Mrs Melissa Stillings & Mr Rezgui Mohamed filed a fraudulent insurance claim in an attempted to discredit our company, as well as acquire funds to rectify an existing water damage issue by filing a fraudulent insurance claim. I've enclosed the insurance investigation & public adjusters results:
David Wilborn
State National Insured: Saviors Custom Carpentry, Inc
State National Claim Number: NXTC-NJGL----------
Claimant(s): Melissa Stillings
Date of Loss: August 3, 2021
Dear David:
Thank you for choosing Next Insurance for your business insurance needs. We strive to provide a fast and thorough response to every claim.
After reviewing your policy, we have determined that your insurance does not cover the damage to Melissa Stilling's property damage. The policy would only cover claims that you are legally liable for. Based on the information obtained, we did not find you liable for the water leak that caused damaged to the kitchen.
On the following page, I have included the policy language that explains why the claim cannot be covered. If you believe this decision was made in error or without consideration of additional information we weren't aware of, please provide details and documentation for further review. I can be reached at 512-865----- or --------------@nextinsurance.com.
We strive to be transparent in our coverage. If you have questions about what your policy covers or areas where it could be updated, we're standing by to assist you. Please call (855) 222----- to speak with a Next Insurance advisor.
Thank you for your understanding in this matter, and for choosing Next Insurance to be your insurance provider
Sincerely,
Zachary -------------
Claims Advocate
NEW JERSEY STATE LAW REQUIRES US TO NOTIFY YOU OF THE FOLLOWING: Any person who knowingly files a statement of claim containing any false or misleading information is subject to criminal and civil penalties. Pursuant to N.J.A.C. 11:25-2.5(a):
Please note the following internal procedures in the event you dispute the final coverage position, liability position, or offer applicable to your claim
1 You may submit your written objections/appeal to the final coverage position, liability position, or offer to your insurer;
2 Upon receipt of your written objections/appeal, a panel of at least three representatives from the insurer who had no prior involvement with the handling of your claim will review the disputed decision;
3 Within ten (10) business days of receipt of your appeal the internal appeals panel will make its decision;
4 Within three (3) business days thereafter, the appeals panel will send you its decision.
State National reserves the right under the Policy and applicable law to cite additional policy provisions and coverage defenses as may be appropriate. This letter should not be construed as a waiver of any known or unknown defense that we may have under the Policy, nor does this letter waive or change any provisions or conditions in the Policy. This letter is premised upon information we currently have available to us and upon the terms and conditions of the Policy.
Next Insurance, Inc. * PO Box 82185 Austin, TX 78708
SECTION I COVERAGES COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY
1. Insuring Agreement
a. We will pay those sums that the insured becomes legally obligated to pay as damages because of "bodily injury" or
"property damage" to which this insurance applies. We will have the right and duty to defend the insured against any
"suit" seeking those damages. However, we will have no duty to defend the insured against any "suit" seeking
damages for "bodily injury" or "property damage" to which this insurance does not apply. We may, at our discretion,
investigate any "occurrence" and settle any claim or "suit" that may result. But:
(1) The amount we will pay for damages is limited as described in Section III Limits Of Insurance and
(2) Our right and duty to defend ends when we have used up the applicable limit of insurance in the payment of
judgments or settlements under Coverages A or B or medical expenses under Coverage C.
No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under
Supplementary Payments Coverages A and B read more
