Civil Remedy Notice of Insurer Violations
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Filing Number:     654539
Filing Accepted:  10/29/2022
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Complainant
Last/Business Name *  
ANATOL PYTLAR AND TRACY PYTLAR   First Name  
Street Address * 14 ROXBURY LANE,
City, State Zip * PALM COAST, FL 32164
Email Address * APYTLAR@CFL.RR.COM
Complainant Type: * Insured
Insured
Last/Business Name*   ANATOL PYTLAR AND TRACY PYTLAR   First Name  
Policy # * 38117351 Claim #* 01-004-002238
Attorney
Attorney is Applicable
Last Name* PASSANTINO First Name * NICHOLAS Initial P
Street Address* 925 S. FEDERAL HWY., 6TH FLOOR
City, State Zip* BOCA RATON , FL 33432
Email Address * NPASSANTINO@KPATTORNEY.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   HOMESITE INSURANCE COMPANY
NAIC Company Code 17221
 
Name of individual responsible for violation (if any):* PHILIP JOHNSON
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.
* 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.

The carrier was immediately put on notice of the insureds’ windstorm claim. Subsequently, the insureds prepared a loss package in the amount of $47,706.82 needed to restore the property back to its pre-loss condition. Whereas, the carrier has failed to prudently inspect the insureds’ property, come to a fair coverage determination and promptly pay the claim. The carrier improperly determined that the roofing portion of the loss was not covered under the policy and stated that only a portion of the damages to the interior could be covered. In turn, the insureds have 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 insureds. About four hundred fifty 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 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 insureds 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 insureds; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insureds’ interests; refusing to pay the full amount owed to the insureds 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 insureds, 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 $47,706.82; 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. 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 Sandy Singh at (561)-892-9666 if you have any questions or concerns. Sincerely, Nicholas Passantino Attorney at Law
Comments
User Id Date Added Comment
jonathan.diocares@qpwblaw.com 12-29-2022 VIA POSTED ONLINE Florida Department of Financial Services Division of Insurance Regulation Bureau of Consumer Assistance/Civil Remedy Section Larson Building, 200 East Gaines Street Tallahassee, Florida 32399-0322 RE: Insureds: Anatol Pytlar and Tracy Pytlar Policy No.: 38117351 Claim No.: 01-004-002238 FL DFS File No.: 654539 Acceptance Date: October 29, 2022 To Whom It May Concern: This correspondence shall serve as the formal response of Homesite Insurance Company (hereinafter “Homesite”) to the Civil Remedy Notice of Insurer Violation (hereinafter “Notice”) filed by Nicholas P. Passantino, Esq. on behalf of Anatol Pytlar and Tracy Pytlar (hereinafter “Complainants” or “Insureds”), which was accepted by the Department of Financial Services (hereinafter “Department”) on October 29, 2022. The Department file number is 654539. We note, at the outset, that the section of the Notice requiring the Complainants to describe the facts and circumstances giving rise to the insurer’s purported violation(s) contains only conclusory allegations, with little to no supporting facts. The allegations with some semblance of factual allegations are blanket statements which proffer allegations without any information corroborating the allegations. Section 624.155, Florida Statutes, requires specificity in civil remedy notices. 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 CRN 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 insurer of any and all alleged violations claimed. Talat Enterprises, Inc. v. Aetna Casualty & Surety Co., 952 F. Supp. 773, 776 (M.D. Fla. 1996). If the Complainants honestly believe that there was any type of violation, Homesite requests that the Complainants provide specific information with respect to each alleged violation, including the name of each individual involved, the date of each violation, a description of each violation, and copies of documentation referencing each violation. As it stands now, the Notice is insufficient for the purpose of allowing Homesite to fully respond and/or remedy the alleged violations, if any. Due to the lack of any factual and circumstantial basis to support such allegations, Homesite requests, through this response, that the Department of Financial Services return the Notice for lack of specificity pursuant to Florida Statutes. Regardless, Homesite does not consider there to have been any manner of violation, and questions the validity of the Notice. Homesite further denies each and every allegation contained in the Notice, and denies any improper or dilatory conduct in its response to, or handling of this claim. Homesite has at all times acted promptly and diligently, and in good faith, acted fairly and honestly toward its insureds, the Complainants, in its claim response and review and adjustment of the claim throughout the claims handling process. To the extent that this reply does not fully address and respond to the allegations set forth by the Notice, such deficiency is the direct result of the lack of specificity and the overall vague nature of the factual circumstances allegedly giving rise to the allegations therein. To illustrate Homesite’s full, diligent and complete investigation of the claim, Homesite proffers the following sequence of claim handling contradicting every allegation of violations cited and referenced by the Complainants. Homesite Insurance Company received first notice of loss on October 20, 2021 with a reported date of loss of July 20, 2021; reported approximately 93 days after allegedly first incurring the loss. The loss was reported by “Brandon” with APEX Roofing as “roof is wind and hail damaged and a leak in the kitchen ceiling next to the garage.” Homesite sent correspondence dated October 20, 2021 to the Insureds acknowledging the claim and explaining the next steps in the claim process including their ability to request DFS Mediation and the like. The claim was thereafter assigned to independent adjuster, Philip R. Johnson of AFICS for further handling and investigation. On October 25, 2021, Homesite sent correspondence to the Insureds advising that they would need a signed contract with APEX who filed the claim. If documentation was not received by November 8, 2021, Homesite advised that they would assume the Insureds did not want to pursue the claim and would close the file. Mr. Johnson inspected the subject property on November 3, 2021 in the presence of a representative from APEX Roofing. Mr. Johnson discussed the condition of the property with the APEX representative and they agreed that there were no damages from wind or hail and that all was related to wear and tear and maintenance. Mr. Johnson conducted his inspection of the roof was found several signs of wear and tear with some water damages to the kitchen ceiling. After having examined the observations through the inspection conducted by Mr. Johnson and the information gathered to that date, Homesite issued its coverage determination in written correspondence to the Insureds dated November 19, 2021. Homesite advised that “while the interior leaking would be the covered ensuing loss the areas noted on your risk roof would not be covered due to age, wear and tear and maintenance….An additional letter will be forthcoming in regards to the coverage for the interior water damages.” On November 22, 2021, Mr. Johnson spoke with Mr. Pytlar through a telephone conversation and explained that the coverage for the interior damages to his home would fall below the policy’s 2% deductible. It was also communicated that Mr. Johnson met with APEX Roofing who agreed that no damages to the roofing system from the windstorm on July 20, 2021. On March 8, 2022, Homesite received documentation from Kanner & Pintaluga (“KP”) claiming to represent the Insureds in its claim. Requested documentation was sent to KP in compliance with their requests for documents – primarily the coverage letter and the certified copy of the policy. On March 9, 2022, Homesite sent correspondence to KP advising that the interior water damages fall below the policy wind and hail deductible of $6,680. Since the loss amount does not exceed the policy deductible, Homesite advised that they were unable to issue payment. On the same date, the Insureds filed a Notice of Intent to Initiate Litigation alleging that Homesite “failed to property pay the claim.” Interestingly, the Estimate of Damages is identified as “unknown” but attached an estimate. The estimate attached was prepared by APEX Roofing & Restoration on or around November 30, 2021. The APEX estimate calls for replacement of about 42 SQ of shingles, replacement of skylights, replacement of roofing felt, re-nailing of sheathing, drip edge, and other incidentals to replacement of the entire roofing system. APEX also allowed for replacement of 230 LF of gutters and replacement of the swimming pool heater (solar). The APEX estimate concluded in a replacement cost value of $47,706.82. Homesite responded to the Notice of Intent to Initiate Litigation on April 12, 2022. Within said correspondence, Homesite advised that they assert that they did not fail to properly pay the claim, they are willing to further discuss resolution and offered to settle the issue in exchange for a signed release. The offer was never responded to. Based on the foregoing sequence of events composing of and illustrating Homesite’s thoroughness in investigation and diligent efforts in assisting its insureds utilizing highly qualified individuals, at no time has Homesite acted dishonestly or unfairly towards its insureds, the Complainants. All actions have been toward a just and equitable resolution. Accordingly, the allegations proffered against Homesite by the Complainants are wholly unfounded and without merit, are not factually supported, and are denied. Further, the Notice provides blanket statement allegations against Homesite that are unfounded and unsupported by factual information in non-compliance with the mandates of Florida Statutes and established Florida case law. Moreover, there are errors in the insureds’ Civil Remedy Notice that are clearly erroneous and are illustrative of boilerplate language furthering Homesite’s challenge that the insureds’ Notice is lacking specific facts relative to the insureds’ claim and Homesite’s investigation of this particular loss. For example, insureds allege that Homesite failed to adopt and implement standards for the property investigation of claims and that Homesite was misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. The foregoing are blanket statements without support as insureds do not provide any semblance of fact to corroborate any claims of improper claims handling and investigation. These allegations are alleged in the absence of any facts or information supporting same and failing to provide a basis for insureds’ accusations against Homesite. As the foregoing are unfounded, they must be stricken from consideration. A review of the remainder of the Notice clearly illustrates that the insureds’ sole basis for the Notice is simply that they disagree with the coverage determination issued by Homesite and nothing more which is improper under Florida law. Conclusion: The Notice submitted by the Complainants to the Department failed to comply with the requirements of F.S. §624.155 and should be rejected by the Department. Homesite has handled the claim of its Insureds, the Complainants, with diligence, and has at all times acted fairly in the administration of the claim and has treated its Insureds with honesty and with due regard to the Insureds’ interests, and has done so in compliance with the policy of insurance and Florida law. Simply because the Complainants may disagree with Homesite’s investigation of the claim and/or Homesite’s findings to date, does not establish that Homesite acted in bad faith. Moreover, the method for curing the violations alleged in a civil remedy notice is not determined by the Insureds. Section 624.155 does not impose on an insurer the obligation to pay whatever the Insured’s demands. See, Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278 (Fla. 2000). Homesite denies all of the allegations contained in the Civil Remedy Notice. Homesite has fully responded to the subject defective and improper Civil Remedy Notice. Homesite has not violated any of the subject statutes and the accusations made against it in the subject Civil Remedy Notice are false. Due to the lack of any factual and circumstantial basis to support such allegations, we request, through this response, that the Department of Financial Services return the Notice for lack of specificity pursuant to Florida Statutes. Homesite continues to reserve all of its rights under the policy, at law and in equity. In the event this matter is not pursued further, the Department may consider this letter to be Homesite’s report on the final disposition of any alleged violation. If anyone at the Department has any question concerning this matter, please contact Homesite or the undersigned, for further response. Very truly yours, QUINTAIROS, PRIETO, WOOD & BOYER, P.A. Jonathan M. Diocares, Esq. Dorothy V. DiFiore, Esq. cc: Nicholas P. Passantino, Esq. on behalf of Anatol & Tracy Pytlar
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