Civil Remedy Notice of Insurer Violations
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Filing Number:     575979
Filing Accepted:  8/9/2021
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Complainant
Last/Business Name *  
FIEBER ADJUSTING INC   First Name  
Street Address * 3011 39TH ST E
City, State Zip * BRADENTON, FL 34208
Email Address * CORYFIEBER@LIVE.COM
Complainant Type: * Third Party
Insured
Last/Business Name*   PENDINO   First Name   ANTHONY
Policy # * 59TK35114 Claim #* 5917J690V
Attorney
Attorney is Applicable
Last Name* OVADIA First Name * ABRAHAM Initial S
Street Address* 4800 N. FEDERAL HIGHWAY SUITE D204
City, State Zip* BOCA RATON , FL 33431
Email Address * CORYFIEBER@LIVE.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   STATE FARM FIRE AND CASUALTY COMPANY
NAIC Company Code 25143
 
Name of individual responsible for violation (if any):* UNKNOWN
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
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)(d) Denying claims without conducting reasonable investigations based upon available information.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Specific policy language is not relevant to the violation.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The property is insured under policy number 59TK35114. On or about March 11, 2021, the named Insureds reported wind damage to the Property. The carrier and their Appraiser assigned are acting in concert, instead of independent as the appraisal policy states. State Farm has set a standard of using the same appraisers and not allowing them to be independent as the appraisal panel is supposed to be. Therefore, to cure the defects outlined in this Civil Remedy Notice, within the next 60 days, Insurer must: (1) Create and implement adequate guidelines for the proper investigation and evaluation of these types of claims and for the training and supervision of employees, which will avoid future statutory violations as set forth above, and prevent this from occurring in the future; (2) Insurer must create and implement adequate guidelines for the proper investigation and evaluation of these type of claims and for the training and supervision of employees with regard to these type of claims to ensure that the claims handling procedure with regard to these types of losses are adequate to prevent other insureds from being treated unfairly and wrongfully.
Comments
User Id Date Added Comment
hkrall@gaflaw.com 09-13-2021 Please be advised that the undersigned represent State Farm Florida Insurance Company (hereinafter, “State Farm®”) with regard to this matter. This letter shall serve as State Farm’s response to the Civil Remedy Notice of Insurer Violations (hereinafter, “Notice”) filed on behalf of the Complainant, Fieber Adjusting, Inc. (“Complainant”). The Notice filed on behalf of the Complainant is legally insufficient as it lacks specificity and was filed against the incorrect State Farm business entity. The Notice fails to set forth the specific policy language at issue. In addition, the Notice fails to identify the specific facts giving rise to the alleged violations 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)(d). Accordingly, the Notice is insufficient as a matter of law and this letter does not waive such legal insufficiency in any way. State Farm objects to the Notice, as it lacks sufficient specificity, as required by §624.155, Fla. Stat., in addition to other defects. Due to the lack of specificity and other defects, the Notice cannot serve as a condition precedent to any action attempted under the above statutes or Florida law. The lack of specificity and other defects deprive State Farm of any meaningful notice and ability to respond and render the Notice invalid. Defects such as these thwart the fundamental purpose of the Notice, which is to give the insurer the opportunity to “cure” the alleged violations within the 60-day statutory period. An invalid Notice is also contrary to the purpose and requirements of Florida law, including the notice and safe harbor or “cure” provisions of §624.155, Fla. Stat., which are a necessary prerequisite to any future bad faith action against State Farm. See, e.g., Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278 (Fla. 2000); see also, Julien v United Property & Casualty, 2021 WL 824438 (Fla. 4th DCA 2021) (civil remedy notice not legally sufficient where insured failed to state with specificity the information set forth in the notice; failed to specify the language of the statute the insurer allegedly violated; and failed to reference specific policy language that is relevant to the violation, if any). State Farm objects to the Notice, and the Notice is defective because it does not reference the specific policy language at issue in the alleged violations, as required by §624.155(3)(b)4. Rather, the Notice merely uses boilerplate language as to State Farm’s actions, which fails to explain how State Farm was wrong in its assessment of the alleged damages. The subject policy issued by State Farm is governed by the policy’s terms, conditions, and exclusions together with any endorsements. State Farm, being the maker of the policy is very familiar with its language and what losses are afforded coverage. This response does not waive any such provisions of the policy. Due to the lack of specificity and other defects, the Notice is invalid and cannot serve as a condition precedent to any action for alleged bad faith under §624.155, Fla. Stat., or otherwise under Florida law. State Farm categorically denies any violation of the Florida Statutes as alleged in the Notice or otherwise. Contrary to the allegations contained in the Notice, State Farm conducted a proper and thorough adjustment, investigation, and evaluation of this claim. State Farm inspected the subject property and at all times performed its obligations under the insurance policy in good faith and with due regard for the interests of the Complainant and the Insureds. This claim was initially reported to State Farm on March 11, 2021, for wind damage that occurred on December 16, 2020. By separate emails to each Insured dated March 11, 2021, State Farm confirmed receipt of the claim. By email dated March 11, 2021, the Insured’s roofer forwarded to State Farm a copy of its contract with the Insured, but failed to include an itemized estimate for the scope of work to be performed (along with the cost for the same). By letter dated March 12, 2021, State Farm advised the Insured as to the name and contact information for the claims professional assisting on the claim, and further provided information in regard to submitting information to State Farm. By letter dated March 12, 2021, State Farm again confirmed receipt of the claim, advised the Insured to protect the property from further damage or loss, and further advised the Insured to complete reasonable and necessary temporary repairs, if needed. State Farm also advised the Insured as to policy limits for services that may have been completed at the property. By letter also dated March 12, 2021, State Farm advised the Insured as to the HOMEOWNER CLAIMS BILL OF RIGHTS. On March 12, 2021, State Farm spoke with the Insured regarding the facts of the loss. The Insured advised the claim was for the roof only, with no interior damage. He also advised the roof was inspected after observing a neighboring property. A roofing company then inspected the roof and observed wind damage. On March 16, 2021, State Farm inspected the property with the Insured and the contractor present. As to the roof, State Farm observed wind damage to twenty-one shingles, which were repairable. State Farm also observed conditions related to wear, tear and deterioration, which are specifically excluded by the terms and conditions of the insurance policy. As to the exterior, no damage was observed. As to the interior, the Insured again confirmed no damage and declined an inspection for this area of the property. By letter dated March 23, 2021, State Farm partially denied the claim, but also opened coverage to repair the roof. State Farm further prepared an estimate but payment was not issued as the repair costs did not exceed the insurance policy deductible. By letter dated March 24, 2021, State Farm advised the Insured of the right to mediate the claim. By email dated March 31, 2021, the Insured demanded appraisal, submitted a copy of an appraisal contract, and named the Complainant as his initial appraiser. By letter dated April 6, 2021, State Farm acknowledged the Insured’s March 31, 2021 demand for appraisal and further stated, as follows: Though we did receive a signed contract from Wolff Roofing, as of the date of this letter, State Farm has not received an itemized estimate of repairs from you. Under the terms of the appraisal condition, neither you nor State Farm has a right to demand appraisal until 10 days after itemized documentation, specifying the disagreement over the amount of loss, is received. Accordingly, State Farm objects to your request for appraisal. The required 10-day notice of dispute allows the other party an opportunity to review the itemized documentation and attempt to resolve the disagreement. If an agreement cannot be reached, you may reassert your demand for appraisal in writing at that time. By email dated April 7, 2021, the Complainant forwarded to State Farm a roof replacement estimate for $16,394.80. The Complainant also asserted the roof was eighteen years old, could not be repaired, and that Complainant had previously reached out to State Farm to obtain the information needed to submit an estimate but with no response from State Farm. By letter dated April 13, 2021, State Farm advised the Insured the contractor’s estimate had been received and reviewed, but no changes were required to State Farm’s estimate dated March 23, 2021. By email dated April 14, 2021, the Insured invoked appraisal to resolve the amount of the loss, and designated the Complainant as his initial appraiser. By letter dated May 10, 2021, State Farm acknowledged the Insured’s demand for appraisal; set forth the Appraisal condition of the insurance policy; provided the name and contact information for its appraiser; objected to the Insured’s initial appraiser as Complainant had already inspected the property and prepared an estimate prior to the appraisal process; and reserved all State Farm’s rights under the insurance policy while it continued to adjust the claim. By email dated May 10, 2021, the Insured advised State Farm he wanted to move forward with appraisal with his initial appraiser (the Complainant). By email dated May 11, 2021 (sent to clarify his May 10, 2021 email), the Insured advised State Farm after speaking with the Complainant, he wanted to move forward with appraisal with his initial appraiser (the Complainant). By email dated May 11, 2021, State Farm advised the Insured the appraisal process could not move with the Insured’s initial designated appraiser (the Complainant). By email dated May 12, 2021, the Insured designated a new appraiser. By email dated May 13, 2021, State Farm accepted the Insured’s new appraiser, and the appraisal process commenced. On August 8, 2021, the Complainant filed its Civil Remedy Notice against State Farm. By email dated August 9, 2021, the Complainant forwarded to State Farm a copy of its contract with the Insured (also dated August 9, 2021). The Civil Remedy Notice filed by the Complainant is in violation of the Julien case cited above (civil remedy notice not legally sufficient where insured failed to state with specificity the information set forth in the notice; failed to specify the language of the statute the insurer allegedly violated; and failed to reference specific policy language that is relevant to the violation, if any). Under the section that calls for the specific policy language relevant to the (alleged) violation, the Complainant failed to set forth any policy language whatsoever and, instead, claimed “specific policy language is not relevant to the violation”. As to the facts and circumstances giving rise to the (alleged) violation of some unknown policy provision, the Notice incorrectly asserts State Farm, and its appraiser, are “acting in concert” during the appraisal process but provides no evidence in support of this allegation. The Notice further incorrectly asserts State Farm designates the same appraisers and does not allow the appraisers to be independent but, again, provides no evidence in support of this allegation. As to the foregoing allegations, and any other allegation of improper conduct in the Notice, State Farm denies these allegations, in full. As to the Complainant’s limited, non-monetary demand for a “cure”, State Farm’s guidelines are, and will remain, adequate during the pendency of this claim (as established, for example, by State Farm proceeding to appraisal once to Insured complied with the insurance policy prior to invoking appraisal). To the extent State Farm has communicated with its appraiser, such communication was limited to the status of the appraisal process (which is entirely proper). It is further noted any issue as to the Complainant serving as the Insured’s appraiser is moot as the Insured has selected a new appraiser, and the appraisal process is well underway with State Farm’s appraiser and the Insured’s new appraiser. Finally, any and all accusations made on behalf of the Complainant in the Notice not already denied or refuted in this response are hereby denied by State Farm. State Farm takes very seriously its responsibility to fairly and accurately evaluate damages and to pay what is properly owed under its policies. We trust the foregoing adequately addresses any concerns that you and your client may have concerning this matter. State Farm Florida Insurance Company does not intend, by this response, to waive any policy or legal defenses and specifically reserves its right to assert all such additional policy and legal defenses at any time. GREEN, ACKERMAN & MATZNER, P.A. Counsel for State Farm Florida Insurance Company By: Walter W. Norton, Esq. and Jay B. Green, Esq. 1200 N. Federal Hwy., Suite 301 Boca Raton, FL 33432 561-347-2400
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