Civil Remedy Notice of Insurer Violations
Login

Filing Number:     649453
Filing Accepted:  9/28/2022
         Print Filing
Complainant
Last/Business Name *  
GOMEZ JR.   First Name   FRANCISCO
Street Address * 14 OLIVE CIRCLE LOOP
City, State Zip * OCALA, FL 34472
Email Address * DAYNETLOPEZ@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   GOMEZ JR.   First Name   FRANCISCO
Policy # * P000255266 Claim #* 229934
Attorney
Attorney is Applicable
Last Name* KESSLER First Name * JOSEPH Initial
Street Address* 333 SE 2ND AVE, SUITE 2000
City, State Zip* MIAMI , FLORIDA 33131
Email Address * JKESSLER@DKLAWFL.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):* TRAVIS BOLGER
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
* Statutory provision(s) which the insurer allegedly violated.
 
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of 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.

“SECTION I – PERILS INSURED AGAINST - COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES - We insure against risk of direct loss to property described in Coverages A and B only if that loss is a physical loss to property”, unless otherwise excluded or limited in the subject policy. “SECTION I – CONDITIONS - 10. Loss Payment. We will adjust all losses with you.”
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

September 28th, 2022 Security First Insurance Company Attn.: Travis Bolger PO Box 105649 Atlanta, GA 30348 Claims@securityfirstflorida.com travis.bolger@securityfirstflorida.com RE: Insured : Francisco Gomez Jr. (“insured”) Policy # : P000255266 Claim # : 229934 Property Address : 14 Olive Circle Loop, Ocala, FL 34472 Insured Email : daynetlopez@yahoo.com Dear Security First Insurance Company, (“carrier”): 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 insureds’ claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insureds and with due regard for their interests. The carrier is required to properly investigate and adjust claims and cannot place that burden upon the insureds. The carrier was put on notice of the insured’s wind damage claim that occurred on 3/16/2022. After being put on such notice, the carrier sent out a representatives to the property to conduct an inspection. It is believed the initial representatives sent by the carrier lacked the credentials/training to determine what caused the damages sustained as a result of the subject loss. It is also believed that the representatives initially sent to the property was unqualified or lacked the necessary training to determine the amount of damages sustained as a result of the loss. The representatives sent by the carrier observed widespread damages to the subject property but was unable to determine what caused the damages as the representative was not trained or qualified to make this determination. The representatives that initially inspected the property and were unable to rule out wind damage as a cause of the damages to the property. The carrier sent out a field adjuster, a roofing contractor, and a leak detection company to inspect the loss. The loss was reported on or about April 12th, 2022. The carrier requested a sworn proof of loss form be signed and returned by the insured. In regards to the sworn proof of loss form, the desk adjuster Travis Bolger, advised the insured’s representative “This document does not affect coverage, this is to verify what happened in this loss from your perspective. It also requires you to know your roofer’s estimate if you have one.” At the time of the request, the insured did not have a damage estimate prepared. On or about May 31st, 2022, the desk adjuster assigned to the loss by the carrier, Travis Bolger, advised the insured’s representative, “I have all the documentation to make my coverage determination for claim # 229934. I have just returned from a vacation, that is the reason why I have not been able to complete the coverage determination. I will be in contact this week for the coverage determination.” Despite having the information necessary to make a coverage decision, the carrier delayed the coverage decision and refused to provide a written coverage decision. The carrier’s adjuster claimed it could not provide a coverage decision due to the fact the carrier had not received a signed sworn proof loss form from the insured. The insured’s representative advised the adjuster that they did not have a roof estimate at that time, which was needed to completed the sworn proof of loss. The carrier’s adjuster continued to insist that a sworn proof of loss be signed and returned to the carrier. The carrier waited from May 31st, 2022 until August 8th, 2022 to issue a coverage decision. Despite having all the information needed to make a decision on May 31st, 2022, the carrier waited more than sixty-eight (68) days to send the insured a written coverage decision. On or about August 8th, 2022, the carrier sent the insured a denial letter. The carrier advised the insured the claim was being denied. The carrier advised “The proof of loss document was mailed and emailed to the named insured on June 7, 2022 and reminders that the insurer was awaiting return of the completed proof of loss were issued throughout the sixty (60) day time period. Due to the requested proof of loss not being returned as required by the Conditions of the policy, no coverage is afforded under the policy.” Despite advising the insured’s representative during the adjustment of the loss that the sworn proof of loss form does not affect coverage, the carrier denied the claim for failing to provide this document. The carrier’s denial letter fails to advise the insured that the damages observed to the property were caused by exclusions or excluded from coverage under the policy. The policy of insurance provides coverage for direct physical damage sustained during the policy period and the carrier did not advise the insured that any of the observed damages were excluded under the policy. The carrier initially failed to pay for all direct physical damages to the property caused by wind. The carrier’s intentional delay of the coverage decision shows the carrier did not adjust the loss with the insured. Rather than inspecting the property and evaluating the damage in a prudent manner or making any good-faith effort to investigate the claim, the carrier incorrectly adjusted and investigated the claim. This investigation by the carrier is in direct violation of the statutory requirement for carriers to promptly and properly investigate all claims. These actions from the carrier as set forth above violate the following Florida Statutes: 626.9541(1)(i)(3)(a), Failing to adopt and implement standards for the proper investigation of claims; 626.9541(1)(i)(3)(d), Denying claims without conducting reasonable investigations based upon available information. The carrier’s actions set forth above also violated the following policy provisions: “SECTION I – PERILS INSURED AGAINST - COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES - We insure against risk of direct loss to property described in Coverages A and B only if that loss is a physical loss to property”, unless otherwise excluded or limited in the subject policy. “SECTION I – CONDITIONS - 10. Loss Payment. We will adjust all losses with you.” Subsequently, the insured procured the services of a licensed public adjuster who presented the insured with an estimate in the amount of $30,395.86, needed to restore the property back to its pre-loss condition. The insured/Insured’s representative provided the Defendant with the estimate and a signed Sworn Proof of Loss advising the Defendant of the amount of damages sustained during the loss. In response, the Defendant did not revise or reconsider its initial denial of the loss. The carrier engages in this practice of incorrectly denying claims with such regularity and frequency as to indicate that it is a general business practice of this carrier, in reckless disregard for the rights of the insureds. The carrier routinely denies claims based on unsupported reasons and denies coverage for losses in an attempt to escape liability for an otherwise covered loss. The carrier’s actions have severely delayed the resolution of this claim and the insured has not yet had been able to restore the property to its pre-loss condition. This delay was caused intentionally by the Carrier for more than (2) months. The carrier did not advise the insured that any of the observed damages were excluded under the policy. The carrier failed to provide coverage for all physical damages observed at the property that were not determined to be excluded under the terms of the policy. The insured was forced to retain a public adjuster, hire an attorney, dispute the initial coverage decision, and provide a damage estimate just to attempt to recover the benefits that were owed under the policy. Had the carrier properly adjusted the loss from the beginning of the claim, none of these actions taken by the insured would have been necessary. The carrier violated the policy provisions by failing to adjust this loss. Rather than inspecting the property and evaluating the damage in a prudent manner or making any good-faith effort to investigate the claim, the carrier incorrectly denied the claim. This investigation by the carrier is in direct violation of the statutory requirement for carriers to promptly and properly investigate all claims. These actions from the carrier as set forth above violate the following Florida Statutes: 626.9541(1)(i)(3)(a), Failing to adopt and implement standards for the proper investigation of claims; 626.9541(1)(i)(3)(d), Denying claims without conducting reasonable investigations based upon available information. The carrier’s actions set forth above also violated the following policy provisions: “SECTION I – PERILS INSURED AGAINST - COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES - We insure against risk of direct loss to property described in Coverages A and B only if that loss is a physical loss to property”, unless otherwise excluded or limited in the subject policy. “SECTION I – CONDITIONS - 10. Loss Payment. We will adjust all losses with you.” The denial of the claim and all the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a willful, wanton, and reckless disregard for the insured’s 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, this carrier must: 1.) Pay the complete covered loss in the amount of $30,395.86, minus the applicable deductible; 2.) Pay the Insureds’ 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.
Comments
User Id Date Added Comment
Natiyah.Washington@securityfirstflorida.com 11-28-2022 Via Electronic Filing: Florida Department of Financial Services Bureau of Consumer Assistance c/o: Civil Remedy Section Larson Building 200 East Gaines Street Tallahassee, Florida 32399-0322 Via Email: Joseph Kessler 33 SE 2nd, Suite 2000 Miami, Florida 33131 JKESSLER@DKLAWFL.COM Re: CIVIL REMEDY NOTICE OF INSURER VIOLATION Filing No.: 649453 Insured: Francisco Gomez Insurer: Security First Insurance Company Claim No.: 229934 Policy No.: P000255266 Date of Loss: 3/16/2022 Dear Sir or Madam: This correspondence is in response to the Civil Remedy Notice of Insurer Violations (hereinafter referred to as the “CRN”) was filed by Joseph Kessler on behalf of his client, Francisco Gomez (hereinafter referred to as “Insured”). Please be advised that the undersigned attorney has been retained to represent the interests of Security First Insurance Company (hereinafter referred to as “Security First”) with respect to the above-referenced matter. The Florida Department of Financial Services (hereinafter referred to as “Department”) assigned this CRN an acceptance date of 9/28/2022 and DFS File No.: 649453. This matter concerns a property damage claim made by the Insured pursuant to a homeowners’ insurance policy provided by Security First Policy No. P000255266 and assigned Claim No. 229934. As the basis for filing the CRN against Security First, Insured asserts in the “Reasons for Notice” section violations such as claim denial and claim delay, along with the following statutory violations: o 626.9541(1)(i)(3)(a)- Failing to adopt and implement standards for the proper investigation of claims; o 626.9541(1)(i)(3)(d)-Denying claims without conducting reasonable investigations based upon available information; Security First welcomes this opportunity to respond to the CRN and denies each allegation contained therein. The allegations made in the CRN are premature, as the insured has failed to Staff Counsel Office 1001 Broadway Avenue Ormond Beach, Florida 32174 perfect the claim for bad faith and the CRN does not meet the specificity requirement of Section 624.155, Florida Statutes. This CRN does not sufficiently support the allegations stated above. As is standard procedure, upon the first notice of the claim, the subject property was dutifully inspected by an adjuster, which was documented through photographs. I. Perfecting a Claim for Bad Faith SFIC specifically denies all allegations set forth in the Notice. SFIC contends that the Notice should be rejected and returned by the Department of Financial Services as it is premature. Pursuant to statute, there is no potential violation until a breach of contract is established. § 624.1551, Florida Statutes. Accordingly, any Notice filed prior to a finding that SFIC has breached the terms of the policy, is not ripe and is premature and thus fails to perfect the Insured’s rights to pursue civil remedies under Florida Statutes. II. Specificity Requirement The Insured’s CRN violates multiple requirements set forth in the Florida courts’ jurisprudence for Civil Remedy Notices. In addition, it fails to meet even the most basic requirements of the Statute. Pursuant to the terms of the statute, (3)(a) As a condition precedent to bringing an action under this section, the department and the authorized insurer must have been given 60 days’ written notice of the violations. Notice to the authorized insurer must be provided by the department to the e-mail address designated by the insurer under s. 624.422. a. The 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 (emphasis added): b.(3)(a) As a condition precedent to bringing an action under this section, the department and the authorized insurer must have been given 60 days’ written notice of the violations. Notice to the authorized insurer must be provided by the department to the e-mail address designated by the insurer under s. 624.422. i. The statutory provision, including the specific language of the statute, which the authorized insurer allegedly violated. ii. The facts and circumstances giving rise to the violation. iii. The name of any individual involved in the violation. iv. 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 Staff Counsel Office 1001 Broadway Avenue Ormond Beach, Florida 32174 insurer has not provided a copy of the policy to the third-party claimant pursuant to written request. v. A statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. In interpreting this statute, courts have emphasized the importance of filing specific civil remedy notices. The civil remedy notice is “crucial to the procedural integrity of an action” under the Statute. Allstate Ins. Co. v. Clohessy, 32 F.Supp.2d 1328, 1333 (M.D. Fla. 1998). “It is, without a doubt, a condition that must be satisfied in order for one to perfect the right to sue under the statute.” Id. “In creating this statutory remedy for bad- faith actions, the Legislature provided this sixty-day window as a last opportunity for insurers to comply with their claim-handling obligations when a good-faith decision by the insurer would indicate that contractual benefits are owed.” Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1284 (Fla. 2000). Thus, the Notice cannot be “vague and ‘shotgun’ in nature,” rather than “the type of specific notice required by the statute that would allow [the insurer] an opportunity to cure.” Heritage Corp. of South Florida v. National Union Fire Ins. Co. of Pittsburgh, PA, 580 F. Supp. 2d 1294, 1299 (S.D. Fla. 2008). Because it is in derogation of the common law, Section 624.155(1)(b), Florida Statutes must be strictly construed. Talat, 753 So. 2d at 1283 (citing Baxter v. Royal Indem. Co., 285 So. 2d 652 (Fla. 1st DCA 1973). To perfect the right to sue under the statute, the insured must specifically notify the insured of any and all alleged violations claimed. Talat Enterprises, Inc. v. Aetna Casualty & Surety Co., 952 F.Supp. 773, 776 (M.D. Fla. 1996) (“Talat I”) See Fox v. Starr Indem. & Liab. Co., No. 8:16-CV-3254-T-23MAP, 2017 WL 1541294, at *2 (M.D. Fla. Apr. 28, 2017) (sufficiency means specificity). In Junior Julien v. United Property and Casualty Insurance Company, 311 So.3d 875, 879 (Fla. 4th DCA 2021), the Honorable Court stated: The Middle District of Florida was confronted with a civil remedy notice that was similarly broad in scope and concluded that listing nearly all policy provisions on the notice did not satisfy the statute. Fox v. Starr Indem. & Liab. Co., No. 8:16-CV-3254-T-23MAP, 2017 WL 1541294, at *2 (M.D. Fla. Apr. 28, 2017). The court explained that “[i]f the statute contained no specificity requirement, [then] the [insureds’] casual ‘reference’ to the entire insurance policy undoubtedly would suffice.” Id. But, the court continued, “the Legislature included ‘specific’ or a variant not once but twice in the statute.” Id. As a result, the insureds’ listing of whole sections of the insurance policy “appear[ed] to lack specificity.” Id. In Valenti, the District Court for the Middle District of Florida considered the practical consequences of an insured’s non-specific civil remedy notice. Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006). The plaintiff’s civil remedy notice included allegations that the defendant conducted an inadequate investigation. The plaintiff, however, failed to identify with the requisite specificity the defendant’s actions that were inadequate. The Middle District held that the plaintiff’s civil remedy notice was insufficient, and stated the following: [T]he civil remedy notice must be specific enough to provide insurers notice of the wrongdoing so the insurer can cure the same within sixty days. … Plaintiffs’ Staff Counsel Office 1001 Broadway Avenue Ormond Beach, Florida 32174 counsel, during the hearing in this matter, argued a civil remedy notice that states “you denied my claim” should be sufficient to place the insurer on notice of what was needed to be cured. Plaintiffs’ counsel further argued that it was up to the insurer, as the insurance expert, to decipher what actions needed to be cured. This argument, in this Court's estimation, is illogical and is counter to the purpose of the civil remedy notice. If a simple “you denied my claim” was sufficient to put insurers on notice, the sixty-day cure period would be little more than a guessing game with the insurer attempting to correctly guess what errors the insured claimed it made in the claims handling process, or risk defending a bad faith action. This surely is not what the legislature had in mind when it created the civil remedy notice. Accordingly, this Court finds that Plaintiffs allegation that Defendant failed to conduct an adequate investigation is insufficient to provide Defendant an opportunity to cure. Id. at *2. The guidance for an insured could not be more clear. “The purpose of the civil remedy notice is to give the insurer one last chance to settle a claim with its insured and avoid unnecessary bad faith litigation.” Lane v. Westfield Insurance Co., 862 So. 2d 774, 779 (Fla. 5th DCA 2004). Its purpose is not “to give the insured a right of action to proceed against the insurer even after the insured’s claim has been paid or resolved.” Id. Ultimately, conclusory allegations without facts fail to perfect a statutory bad faith claim. Merely alleging the bare minimum allegations is insufficient pursuant to Florida courts’ interpretations of Section 624.155, Florida Statutes. III. Conclusion At all times, Security First has acted in good faith in its handling of the claim and it has acted fairly, honestly, and with due regard for the Insured’s interest and in determining obligations to Insured. Specifically, Security First has complied with its obligations under the applicable Florida Statutes and the applicable Security First Insurance policy. Security First specifically denies any claim for bad faith and argues that the insured’s claim for bad faith is premature. Security First continues to reserve all its rights under the policy, at law and in equity. Regardless, Insured’s conclusory allegations fail to place Security First on notice of any purported violations. Furthermore, the Civil Remedy Notice fails to identify how to cure the allegations set forth. The allegations are without basis. It is clear Security First properly handled and adequately investigated the claim. We hope that this response has answered any concerns regarding this matter. If the Department has any question concerning this matter, please do not hesitate to contact the undersigned counsel. Sincerely, _______________________ /s/ Natiyah D. Washington Natiyah D. Washington, Esquire Florida Bar No: 1031752 Attorney for the Defendant Staff Counsel Office 1001 Broadway Avenue Ormond Beach, Florida 32174 Security First Insurance Company 1001 Broadway Avenue Ormond Beach, Florida 32714 Natiyah.Washington@securityfirstflorida.com Telephone Number: (813) 244-5452
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.

Before submitting a Notice using this system, please verify that all text has been entered correctly and completely. Once the Notice has been submitted, the text cannot be changed or deleted.




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