Civil Remedy Notice of Insurer Violations
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Filing Number:     530743
Filing Accepted:  12/14/2020
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Complainant
Last/Business Name *  
RAPHAEL   First Name   LINDSAY
Street Address * 5944 MICHAUX STREET
City, State Zip * BOCA RATON, FL 33433
Email Address * LINDSAY@RAPHAELLAWPA.COM
Complainant Type: * Insured
Insured
Last/Business Name*   RAPHAEL   First Name   LINDSAY
Policy # * 4763900714 Claim #* 01000002233
Attorney
Attorney is Applicable
Last Name* HANDFINGER First Name * ADAM Initial P.
Street Address* ONE S.E. THIRD AVENUE, SUITE 2000
City, State Zip* MIAMI , FL 33131
Email Address * AHANDFINGER@PCKLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   FRONTLINE INSURANCE UNLIMITED COMPANY
NAIC Company Code 10074
 
Name of individual responsible for violation (if any):* FRONTLINE
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
624.155(1)(b)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
624.155(1)(b)(3) Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

10. Loss Payment. We will adjust all losses with you. We will pay you unless some other person is named in the policy or is legally entitled to receive payment. Loss will be payable 60 days after we receive your proof of loss and: a. Reach an agreement with you; There is an entry of a final judgment; or There is a filing of an appraisal award with us.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Frontline failed and refused to timely pay my claim without any reasonable basis, and forced protracted litigation. I submitted a claim for property damages to my residence in Palm Beach. After investigation, Frontline paid some of my claim, but not all. The failure lacked sense, and then we were forced to engage in protracted litigation when Frontline failed to honor its commitments and agreements made at Mediation. Frontline ultimately paid my claim (after a long period of time after submission), but is still refusing to pay all of my legal fees and expenses, and continues to engage in litigation with me even after the Appraisal Award in my favor. Frontline failed to timely settle my claim when, under all the circumstances, it could and should have done so had it been acting fairly and honestly towards my interest as the Policy Holder. Frontline failed to promptly settle my claim when the obligation to settle became reasonably clear under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage. Frontline’s misconduct forced me to incur significant out of pocket expenses, including that for temporary housing, repairs and legal fees/expenses, and it continues to refuse to pay all of same and its conduct requires me to continue to incur legal fees. Frontline violated, among other things, the Policy it issued and Florida Statute 627.70131, which specifically states as follows: “Within 90 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim”.
Comments
User Id Date Added Comment
ksellar@kelleykronenberg.com 02-02-2021 February 2, 2021 VIA ELECTRONIC SUBMISSION Florida Department of Financial Services Consumer Assistance Civil Remedy Section Larson Building 200 E. Gaines Street Tallahassee, Florida 32399-0322 RE: Response to Civil Remedy Notice of Insurer Violation Complainant: Lindsay Raphael Insured: Lindsay Raphael Claim #: 01000002233 Policy #: 4763900714 Date of Loss: September 5, 2018 DFS filing No.: 530743 DFS Acceptance Date: December 14, 2020 Property Location: 5944 Michaux Street Boca Raton, FL 33433 To Whom It May Concern at the Department of Financial Services: This is First Protective Insurance Company D/B/A Frontline Insurance’s (“Frontline”) formal response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed by Lindsay Raphael, Esq. (the “Complainant” or “Insured”) on her behalf as it relates to claim number 01000002233. The Department of Financial Services accepted this Civil Remedy Notice December 14, 2020, and assigned it filing number 530743. The following reply has been uploaded to the Department of Financial Services. After reviewing the CRN, Frontline conducted a thorough review of its handling of the Complainant’s claim no. 01000002233. Frontline denies that it has violated any of the statutes as alleged in the CRN. At all times, Frontline acted in good faith, fairly and honestly toward its Insured and with due regard for the Insured’s interests. The Complainant alleges violations of various provisions in CRN, filing 530743, dated December 14, 2020 as to claim no. 01000002233. Specifically, the Complainant alleged violations of the following provisions in the CRN: 624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests. Frontline specifically denies the Complainant’s allegations that Frontline violated the above referenced statute. 624.155(1)(b)(2) Making claims payments to the insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made. Frontline specifically denies the Complainant’s allegations that Frontline violated the above referenced statute. 624.155(1)(b)(3) Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage. Frontline specifically denies the Complainant’s allegations that Frontline violated the above referenced statute. In addition to the allegations specifically denied above, Frontline generally denies all allegations presented in this Civil Remedy’s Notice as Frontline has not violated any statute or rule. CRN MUST BE DISMISSED The Civil Remedy Notice must be dismissed first and foremost because the Complainant failed to allege any actual facts in support of the specific statutory allegations. The Civil Remedy Notice requires the Complainant “pursuant to section 624.155, F.S. please indicate all statutory provisions alleged to have been violated.” The notice filed by Lindsay Raphael, Esq. on her behalf in this matter includes statutory provisions that not are relevant, accurate or applicable to the facts in this matter. The Civil Remedy Notice first identifies Section 624.155(1)(b)(1), Florida Statutes, which addresses an insurer's refusal to attempt to settle in good faith. The Civil Remedy Notice, however, leaves out important facts such as how Frontline issued multiple payments to the Insured and even demanded appraisal prior to suit being filed when disagreement remained over the amount due. When suit was filed, again Frontline demanded appraisal and adjusted the loss along with the Insured the entire time. Therefore, there is no basis for this CRN as it cannot be supported by facts as Frontline always acted in good faith towards its Insured. As to Section 624.155(1)(b)(2), Florida Statutes, which addresses and insurer’s failure to make payments accompanied by a statement setting forth the coverage under which payments are being made, the Civil Remedy Notice again does not describe any facts to support such allegations. As to Section 624.155(1)(b)(3), Florida Statutes, the Civil Remedy Notice fails to specify the facts or circumstances indicating that Frontline failed to promptly settle claims when Frontline issued multiple payments to the Insured and has already paid the appraisal award in full, thus leaving nothing else owing and due. The Insured makes the erroneous claim that Frontline failed or has refused to pay her attorney’s fees, but it is well settled Florida law that when appraisal is demand prior to suit being filed, the appraisal process become a condition precedent to suit being filed. Here, the Insured filed suit eighteen days after the demand for appraisal was made. Furthermore, the Court has agreed with Frontline that pursuant to the policy of insurance, appraisal was a contractual prerequisite to filing suit. In these circumstance, the Insured is not owed the payment of attorneys fees. Additionally and more importantly, the Court in this matter has already denied Plaintiff’s motion for attorneys fees. The remaining allegations set forth in Lindsay Raphael’s civil remedy notice are expressly denied as they are mere conclusory allegations unsupported by facts, devoid of logic and intended soley to tarnish Frontline’s name and reputation. Said allegations are denied as they are clearly intended to harass and disparage Frontline. Complainant cites no facts or evidence to support the claims put forth in its Civil Remedy Notice. Frontline, at all times acted fairly, honestly and in good faith with the Insured, Lindsay Raphael. Frontline did not fail to promptly settle the claim or attempt to settle the claim in order to influence settlement under a different portion of the policy. Frontline at no time misrepresented any pertinent facts or insurance policy provisions. Frontline conducted a reasonable and prudent investigation of the claim and acted upon all communications from the Insured. Finally, Frontline promptly and appropriately communicated with the Insured and provided explanations for the actions and decisions that were made. As it relates to the facts of the claim, Frontline submitted its Demand for Appraisal on May 6, 2019. However, rather than participating and completing the appraisal process, the Insured instead raced to the courthouse and filed a lawsuit against Frontline just eighteen days after Frontline submitted its demand for appraisal. The policy of insurance under which Plaintiff brings this suit, makes appraisal a condition precedent to an insured’s ability to bring suit once appraisal is demanded by either party. Despite this, the Insured chose to file suit and refused to participate in the appraisal process. In this case, it was reasonably necessary for Frontline to revisit the property to investigate the disputed amount of loss to properly evaluate and adjust the Insured’s claim. Frontline never disputed coverage, but rather disputed the amount of the loss which is precisely the reason why Frontline demanded appraisal on May 6, 2019. Frontline always stood willing to continue the adjustment process according to the terms of the policy and without any need for the Insured to file suit or file this Civil Remedy Notice. Lastly, pursuant to the Court’s January 25, 2021, order, Frontline has prevailed fully in this legal action and is entitled to recover its reasonable attorney’s fees and costs from the Insured. Based on the foregoing, Frontline conducted a comprehensive investigation into the subject claim and rendered its coverage decision based on the terms and conditions of the subject policy and communicated effectively with the Insured regarding coverage and in responding to her questions and untimely resolving the claim through the appraisal process. It is important to note, that while an insurance company is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested or that are still in the claims process. Florida law continually affirms the principle that an insurer has the right to investigate claims presented for payment. An insurance company is expressly afforded an opportunity to evaluate its rights and liabilities. Neither the subject policy nor does Florida law provide that a carrier must accept whatever demand for repairs it is provided by its Insureds as the amount necessary to repair a loss. In the instant case, the violations alleged by the Insured all revolve around the contention that that Frontline did not accept and pay the Insured’s full demand for repair, which isn’t the case as Frontline paid for the covered damages. In closing, Frontline first believes that the Civil Remedy Notice should be rejected and returned by the Department of Financial Services due to its failure to comply with Florida Statute §624.155 and Florida Case law, and regardless of the rejection, Frontline denies all allegations contained in the Civil Remedy Notice and submits that there are no violations. Please note that Frontline’s response is not necessarily exhaustive and does not preclude us from asserting any other valid reason for seeking rejection and return of the Civil Remedy Notice. Also, this letter or any act or failure to act on the part of Frontline or any agent or representative of Frontline should not be construed as a waiver of any rights or defenses available to it by contract or at law as all such rights and defenses are hereby specifically reserved. We trust that this response addresses the allegations of insurer violation alleged in the Civil Remedy Notice of Insurer Violation. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Very truly yours, /s/ Christine G. Soto Christine G. Soto, Esq. For the Firm cc: Adam P. Handfinger, Esq. Counsel for Lindsay Raphael, Esq. AHandfinger@pecklaw.com
Acknowledgement
* The submitter hereby states that this notice is given in order to perfect the rights of the person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.

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DFS-10-363
Rev. 10/14/2008