Florida Lawsuit Charges United P&C With RICO Violations in Widespread Claims Denials

In the war between restoration companies and insurers in Florida, contractors suing carriers in assignment-of-benefits claims is nothing new. And insurers have long argued that some construction firms are colluding with adjusters and law firms to jack up claims and churn lawsuits.

A Stuart, Florida, roofing and restoration company has now brought in a new type of weapon: The contractor claims in a federal lawsuit filed Jan. 14 that United Property & Casualty Insurance Co. conspired with adjuster firms to systematically deny and underpay thousands of AOB roof claims after Hurricane Irma hit the state in 2017.

The lawsuit, filed in U.S. District Court for the Middle District of Florida, charges United, FKS Insurance Services and Property Loss Specialists with violating the federal Racketeer Influenced and Corrupt Organizations Act, known as the RICO Act, along with fraud, breach of contract and unfair trade practices.

The plaintiff, SFR Services, or Southern Florida Restoration Services, said it was assigned benefits on more than 200 claims that were underpaid or denied, but thousands more policyholders may be victims of the alleged scheme. SFR is represented by attorney Robert Pelier, of Coral Gables, and others.

“Instead of ensuring that field adjusters created honest, accurate reports, defendants specifically instructed desk adjusters to … to decrease estimates,” the complaint reads.

United also instructed field adjusters to modify their reports and add false statements, SFR charges.

The insurer, which was reportedly considering purchasing the PLS adjuster firm, pressured the firm’s owners to downplay damage assessments, the suit claims.

“SFR believes this fraud is widespread,” the complaint notes.

The lawsuit shows copies of text messages by an FKS adjuster, purportedly sent at the request of UPC, to avoid estimating roof damages because the insurer would issue blanket denials. Adjusters who played along were paid much more quickly, the suit alleges.

Topics Lawsuits Florida Claims Property Casualty