Civil Remedy Notice of Insurer Violations
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Filing Number:     649352
Filing Accepted:  9/28/2022
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Complainant
Last/Business Name *  
JACKSON   First Name   WOLFE
Street Address * 308 S CHECKERBERRY WAY
City, State Zip * JACKSONVILLE, FL 32259
Email Address * CZANAKOS@DAVIDLOWPA.COM
Complainant Type: * Insured
Insured
Last/Business Name*   JACKSON   First Name   WOLFE
Policy # * 13936759-02 Claim #* 092022008543
Attorney
Attorney is Applicable
Last Name* ZANAKOS First Name * CHRISTINA Initial N
Street Address* 2101 W COMMERCIAL BLVD SUITE 2800
City, State Zip* FORT LAUDERDALE , FL 33301
Email Address * CZANAKOS@DAVIDLOWPA.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   FEDERAL INSURANCE COMPANY
NAIC Company Code 20281
 
Name of individual responsible for violation (if any):* BRANDON LYDEN, ON BEHALF OF FEDERAL INSURANCE COMPANY, SEEK NOW ON BEHALF OF FEDERAL INSURANCE COMPANY, PATRICK RUTLEDGE ON BEHALF OF FEDERAL, EFI GLOBAL ON BEHALF OF FEDERAL, AND ALL OTHER ADJUSTERS, ENGINEERS, SUPERVISORS, MANAGERS, AND INDIVIDUALS
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Claim Denial
Unfair Trade Practice
Other : Disregarding Covered peril damage
Other : Placing Unreasonable Requirements on the Insured to Properly Adjust the Claim
Other : Failure to Respond to the Insured in a Timely Manner
Other : Ignoring weather reports confirming damage
* 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)(2) A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
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)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

In addition to the above statutory provisions that have been violated, the following provisions of the Florida Administrative Code regarding ethical requirements for adjusters have also been violated:? 69B-220.201(3)(B) – An adjuster shall treat all claims equally. 69B-220.201(3)(C) – An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured. 69B-220.201(3)(E) – An adjuster shall handle every adjustment and settlement with honesty and integrity, and allow a fair adjustment or settlement to all parties. 69B-220.201(3)(F) – An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim Despite request, Federal Insurance Company has failed and refused to provide a certified copy of the Policy. The Insured is not required to provide policy language with the carrier refuses to provide the Policy. Notwithstanding, to the best of the Insured’s information and belief, the following policy provisions were violated by FEDERAL INSURANCE COMPANY in the improper handling of his claim, pursuant to Policy Number 001393675902: COVERAGE A – DWELLING 1. We cover: a. the dwelling on the “residence premises” shown in the Declarations, including structures attached to the dwelling; SECTION I – PERILS INSURED AGAINST COVERAGE A – DWELLING AND COVERAGE B – OTHER STRUCTURES 1. We insure against direct physical loss to property described in Coverages A and B F. Additional coverages 2. Reasonable Emergency Measures SECTION I – CONDITIONS 3. Loss Settlement 10. Loss Payment Including all definition sections, coverage sections, and loss payment provision sections of the Policy.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

This notice is given in order to perfect the right to pursue the civil remedy authorized by section 624.155, Florida Statutes. In Florida, the work of adjusting insurance claims engages the public trust. The insurance company has breached this duty in the adjustment of the Insured’s claim of loss. Insurance company has failed to create and implement adequate guidelines for proper investigation of claims handling and for training and supervision of employees resulting in statutory violations (as set forth above). Further, insurance company has failed and/or refused to thoroughly, accurately, and completely investigate, evaluate, and pay the Insured’s insurance claim for damages. Insurance company has also ignored important information that would benefit the Insured, as described in further detail below. Though the Insured sustained a loss that, pursuant to the terms of his policy, should be covered by FEDERAL INSURANCE COMPANY, the carrier has failed to tender all monies due and owing to the Insured for the damage caused to his property. The entire concept of insurance promises the Insured timely and prompt indemnity in exchange for their premium payments to the Insurance company.? Florida Statute section 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that the insurance company must issue payment for a covered loss in a timely manner so that the Insured may mitigate his damages and put him back in the position he was in prior to the loss as quickly as possible. Insurance company has breached this duty by refusing and failing to tender all insurance proceeds due and owing to the Insured upon his proper and timely submission of a claim. Insurance company charged the Insured a premium for coverage under the policy of insurance but refused and/or failed to fulfill its obligations per the Policy, when under all circumstances it could and should have done so had it acted fairly and honestly towards the Insured. Furthermore, the Insured believes Insurance Company repeatedly and as a standard business practice engages in this behavior to deprive its Insureds of their rightful insurance proceeds when they experience a covered loss. Insured contends other Insureds have been refused insurance proceeds due and owing under the policy in the same or similar circumstances, and have been provided inadequate insurance monies under the same or similar facts or circumstances. The Insured further contends that Insurance company commits this standard business practice only to keep the claims adjustment process open and pending so that it does not have to pay fully on the claim. This is wrongful conduct and directly violates the purpose of insurance coverage. Insurance company’s wrongful conduct and omissions include, but are not limited to: ignoring weather data, claim delay, not conducting a full and prompt investigation, not treating the policyholder with good faith claims conduct, looking for ways to reduce recovery to Insured; looking for ways to delay full recovery to Insured; wrongfully denying claim; holding back and failing to pay portions of claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the Insured; not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholder’s interests; establishing severity control initiatives and otherwise establishing a culture of not fully and promptly paying claims following losses; and failing to pay the full amount of the Insured’s damage despite knowing it must do so. In Florida, the work of adjusting insurance claims engages the public trust. FEDERAL INSURANCE COMPANY has breached this trust by its adjustment of the Insured’s claim of loss by refusing to properly indemnify the Insured for his loss in direct contradiction of the terms of the Policy and Florida Statutes. On or about June 25, 2020, Wolfe Jackson (“the Insured”) suffered a loss at the Property located at 308 S Checkerberry Way, Jacksonville, FL 32259 (“the Property”) caused by wind and hail. At the time of the loss, Federal Insurance Company insured the Property under an all perils policy, which covers the property due to loss from wind and hail. After the date of loss, the Insured had a roofer confirm wind and hail damage to the roof and then contacted a licensed and insured public adjuster (Jason Newsom) from River City Claims, LLC to assist him with submitting his loss to the insurance company. Mr. Newsom performed an inspection and confirmed wind and hail damage to the roof. Mr. Newsom created an XACTIMATE estimate of damages to return the Property to its pre-loss condition, including roof replacement, stucco repairs, and flashing replacement. Mr. Newsom also took extensive up-close photos of the damages to the roof, showing several instances of wind-lifted shingles, hail indents, rippled shingles, creased shingles, and displaced shingles. At some point after the claim was reported, Federal sent Patrick Rutledge from EFI Global to inspect the Property, who later reported no hail or wind damage was found to the roof. In its correspondence dated April 25, 2022, signed by Brandon Lyden, Federal states that although damages were observed and noted, they were caused by “typical aging, natural wear and tear, and lack of maintenance.” Importantly, neither EFI nor Federal states which of the laundry list of exclusions cited caused the damages or why it believes that the damages were due to aging, wear and tear, or lack of maintenance despite a storm in the area on the date of loss. Further, Federal provides EFI Global’s assessment, which specifically states on page 2 the weather conditions at the time of the loss confirm five hail storm events with hail ranging from .75 to 1.75 inches for the area and two wind events were reported with wind gusts of 50 (57.5 mph) and 52 knots (59.8 mph). Incredibly, despite Federal’s own admission of the severe weather which was more than sufficient to cause the damages suffered to the Property, Federal states the damages suffered were not due to wind and hail and denied the loss in its entirety. Additionally, the photos provided by EFI are limited and do not show in detail the damages suffered, unlike the public adjuster’s photographs. Incredibly, despite all the evidence presented and its own evidence collected from weather reports and at the Property, Federal Insurance Company has failed and refused to open coverage for the loss caused by wind and hail. The Insured sent in a Notice of Intent to Initiate Litigation, to which Federal responded it was standing by its denial. Frustrated by Federal Insurance Company’s denial and complete lack of assistance with his covered property insurance claim, the Insured felt he had no choice but to file this Civil Remedy Notice to protect his rights going forward and initiate litigation. Federal Insurance Company has done nothing but wrongfully deny the claim and ignore information that would benefit the Insured. Pursuant to Florida Statute §624.155(1)(b)(1), the Insurer, FEDERAL INSURANCE COMPANY, has a duty to attempt, in good faith, to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly towards the Insured and with due regard for his interests. FEDERAL INSURANCE COMPANY has breached these duties in the handling of the Claim for financial gain and profit. FEDERAL INSURANCE COMPANY did so when it refused to properly adjust the claim, purposefully delayed the claim process, and ignored information from the Insured that would assist the Insured in resolving his claim. Consequently, FEDERAL INSURANCE COMPANY has violated Florida Statute §624.155(1)(b)(1). It would seem that FEDERAL INSURANCE COMPANY is indifferent to the needs of its loyal customers, whose insurance premiums it did not hesitate to collect. FEDERAL INSURANCE COMPANY had the duty to investigate and settle the Insured’s Claim in an honest manner and according to the coverage provided under the Policy. To be clear, FEDERAL INSURANCE COMPANY and its representatives had a duty to investigate the Claim and pay the Insured the benefits he would be entitled to for the repairs under the terms and conditions outlined in the Policy and under Florida law. It has not done so to date, despite the Insured and his representative making every effort to resolve the claim in the meantime. What FEDERAL INSURANCE COMPANY did was wrongfully deny the Claim without conducting a reasonable investigation with qualified and competent adjusters and experts, despite the fact that the evidence clearly shows the property was damaged by a covered cause of loss, resulting in significant damage. This unfair and unsupported underpayment of the Claim is evidence that FEDERAL INSURANCE COMPANY has mishandled the Claim and its conduct is nothing less than common bad faith claims handling practices. Pursuant to Florida Statute §626.9541(1)(i)(3)(a), FEDERAL INSURANCE COMPANY had a duty to adopt and implement standards for the proper investigation and settlement of claims. It is clear from the facts in this case that FEDERAL INSURANCE COMPANY was ill equipped to handle the Claim. The representatives sent to the Property by FEDERAL INSURANCE COMPANY failed to correctly attribute the cause of loss and proper scope of damages resulting from the wind and hail event, despite its inspection of the Property and the extent of documentation sent from the Insured’s representative evidencing the damages. Federal Insurance Company also chose to ignore multiple weather reports provided to pretend the storm wasn’t bad enough to cause the damage the Insured suffered. To date, the Insured still has not been properly compensated for her loss. The Insured is at a loss of how to proceed, as FEDERAL INSURANCE COMPANY has failed and refused to properly assist the Insured with her covered loss despite its ethical, contractual, and statutory obligation to do so. There may be further wrongful conduct which has not yet been made known to the Insured at this time. For example, certain conduct or actions cannot be verified without a complete review of FEDERAL INSURANCE COMPANY’s claim file and claim guidelines. The Insured therefore retains the right to address additional concerns as they become known.? FEDERAL INSURANCE COMPANY improperly shifted the burden of proving the loss onto the Insured before adequately tendering insurance proceeds (which FEDERAL INSURANCE COMPANY still has not done). This completely defeats the purpose of insurance, as the insurance company should adequately compensate its Insureds for covered losses properly at the outset of a claim, not after months of being chased by and sent multiple pages of documentation by the Insured and his representatives, fighting to have his covered loss properly compensated. Pursuant to Florida Statutes, Section 624.155, punitive damages may be awarded against an insurance company if the acts giving rise to the violation occur with such frequency as to indicate a general business practice and these acts are:? (a) willful, wanton, and malicious;? (b) in reckless disregard for the rights of any insured; or? (c) in reckless disregard for the rights of a beneficiary under a life insurance contract.? It is the Insured’s position that Insurance Company engages in the practice of wrongfully denying or underpaying insurance claims as a general business practice in a willful effort to increase profits and in reckless disregards for the Insured’s rights. This is wrongful conduct.? Notwithstanding the above, to cure the defects outlined in this Civil Remedy Notice, FEDERAL INSURANCE COMPANY must do the following:? (1) FEDERAL INSURANCE COMPANY must assist the Insured in mitigating his damages; (2) FEDERAL INSURANCE COMPANY must act promptly, fairly and honestly towards the Insured and with due regard for his interests in attempting to resolve the Insured’s claim;? (3) FEDERAL INSURANCE COMPANY must immediately tender all insurance proceeds due and owing the Insured for the fair value of his claim which is fairly owed under his insurance policy that would reasonably place the Insured back to a pre-loss condition, which is the full amount of the Insured’s estimate previously provided by the public adjuster for $61,040.42 (less deductible); (4) FEDERAL INSURANCE COMPANY must agree to reimburse the Insured for his expenses incurred by having to retain legal counsel and his own experts to present his claim, which will be provided upon request to counsel based on the fees and costs accrued at the time of the request; (5) FEDERAL INSURANCE COMPANY must immediately tender statutory pre-judgment interest pursuant to Florida Statute Section 627.70131 and/or Section 55.03. The Insured still hopes that this claim can be resolved amicably. Failure to cure the defects as described herein will result in additional extra-contractual damages.
Comments
User Id Date Added Comment
ithaler@clausen.com 11-14-2022 Irene Thaler Direct Line: 813 519-1027 E-Mail: ithaler@clausen.com November 14, 2022 Via E-mail (czanakos@davidlowpa.com) Christina N Zanakos, Esq. 2101 W Commercial Blvd., Suite 2800 Ft. Lauderdale, Florida 33301 RE: Civil Remedy Notice Filing No. 649352; Accepted Date: 09/28/22 Insured: Wolfe Jackson Claim Number: 092022008543 Policy Number: 13936759-02 Property: 308 S Checkerberry Way, Jacksonville, FL 332259 Dear Ms. Zanakos, Please accept this response to the Civil Remedy Notice of Insurer Violation Number 649352 (the “Notice”) on behalf of Federal Insurance Company (“Federal”) that was filed on behalf of Wolfe Jackson (hereinafter “Insured”). The Notice alleges wrongdoing by Federal in relation to a claim for property damaged, which is alleged to have occurred on June 25, 2020. The Department accepted the Notice on September 28, 2022, so this response is timely. As state by the Florida Supreme Court, the purpose of a civil remedy notice filed pursuant to Section 624.155. Florida Statutes, is to put the insurer on notice of an alleged violation, the circumstances surrounding same, and indicate the details of the alleged violation order to provide an insurer with 60 days to “cure” the alleged claim defects. See Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So. 2d 1278, 1283-4 (Fla. 2000). This is so the insurer is provided with an opportunity to resolve a first-party coverage dispute and otherwise avoid litigation. Id. see also Lane v. Westfield Ins. Co., 862 So. 2d 744 (Fla 5th DCA 2003). Further, a Notice must be sufficiently specific to provide the insurer with an opportunity to cure the alleged violations. This would include identifying the specific policy provision(s) at issue, citing specific language of the statutory provision(s) the insurer allegedly violated, and specifically identifying what actions the insurer must take to remedy the alleged violations. Heritage Corp. Of South Florida v. National Union Fire Ins. Co. of Pittsburg, PA, 580 F. Supp. 2d 1294, 1299-1300(S.D. Fla. 2008); see also Rousso v. Liberty Surplus Ins. Corp., 2010 U.S. Dist. LEXIS 82328 (S.D. Fla. Aug. 13, 2010) In contravention to these requirements, the Notice provides a number of contradictory and incomplete instructions for the demanded cure. For instance, the Notice ignores Federal’s application of the Policy’s terms, limitations, exclusions, and exceptions to the reported damages and origin of loss. Specifically, the Notice states that the Property is covered under an “all perils policy, which covers the property due to loss from wind and hail.” However, Federal timely investigated the loss and properly rendered a coverage determination. Federal did not fail to issue full payment, rather, Federal investigated the loss and determined that the cause and origin of the reported damage was not covered under the Policy, as explained in the coverage determination letter dated April 25, 2022. As explained in Federal’s coverage determination communication, no hail or wind damage was observed to the roof shingles at the insured Property. Notwithstanding Federal’s denial of the above referenced allegations, the Notice concedes that “Federal sent Patrick Rutledge from EFI Global to inspect the Property” and “refused to open coverage” without going into further detail. Furthermore, Federal’s receipt of the Insured’s estimate for damages does not establish the existence of a covered loss despite the allegation in the Notice that there were approximately $61,040.42 worth of damages to the Property. Further, the Insured asserts specific statutory violations, which are typically found in virtually all Civil Remedy Notice of Insurer Violation regardless of the facts and circumstances of the individual case. Federal denies each and every allegation of statutory or code violation individually as follows: Fla. Stat. §624.155(1)(b)(1): Denied. The allegation is without merit. Federal, in good faith, performed a detailed and reasonable investigation into the claim and thoroughly explained the basis and rationale for its coverage determination dated April 25, 2022. Federal has acted fairly and honestly toward its insured with due regard for his interests. Fla. Stat. §624.155(1)(b)(3): Denied. The allegation is without merit. Federal, in good faith, performed a detailed and reasonable investigation into the claim and thoroughly explained the basis and rationale for its coverage determination dated April 25, 2022. Federal has acted fairly and honestly toward its insured with due regard for his interests. Fla. Stat. §624.155(1)(i)(2): Denied. The allegation is without merit. Federal, in good faith, performed a detailed and reasonable investigation into the claim and thoroughly explained the basis and rationale for its coverage determination dated April 25, 2022. Federal has acted fairly and honestly toward its insured with due regard for his interests. Federal made no material misrepresentation to the insured or any person having interest in the proceeds payable under the Policy. Fla. Stat. §626.9541(1)(i)(3)(a): Denied. The allegation is without merit. Federal, in good faith, performed a detailed and reasonable investigation into the claim and thoroughly explained the basis and rationale for its coverage determination dated April 25, 2022. Federal has not failed to adopt and implement standards for the proper investigation of claims. Fla. Stat. §626.9541(1)(i)(3)(b): Denied. The allegation is without merit. Federal, in good faith, performed a detailed and reasonable investigation into the claim and thoroughly explained the basis and rationale for its coverage determination dated April 25, 2022. Federal has not misrepresented any facts or insurance provisions relating to the coverages at issue. Fla. Stat. §626.9541(1)(i)(3)(i): Denied. The allegation is without merit. Federal, in good faith, promptly performed a detailed and reasonable investigation into the claim based on the information available to Federal. Federal at all times acknowledged and acted promptly to respond to communications from the Insureds and their representatives. Moreover, Federal thoroughly and promptly explained the basis and rationale for its coverage determination letter dated April 25, 2022. Lastly, the Insured asserts that Federal’s adjusters violated specific ethical requirements under the Florida Administrative Code. Although a Civil Remedy Notice is an improper vehicle to set forth such allegations, in an abundance of caution, Federal denies each and every allegation of ethical or administrative code violation individually as follows: Fla. Admin. 69B-220.201(3)(b): Denied. The allegation is without merit. Federal, in good faith, performed a detailed and reasonable investigation into the claim and thoroughly explained the basis and rationale for its coverage determination dated April 25, 2022. Federal’s adjusters treat all claimants equally. Fla. Admin. 69B-220.201(3)(c): Denied. The allegation is without merit. Federal, in good faith, performed a detailed and reasonable investigation into the claim and thoroughly explained the basis and rationale for its coverage determination dated April 25, 2022. Federal’s adjusters approach investigations, adjustments, and settlements in good faith to the insured. Fla. Admin. 69B-220.201(3)(e): Denied. The allegation is without merit. Federal, in good faith, performed a detailed and reasonable investigation into the claim and thoroughly explained the basis and rationale for its coverage determination dated April 25, 2022. Federal’s adjusters handle every adjustment and settlement with honesty, integrity, and allow fair adjustment or settlement to all parties without any remuneration to himself except to that which he is legally entitled. Fla. Admin. 69B-220.201(3)(f): Denied. The allegation is without merit. Federal, in good faith, performed a detailed and reasonable investigation into the claim and thoroughly explained the basis and rationale for its coverage determination dated April 25, 2022. Federal’s adjusters act with dispatch and due diligence in achieving a proper disposition of the claim. Federal desires to resolve this matter with the Insured amicably, if at all possible. At the same time, please be advised that by sending this letter, Federal does not waive, but rather expressly preserves, the right to raise any and all available objections and defenses to this matter and to the Notice. Please also be advised that the subject policy issued by Lexington is governed by the Policy’s terms, conditions, and exclusions together with any endorsements. This letter does not waive any such provisions of the Policy. Similarly, any action taken by or on behalf of Federalor its authorized representative(s), whether in the past or future, to investigate the alleged loss, to adjust any claim or request for payment, or in any way related to or arising out of the subject claim or loss, shall not waive any of the terms, conditions, or any other provisions of the Policy. Should you or your client have any questions regarding the contents of this letter, please feel free to contract me at the information provided herein. Regards, CLAUSEN MILLER P.C. By: /s/ Irene Thaler Irene Thaler
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