelite and other repair facilities(in-network facilities). It must be noted that Safelite is a direct competitor
`of the complainant herein. This is not disclosed to the policyholder. GEICO claims that whateverprice it can
`secure from a competent and conveniently located repair facility is the prevailing competitive price. Despite
`the fact that GEICO eliminates the competitive element by claiming it can use any price it can secure and
`define it as the prevailing competitive price, GEICO fails to accountfor the fact that the charge from any
`repairfacility that is competent, conveniently located and can be secured by GEICO would also constitute
`the prevailing competitive price.
`
`GEICOhas instead engagedin an unfair claims practice act in the following manner: Long before the
`issuance of this policy Geico made a decision to engagein the practice ofutilizing data intentionally
`designedto artificially skew reimbursem*nts for glass repairs in a manner that bore no rationale
`relationship to the actual “prevailing competitive price”. GEICO knew whenthis policy was issued the exact
`amountit would not pay in excess of for glass repair/replacement(upon information and betief no more than
`48% of NAGS) since GEICO had decided to use Safelite Solution LLC data and referral network’s previously
`agreed upon rates to constitute the shops from which GEICO could “secure the price.” Instead of
`adequately and clearly notifying its insureds in the policy that Geico will pay the “lowest price it can
`secure” or adequately explaining the methodology it used to determine the “price we can secure” GEICO
`misrepresents that its insured have the freedom to use any repair facility it chooses and will pay the claim
`| so long as thefacility is competent, conveniently located and charges a price that GEICO can secure,
`
`Consequently GEICO misrepresents insurance policy provisions, does not adopt and implement standards
`for the properinvestigation of glass claims, denies giass claims without conducting reasonable
`investigations, and fails to provide any explanation, let alone a reasonable explanation, in writing to the
`insured of the basis in the insurancepolicy, in relation to the facts or applicable law, for the denial of a
`claim or for then offer of a compromise settlement.
`
`GEICOtells its insureds, after the work is performedthatit will pay no more and the insured is left holding
`the bag. Theseactsare in violation of Florida Statutes 624.155, 626.9541(1}(i)(2)(3-a,b,d,f}, are willful, wanton
`malicious in nature and in reckless disregard for the rights of its insureds. They also occur with such
`frequency as to indicate a general business practice. After litigation is initiated GEICO continues to engage
`in bad faith by misrepresenting which shops they “can secure the price” from. GEICO can remedy the
`claim by paying the overdue amountwith interest, costs and any associated attorney’s fees.
`
`
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`User Id
`
`Date Added
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`Comment
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`DFS-10-363
`Rev. 11/2007
`
`