Civil Remedy Notice of Insurer Violations
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Filing Number:     654260
Filing Accepted:  10/27/2022
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Complainant
Last/Business Name *  
HIS & HERS ROOFING, LLC   First Name  
Street Address * 515 18TH STREET
City, State Zip * ORLANDO, FL 32805
Email Address * JBAER@HHROOFS.COM
Complainant Type: * Third Party
Insured
Last/Business Name*   JOACHIM   First Name   JEAN
Policy # * 0763042078 Claim #* 7005190697-1
Attorney
Attorney is Applicable
Last Name* FERTEL First Name * JORDAN B. Initial
Street Address* 200 SE 9TH STREET
City, State Zip* FORT LAUDERDALE , FL 33316
Email Address * JORDAN@ROBERTMALOVELAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   TRUCK INSURANCE EXCHANGE
NAIC Company Code 21709
 
Name of individual responsible for violation (if any):* JESSICA KOCH
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
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.
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.

Loss Settlement Provision Perils Insured Against
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

October 27, 2022 Sent Via E-mail and DFS website: myclaim@farmersinsurance.com Truck Insurance Exchange ATTN.: Jessica Koch P.O. Box 268994 Oklahoma City, OK 73126 RE: Client : HIS & HERS ROOFING, LLC Insured : JEAN JOACHIM Policy # : 0763042078 Claim # : 7005190697-1 Property Address : 4805 Elderwood Lane Orlando, FL 32808 Dear Truck Insurance Exchange: Please find enclosed our Civil Remedy Notice that has been filed. As discussed in greater detail in the notice, the carrier has not attempted in good faith to settle the claimant’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 its interests. 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 claimant’s storm damage claim. Subsequently, the claimant prepared a loss package in the amount of $58,625.68 needed to restore the property back to its pre-loss condition. Whereas, the carrier wrongfully represented the damages to the insured’s property to be under deductible. The carrier determined only the chimney needed to be resealed, five (5) window screens needed to be rescreened, and trees needed tear out as the entire damages after a hurricane. Even though a category 3 hurricane ravaged the property, the carrier conveniently denied the roofing system. If a thorough investigation was completed by the carrier, they would have found that the entire roofing system needed to be replaced. This intentional delay with the claim has led to direct prejudice of the insured. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of the damage sustained by the insured’s property and has not taken any meaningful ensuing action. It is clear that the carrier is not treating the claimant 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 claimant; failing to implement proper standards for the adjustment and investigation of claims and placing the company’s interests before the claimant’s interests; not training, supervising or managing adjusters properly so that prompt and full payments are made; refusing to pay the full amount owed to the claimant despite the fact that the damages are covered under the policy; looking for ways to delay full recovery or any recovery to the claimant; and refusing to provide coverage for the claimant’s loss in a timely manner. 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), 626.9541(1)(i)(3)(f), and 626.9541(1)(i)(3)(i), 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. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1) Pay the complete covered loss in the amount of $58,625.68; 2) Pay the Claimant’s attorneys’ fees and costs as they have been forced to retain counsel; and 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. Sincerely, Jordan B. Fertel Jordan B. Fertel, Esq. Attorney at Law Enclosed: Civil Remedy Notice Filing
Comments
User Id Date Added Comment
nhernandez@chartwelllaw.com 11-30-2022 To Whom It May Concern, This firm represents Truck Insurance Exchange (“TIE”) in connection with a claim submitted by His and Hers Roofing, LLC a/a/o Jean Joachim (“Complainant”), following a purported loss occurring on or about September 30, 2022, allegedly as a result of Hurricane Ian. This correspondence shall serve as a formal response by TIE to the Civil Remedy Notice of Insurer Violation (“CRN”), filing number 654260, recently submitted on behalf of the Complainant and associated with Policy number 0763042078, and a date of loss of September 30, 2022. TIE denies each and every allegation brought forth in the CRN and denies any wrongdoing in the handling of this matter. Below we include a detailed factual history of the claim handling and actions by TIE, which clearly reveals TIE acted properly in responding to the claim, and is in compliance with both its contractual and legal obligations. TIE would further state the Complainant’s CRN is defective as it fails to comply with the strict governing requirements contained within Florida Statute Section 624.155. Namely, the statute requires that a CRN shall “state with specificity . . . [t]he facts and circumstances giving rise to the violation.” Fla. Stat. § 624.155(3)(b)2. Under Florida law, a civil remedy notice must state the facts and circumstances that give rise to an alleged violation with such specificity sufficient to allow an insurer to cure any alleged violation within the sixty (60) day statutory period. See Lane v. Westfield Insurance Company, 862 So. 2d 774 (Fla. 5th DCA 2003). However, the Complainant’s CRN is deficient as the limited facts and circumstances set forth therein are false, incomplete, and misleading, as well as insufficient to establish a violation of any statute or policy provision. Additionally, the CRN includes a list of seven (7) statutory and three (3) administrative provisions alleged to have been violated. The referenced statutes and code sections, however, do not appear to be pertinent to the subject claim, and the CRN fails to specify each statutes’ relative applicability to same. Further, the CRN does not contain specific facts addressing and supporting each alleged statutory violation against TIE, but rather sets forth only stock, conclusory allegations of purported bad faith. For these reasons alone, the CRN is defective on its face. In light of the incomplete, misleading, and false allegations set forth in the CRN, TIE hereby provides the Department of Financial Services with the following facts of the claim that, in and of themselves, disprove all of the allegations brought forth in the CRN. TIE hereby asserts that all actions taken in the handling of this claim were done so in good faith for the purpose of fair and timely disposition of this matter. CLAIM FACTS The Insured property is located at 4805 Elderwood Lane Orlando, Florida 32828. TIE issued a property insurance policy bearing policy number 0763042078 to the named Insureds, Jean Joachim and Rajwandaye Joachim, with effective dates of February 11, 2022, through February 11, 2023. This loss was reported to TIE on or about October 15, 2022, as damage to the home allegedly as result of Hurricane Ian. On October 15, 2022, the Insured executed an Assignment Agreement with His & Hers Roofing. On October 15, 2022, TIE sent correspondence to the Insured regarding TIE’s receipt of the claim. On October 18, 2022, Jordan Fertel of Robert Malove, P.A. (“Counsel”) sent a Letter of Representation to TIE regarding their representation of the Insured. On October 19, 2022, His & Hers Roofing sent an email to TIE regarding their Assignment of Benefits with the Insured. The next day, on October 20, 2022, TIE sent correspondence to Counsel regarding TIE’s acknowledgment of the Letter of Representation sent by Counsel. On October 21, 2022, TIE inspected the property and took photographs. Thereafter, on October 23, 2022, TIE sent its Claim Outcome Letter to Counsel. The letter stated “In order for payment to be issued for the damages, the amount of the loss must exceed the amount of your deductible. Since the amount of estimated damages is less than your deductible, no payments can be issued at this time, and we are closing our claim file.” “Our investigation revealed wear and tear of the caulking on the roof around the meter mast. Unfortunately, there is no coverage for this portion of your claim based on the facts known to us at the present time.” “As discussed, the damages to the interior of the home was not due to damages to the exterior of the home, however due to the piping located in the attic space.” The letter cited to the Policy – Coverage A – Dwelling and Coverage B – Other Structures (2)(c)(f)(i) for wear and tear and Section I – Exclusions A for constant and repeated seepage and leakage. On October 25, 2022, His & Hers prepared an estimate for the following areas and amounts: Roofing - $0.00, 1/12 Roof | Mod Bit - $57,020.84, Gutters - $1,115.44, Interior - $0.00, Windows - $221.24, Labor Minimums - $268.16, Line Item Total - $58,625.68. The same day, TIE sent correspondence to Counsel wherein Farmers provided Counsel with the Policy as requested. On October 27, 2022, a Civil Remedy Notice was filed. The same day, Counsel sent a correspondence to TIE regarding their filing of the Civil Remedy Notice and demand for $58,625.68. On November 2, 2022, Counsel sent correspondence to Farmers regarding their disagreement with Farmers evaluation and claim decision. As demonstrated by the narrative above, TIE has been engaging in a timely, thorough, and good faith evaluation of this claim. A shown, TIE has at all times fully complied with all obligations imposed by the subject Policy and Florida law. As such, TIE acted diligently in the handling of the underlying claim. TIE thoroughly investigated the claim and informed the Complainant of its coverage determination. TIE asserts that it acted diligently and in good faith in the evaluation and handling of the underlying claim and complied at all times with the provisions of the Policy and applicable Florida Statutes. ALLEGED REASON FOR NOTICE: Claim delay: TIE denies any delay in the claims handling and process of the loss as evident from the facts outlined above. TIE promptly acknowledged the Complainant’s claim and timely initiated its investigation of the loss. Moreover, TIE routinely communicated with the Complainant, advising of its efforts to evaluate the claim, providing notice of all actions necessary to evaluate the loss and promptly noticing the Complainants of its coverage determination. As such, TIE acted in accordance with its duties and obligations pursuant to the policy of insurance. Unsatisfactory Settlement Offer: There is no basis for this allegation, thus it is denied. TIE promptly inspected and adjusted this loss. The facts of this claim set forth herein evidence the proper administration of this claim in strict compliance with the statutory and contractual requirements imposed upon TIE. Unfair Trade Practice: There is no basis for this allegation, thus it is denied. The Complainant submits no facts or circumstances to support this allegation. It is clear from the facts outlined herein the handling and administration of this claim occurred with the utmost expediency and timeliness allowed by the statutory and contractual requirements imposed upon TIE. At no time did TIE, its agents, or its employees act improperly in the handling, administration, or disposition of this claim. The facts show that TIE acted promptly with respect to the investigation of the underlying claim. TIE made all communications required to adjust this claim in a prompt and appropriate matter. Specifically, information necessary and relevant to the proceeding of this claim was communicated to the Complainant in an appropriate manner. As outlined above, the facts of this claim set forth herein evidence expedient and timely administration of this claim and full and strict compliance with the statutory and contractual requirements imposed upon TIE. ALLEGED STATUTORY VIOLATIONS The Complainants allege six (7) statutory and three (3) administrative violations in the CRN, however, no specific facts or circumstances are provided to support these allegations. The CRN is simply a recitation of general, stock allegations of bad faith conduct, along with a list of statutory violations that are not specifically alleged or described. Notwithstanding, TIE denies each and every allegation of statutory violation individually as follows: 624.155(1)(b)(1): Denied. TIE has not failed to attempt to settle this claim in good faith and has always acted fairly and honestly towards the Complainant. As shown in the above factual summary, the conduct of TIE following its receipt of the first notice of the loss has complied with all aspects of Florida law. TIE timely inspected the loss and informed the Complainant of the coverage determination. Moreover, the Complainant has submitted no facts or circumstances supporting this allegation. TIE asserts its full and strict compliance with the statutory requirements imposed upon it and all duties and obligation set forth in the subject insurance policy. 624.155(1)(b)(3): Denied. TIE has not failed to attempt to settle this claim in good faith and has always acted fairly and honestly towards the Complainant. As shown in the above factual summary, the conduct of TIE following its receipt of the first notice of the loss has complied with all aspects of Florida law. TIE timely inspected the loss and informed the Complainant of the coverage determination. Moreover, the Complainant has submitted no facts or circumstances supporting this allegation. TIE asserts its full and strict compliance with the statutory requirements imposed upon it and all duties and obligation set forth in the subject insurance policy. 626.9541(1)(i)(3)(a): Denied. This allegation is without basis. TIE has adopted and implemented standards for the proper investigation of claims at all times. The aforementioned facts demonstrate that TIE employed proper and customary claims practices in the investigation and adjustment of this claim, and in strict compliance with the statutory requirements imposed upon it. Furthermore, the Complainant submitted no facts or circumstances supporting this allegation. 626.9541(1)(i)(3)(b): Denied. This allegation is without basis. TIE has adopted and implemented standards for the proper investigation of claims at all times. The aforementioned facts demonstrate that TIE employed proper and customary claims practices in the investigation and adjustment of this claim, and in strict compliance with the statutory requirements imposed upon it. Furthermore, the Complainant submitted no facts or circumstances supporting this allegation. 626.9541(1)(i)(3)(c): Denied. This allegation is without basis. As demonstrated above, TIE promptly acknowledged the claim upon receiving first notice of the reported loss and promptly initiated its investigation and scheduled an inspection of the premises. Upon completing its investigation, TIE promptly noticed the insured and Complainant of its coverage determination. At all times throughout the handling, adjustment of this claim, TIE acted in strict compliance with the statutory requirements imposed upon it. 626.9541(1)(i)(3)(f): Denied. Again, there is no showing by the Complainant to support this alleged violation. As set forth above, TIE provided the Complainant with a clear explanation of any and all requested information, in strict compliance with the statutory requirements imposed upon it. At all times throughout the handling, adjustment and settlement of this claim, TIE acted in strict compliance with the statutory requirements imposed upon it. 626.9541(1)(i)(3)(i): Denied. As demonstrated above, TIE’s adjusters took prompt action at all times during its investigation and adjustment of the claim, and at all times worked diligently towards a proper disposition of the claim. The aforementioned facts demonstrate that TIE employed proper practices in the investigation and adjustment of this claim, in strict compliance with the statutory requirements imposed upon it and all duties and obligation set forth in the subject insurance Policy. ALLEGED VIOLATIONS OF THE INSURANCE POLICY TIE further asserts that the Complainant has failed to reference any specific Policy language, and that the failure to provide such specific reference to policy language is a direct and clear noncompliance with the requirements of Fla. Stat. § 624.155, rendering the CRN deficient on its face as to form and substance. Notwithstanding, TIE denies violating any provision or duties set forth in the Policy and further asserts compliance with the Policy and all of its provisions and endorsements. TIE handled the Complainant’s claim with diligence and at all times acted fairly in administration of this claim and treated its Complainant with honesty and with due regard for their interests. All actions by TIE were done in compliance with the Policy. TIE DENIES ALL ALLEGATIONS IN THE CRN TIE hereby denies any and all allegations of bad faith by the Complainant, and states that it has, at all times material, handled and adjusted the Complainant’s claim with utmost good faith. Any and all allegations of bad faith contained within the CRN are expressly rejected by TIE. As stated above, the CRN is simply a recitation of general, stock allegations of bad faith conduct, along with seven (7) statutory and three (3) administrative violations that are not specifically alleged or described. The CRN is therefore non-compliant with Florida Statute Section 624.155(3), which requires that a civil remedy notice of insurer violation “state with specificity”, inter alia, the facts and circumstances giving rise to the violation and the “specific” language of the subject insurance policy that is relevant to any alleged violation(s). The Complainants wholly fail to provide any specific facts or circumstances giving rise to the alleged violations in the CRN, and instead simply allege a litany of non-specific, boilerplate allegations against TIE as purported acts of bad faith. Moreover, there is not a single reference in the CRN to any specific policy language that the Complainant allege as relevant to the allegations of bad faith. Failure to provide such specific reference to policy language is direct and clear noncompliance with the requirements of Fla. Stat. § 624.155, and renders the CRN deficient on its face, as to form and substance. Accordingly, the CRN does not provide the contemplated and mandated notice of alleged bad faith that is required as a condition precedent to any civil claim for bad faith pursuant to Fla. Stat. § 624.155. For these reasons, the CRN is denied and rejected. Additionally, as described in detail above, the facts alleged in the CRN are contrary to the actual facts underlying the subject claim. TIE further denies any and all other allegations not specifically addressed in this response related to the above-referenced Civil Remedy Notice. There has been no violation of the referenced statutory sections by TIE. By responding to the Civil Remedy Notice filed by the Complainant, TIE neither waives nor abandons but expressly reserves any and all rights, claims and defenses it has or may have under the terms and conditions of the Policy and applicable Florida law. Herein, TIE has attempted to fully and adequately respond to the allegations alleged in the CRN. Should the Florida Department of Financial Services have any questions or further inquiry with respect to this matter, please contact the undersigned. Thank you for your attention to this matter. Very truly yours, THE CHARTWELL LAW OFFICES, LLP; Nikolaos M. Hernandez, Esq.; nhernandez@chartwelllaw.com; Marcus Mahfood, Esq.; Christopher R. Cooper, 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