Civil Remedy Notice of Insurer Violations
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Filing Number:     537738
Filing Accepted:  1/22/2021
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Complainant
Last/Business Name *  
MARY RETAMAR TOLOSA   First Name  
Street Address * 1324 HAWKES AVENUE
City, State Zip * ORLANDO, FL 32809
Email Address * MRETAMART@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   MARY RETAMAR TOLOSA   First Name  
Policy # * P000286974 Claim #* 184976
Attorney
Attorney is Applicable
Last Name* DENNIS First Name * ANTHONY Initial
Street Address* 925 S FEDERAL HIGHWAY
City, State Zip* BOCA RATON , FLORIDA 33432
Email Address * ADENNIS@KPATTORNEY.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   SECURITY FIRST INSURANCE COMPANY
NAIC Company Code 10117
 
Name of individual responsible for violation (if any):* JUAN BRANDARIZ SR
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
* 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)(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.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Loss settlement provision.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

January 22, 2021 Sent Via Email Security First Insurance Company Attn.: Juan Brandariz SR 1001 Broadway Avenue, Ormond Beach, FL 32174 claims@securityfirstflorida.com RE: Insured : Mary Retamar Tolosa Policy # : P000286974 Claim # : 184976 Property Address : 1324 Hawkes Avenue, Orlando, FL 32809 Dear Security First Insurance Company: Please find enclosed the civil remedy notice filed for the above referenced claim. As discussed in greater detail in the notice, the carrier has not attempted in good faith to settle the insured’s claim 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 their interests. The carrier has done everything possible to delay the claim and refuses to pay the complete covered loss amount due under the policy. Furthermore, the carrier is required to properly investigate and adjust claims and cannot place that burden upon the insured. This was made clear by the appellate court and the Florida Supreme Court in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005)(“The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insureds…”). The carrier was put on notice of the insured’s water damage claim. The carrier initially attempted to low-ball the claim. Subsequently, the insured prepared a loss package in the amount of $106,629.08 needed to restore the property back to its pre-loss condition. Whereas, the carrier furnished a wrongful estimate and represented the damages to the insured’s property to be below the policy deductible. The insured has complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insured. About five hundred days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of damage sustained by the insured’s property and has not taken any meaningful ensuing action. In order to confirm the cause of the damage and determine amount for repairs to the water damaged property and the necessary tear out to access the failed plumbing system, Advanced Pace Technologies (“APT”) was retained on behalf of the insureds to do an inspection and prepare an estimate. After APT conducted its inspection, it was determined that the plumbing system caused the reported damage. In order to return the property to its pre-loss condition, the necessary repairs include not only repairs to the water damaged property, but also the costs to tear out and repair the parts of the insureds’ home necessary to access the failed plumbing system. It is clear that the carrier is not treating the insured with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insured; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insured’s interests; refusing to pay the full amount owed to the insured despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insured, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $106,629.08, less any applicable policy deductible; 2.) Pay the Insured’s attorneys’ fees and costs as they have been forced to retain counsel; 3.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier. Please do not hesitate to contact the undersigned or Fernando Ortigoza at (561)-892-9666 if you have any questions or concerns. Sincerely, Anthony Dennis Anthony M. Dennis Attorney at Law Enclosed: Civil Remedy Filing
Comments
User Id Date Added Comment
dstoller@mylegalwolfe.com 03-21-2021 March 21, 2021 Anthony Dennis, Esq. Kanner & Pintaluga 925 S Federal Hwy Boca Raton, FL 33432 Re: MARY RETAMAR TOLOSA V. SECURITY FIRST INSURANCE COMPANY CRN FILING NO.: 537738 Claim No.: 184976 Date of Loss: 09/09/2019 Our File No.: 00223 Dear Mr. Dennis: We represent Security First Insurance Company (“Security First”) regarding the claim presented by MARY RETAMAR TOLOSA (hereinafter the “Insured”), for alleged damages sustained to the property located at 1324 Hakes Avenue, Orlando, FL 32809-6326. On January 22, 2021, the Department of Financial Services accepted the filing of a Civil Remedy Notice of Insurer Violation (hereinafter “CRN”) number 537738. This will serve as Security First’s response to said CRN. The CRN alleges that Security First violated Florida Statute §624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(f) as the basis for filing the instant notice. Security First explicitly denies violation of any applicable Florida Statute in the evaluation and adjustment of the referenced claim, including the specific allegations outlined above. Security First maintains that it has acted promptly, fairly, and honestly with its Insured at all times in the handling of this claim. Further, many of the sections the filing cites to are wholly inapplicable to this matter on their face. The CRN fails to comply with the very Statute the Complainant is seeking to invoke. Contrary to the specific requirements of Section 624.155(3)(b)(4), the CRN fails to identify the specific policy language that is relevant to the purported violation(s). Fla. Stat. §624.155 states, in pertinent part, as follows: . . . b. notice shall be on a form provided by the department and shall state with specificity the following information, and such other information as the department may require: * * * 2. The facts and circumstances giving rise to the violation. * * 4. 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 language if the authorized insurer has not provided a copy of the policy to the third party claimant pursuant to written request. § 624.155(3)(b)(2) & (4), Fla. Stat. (2017) [emphasis added]. As filed, the CRN fails to describe the facts and circumstances of Security First’s alleged statutory violation accurately and specifically. Instead, the Insured’s recitation of “facts” presents mere conclusory statements and offer no support as to the acts and/or omissions purportedly taken by Security First which substantiate the allegations. The Insured’s assertions are vague, baseless, and contrary to Florida law. Section 624.155(2)(d) “requires that the civil remedy notice state with specificity the facts and circumstances giving rise to the violation.” Lane v. Westfield Ins. Co., 862 So.2d 774, 778 (5th DCA 2003). The purpose of a civil remedy notice is to give the insurer one last chance to settle a claim with the Insured, and not to give the Insured a right of action to proceed against the Insurer. Lane, 862 So.2d at 779; see also Talat Enterprises, Inc. v. Aetna Casualty & Surety Co., 952 F.Supp. 773 (M.D. Fla. 1997) (holding that a claimant must give the Florida Department of Insurance and the insurer sixty days written notice of a violation so that the insurer may cure any violation). Without such notice, Security First is unable to cure any alleged defect, if warranted. Instead of citing actual facts and policy language, where the CRN form requires the Complainant to do so, the Complainant provides a vague, inaccurate, and misleading recitation of the facts of this claim, omitting pertinent facts, and misstating others. It fails to allege any specific policy language as the Complainant simply states that the insurer has failed to comply with the terms of the policy it has with the insured in regard to the payment of damages to the physical and personal property of the insured. This approach in completing a CRN is not only non-conforming to the requirements of Florida law, but it also fails to place Security First notice as to what the Complainant contends Security First has or has not done to the insured’s satisfaction. Stripped of its purpose to give Security First notice of potentially applicable cures, the CRN is entirely deficient with respect to the explicit requirements of Fla. Stat. §624.155 and should be rejected as being non-compliant with the statute. Despite the allegations made by the Insured, Security First diligently and thoroughly complied with guidelines throughout its investigation of the alleged loss. Because no specific facts or remedies are referenced, Security First cannot be expected to investigate the Insured’s allegations and determine whether any corrective measures are warranted. As such, the CRN is defective and must be rejected. Fla. Stat. §624.155 sanctions recovery of extra-contractual damage in insurance disputes when the insurance carrier fails to attempt in good faith to settle a claim. The Statute requires the Insured to file a Civil Remedy Notice of Insurer Violation as a condition precedent to the bad faith cause of action. The Statute demands strict compliance and lays out specific notice requirements the Insured’s CRN has to meet for it to be legally sufficient. The filing of a legally sufficient CRN is not only a condition precedent but is essential to the procedural integrity of an action for bad faith. See Allstate Ins. Co. v. Clohessy, 32 F. Supp. 2d 1328 (M.D. Fla. 1998); see also Talat Enters. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278 (Fla. 2000). The Statute’s clear and unambiguous standards for proper notice require the claimant to state with specificity the facts and circumstances giving rise to the violation and to reference the policy language relevant to such alleged violations. The purpose behind the notice requirement of the Civil Remedy Statute is to give an opportunity to the insurer to remediate the alleged statutory violation. The statute provides a sixty day cure period during which an insurer may avoid bad faith litigation by (i) paying the contractual amount due under the policy or (ii) by correcting the circumstances giving rise to the violation. The CRN provides no such opportunity to Security First, as the CRN does not specify the circumstances giving rise to Security First’s violations and fails to specify the specific amount necessary to cure the alleged violations. The CRN does not indicate any specific policy language or how the referenced policy language is relevant to any violations cited and does not state with specificity any facts or circumstances giving rise to any violation. As such, the Insured’s CRN does not afford Security First adequate notice or an opportunity to cure any alleged violation, if warranted. The Insured’s CRN is deficient and should be rejected. Without waiver of the objections above, in good faith, Security First herein responds that: • Security First received a claim for alleged water damages to the subject property due to a dishwasher leak as reported by the insured’s attorney on October 16, 2019 - one month after it occurred. Security First assigned Claim No. 184976 and began its investigation, including an inspection of the subject property. • Security First requested a recorded statement from the insured and a dishwasher repair invoice on 10/22/19 and again on 12/2/19. On 12/12/19 it sent a letter to the insured’s attorney regarding these unanswered requests stating that the claim would be closed if there has been no response by 12/23/19. The plumbing receipt and home depot receipt were later produced on 12/31/19. • The insured submitted a Sworn Proof of Loss dated June 23, 2020 in the amount of $15,079.53 (ems included), and subsequently filed suit on September 1, 2020 in County Court, alleging that damages do not exceed THIRTY THOUSAND DOLLARS ($30,000.00). See, Orange County Case Number 2020-CC-00792. That suit was filed by Elizabeth Taveras, Esq., Morgan Law Group, P.A. • Security First’s legal counsel sent the Insured’s attorney correspondence on October 20, 2020 advising of the following: I found no record of Plaintiff making a demand before filing suit or providing any documents to support the alleged damages stated in her sworn proof of loss. In that regard, we ask that you agree to the sequence of depositions where Plaintiff is deposed first, along with the contractor or estimator who produced the invoice or estimate Plaintiff relies on to claim damages owed. If Plaintiff has these documents and you can forward them to my attention along with Plaintiff’s demand, we can immediately evaluate same. • The insured’s attorney did not respond or provide any information in response to the above referenced correspondence. • On November 4, 2020, Security First served written discovery on the insured in Orange County Case Number 2020-CC-00792 regarding the subject claim and loss. • As of the date of filing this response to the Insured’s Civil Remedy Notice, the insured has refused to provide any discovery responses, including any estimates referenced in her Civil Remedy Notice. • On January 22, 2021 attorney Anthony M. Dennis, Esq., Kanner & Pintaluga, P.A. filed CRN 537738 on the insured’s behalf alleging that Security First must now pay $106,629.08 under claim 184976 based on Advanced Pace Technologies estimate in order to cure its alleged bad faith. • On January 28, 2021, Anthony M. Dennis, Esq. also filed suit on behalf of the same insured, date of loss and claim. See Orange County Circuit Court Case Number 2021-CA-000852-O. • Security First’s legal counsel informed attorney Dennis that a different attorney and law firm was representing the insured, copied that second attorney on the correspondence, and requested that they determine who was going to proceed with their representation. Neither attorney responded. • Any and all delays in the investigation of the claim were due to the insured’s legal counsel, failure to provide information when requested, failure to answer discovery and failure to communicate. This Civil Remedy Notice therefore appears to be an attempt to harass and intimidate Security First pending the outcome of the litigation for which trial by jury will be requested. In Summary, Security First denies any violation of Florida Statute Florida Statute §624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(f). Security First has acted promptly, fairly, in good faith, and in the best interest of the Insured at all times during the claims process. At no point has Security First wrongfully denied the Insured’s claim or delayed the Insured’s claim. Security First does not intend by this letter or any aspect of its investigation to waive its rights afforded either under the contract of insurance or at law. Security First explicitly reserves all rights. Regards, Drew A. Stoller, Esq.
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