Civil Remedy Notice of Insurer Violations
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Filing Number:     694923
Filing Accepted:  5/15/2023
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Complainant
Last/Business Name *  
ALBANESE   First Name   PAMELA
Street Address * 1364 NORTH MARCY DRIVE
City, State Zip * LONGWOOD, FL 32750
Email Address * SUNSHINE43X@HOTMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   ALBANESE   First Name   PAMELA
Policy # * 80-B7-Y243-9 Claim #* 59-41B0-29V
Attorney
Attorney is Applicable
Last Name* KRAPF First Name * GRANT Initial W
Street Address* 2790 SUNSET POINT RD
City, State Zip* CLEARWATER , FL 33759
Email Address * GRANT@KRAPFLEGAL.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   STATE FARM FLORIDA INSURANCE COMPANY
NAIC Company Code 10739
 
Name of individual responsible for violation (if any):* ANDRES GIRALDO AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, STATE FARM FLORIDA INSURANCE COMPANY WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Unfair Trade Practice
Other : Not treating the policyholder with good faith claims conduct
Other : Looking for ways to deny full recovery to the Claimants
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made,
Other : Failing to provide the Claimants with the full benefits awarded to him under the contract of insuran
* 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)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

627.444(2)(a) Notwithstanding any other law, an insurer shall provide to an Claimant within 15 calendar days after an individual or entity designated by the insurer receives the Claimant’s written request, either: A loss run statement . . . Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

State Farm Florida Insurance Company (the “Insurer”) has committed the following in handling the Claimants’ claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the Policy Holder and Claimant; 3) not adjusting the claims promptly and fairly; 4) not attempting in good faith to settle claims; 5) looking for ways to delay benefit payments; 6) requesting a re-inspection only after the Claimants retained a public adjuster; 7) shifting the burden of investigating the loss onto the Claimants; 8) conducting inadequate investigations; 9) making material misrepresentations of the coverages afforded under the insurance policy; and 10) denying a claim which it knew or should have known the policy and Florida law provided coverage for; and 11) failing to timely provide a loss run statement. The Claimant timely submitted a claim to the Insurer for wind and hail damage sustained to the above-referenced Claimant property on or about March 16, 2022, including the ensuing damage therefrom. In response the Claimant received a wrongful denial letter, dated December 2, 2022, wrongfully stating that the roof was not caused by a covered cause of loss and that the interior damage “was caused by long term, repeated water leaks from wear tear deterioration to the roof flashing as well as settlement cracks to the drywall. This type of damage is not covered by your policy.” Given the clear covered nature of the damage the Claimants retained a public adjuster who produced an estimate dated January 30, 2023 detailing $92,207.09 in covered damage to the dwelling. The Insurer has failed to substantively respond to this estimate. The Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an Claimant risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697. The Insurer intentionally ignored covered damage to deny the reported loss and wrongfully fail to pay the Claimant. This is an underhanded attempt to place the financial interests of the Insurer over those of the Claimant and to delay and frustrate the Claimant’s ability to have his claim adjusted promptly to begin restoring his property. The Insurer upon the Claimants’ loss had the duty to provide the full benefits under the policy. This includes providing the Claimants with a proper investigation and the funds necessary to return their home to its pre-loss condition. Despite the obvious covered wind damage under this All-Risk policy, the Insurer here placed its financial interest over the health and safety of the Claimant by denying the claim. Moreover, Insurer shifted the burden and cost of investigating and insuring the loss onto the Claimant. The Insurer upon the Claimant’s loss had the duty to provide the full benefits under the policy. This includes providing the Claimant with the proper investigation and the funds necessary to return their home to its pre-loss condition. The Insurer is placing its financial interest over the health and safety of the Claimant. Although there was interior moisture damage, the adjuster did not use a moisture meter or inspect for mold. A moisture meter can be purchased online from Amazon for around $44 before tax. The Insurer could purchase a water meter and assess thousands of properties with one meter. The Insurer’s adjuster should have a full tool belt to thoroughly investigate claims. Instead, the Insurer’s adjuster has no need for a tool belt because they don’t have the necessary tools to fill it. It is clear the Insurer would rather place its financial interests over those of the Insured by failing to provide the adjuster with the necessary tools to correctly inspect the loss. As a result of the inadequate investigation and surrounding circumstances, it is apparent that the Insurer significantly underestimated the scope of the loss to the Insureds property. Further, agents of the Insured have requested a Loss Run Report from the Insurer on February 17, 2023 which was not acknowledged by the Insured. The Insurer also failed to respond within 14 days to the request. Upon an Insurer’s receiving a communication with respect to a claim, the Insurer is required, within fourteen (14) calendar days, to review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevents such acknowledgement. There has been no response within the fourteen (14) calendar days of receipt of the Insureds’ communication and the Insurer has not alleged any factors beyond their control that would make such communication impossible. Insurers have a duty to settle claims in good faith 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 Insurer has failed or refused to promptly acknowledge the Claimants’ communications in an attempt to frustrate and delay the resolution of Claimants’ claim. In short, Insurer is not acting with due regard for the Claimants’ interests or safety. In Florida the work of adjusting insurance claims engages the public trust. Insurers have a duty to treat all Claimants equally and the Insurer has breached this duty. The Insurer has conducted poor and inadequate investigations and has significantly underestimated the replacement costs of Claimants’ property to further frustrate and delay the Claimants’ claim. The Insurer is placing their financial interests over those of the Claimants and the Claimants’ safety. The foregoing has only delayed the Claimants’ ability to begin restoring their home to its pre-loss condition. The Insurer’s actions amount to but are not limited to the following: 1. Claim denial. 2. Not treating the policyholder with good faith claims conduct 3. Looking for ways to reduce recovery to the Claimants 4. Looking for ways to deny recovery to the Claimants 5. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Claimant 6. 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 7. Placing the financial interest of the Insurer over that of the Claimant 8. Shifting the burden of investigating the loss onto the Claimants 9. Conducting inadequate investigations 10. Making material misrepresentations of the coverages afforded under the insurance policy. 11. Failing to timely provide a loss run statement. Therefore, to cure the defects outlined in this Civil Remedy Notice, the Insurer must: (1) Admit full coverage for the Claimants’ loss. (2) Tender full benefits owed to the Claimants under the insurance contract. (3) Pay all attorney’s fees, costs, and interest. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. Via E-mail: State Farm Florida Insurance Company 7401 Cypress Gardens Blvd. Winter Haven, FL 33888-0007 statefarmfireclaims@statefarm.com
Comments
User Id Date Added Comment
grant@krapflegal.com 10-20-2023 The details herein have been amicably resolved between the parties; therefore, we withdraw this Civil Remedy Notice. This Civil Remedy Notice is hereby withdrawn.
lalfano@alfanokingsford.com 07-14-2023 Dear Mr. & Mrs. Albanese: This letter has been directed to you through your attorney as State Farm Florida Insurance Company’s (“State Farm”) formal response to the allegations set forth in the purported Civil Remedy Notice (“Notice”) of insurer violation dated May 15, 2023. This Notice was filed on your behalf by Attorney Grant Krapf, Esq. of Krapf Legal, P.A. and purports to comply with §624.155, Florida Statutes. (A copy of this Notice is attached as Exhibit A). This Notice follows your first and second Civil Remedy Notices, which were filed on March 10, 2023 and March 20, 2023, respectively. State Farm previously responded to those Notices under separate cover dated May 3, 2023 and May 17, 2023, and reiterates many of its points herein. In your purported Notice, there is an indication that State Farm did not handle your claim in good faith because State Farm delayed your claim, it denied your claim, it committed some unidentified unfair trade practice, it somehow misrepresented the insurance policy, and did not issue payment of benefits you believe are owed to you, along with many other unfounded claims. State Farm denies each of these allegations, and as the facts below will demonstrate, your claim was properly investigated, and State Farm did not treat you unfairly in its adjustment of the claim. In the section of the Notice requiring you to refer to specific policy language that is relevant to the violations you allege, the Notice does not contain any policy language whatsoever. Instead, it states that “[t]he violations alleged are statutorily based and do not rely on any specific policy language.” Despite this assertion, your Notice alleges that State Farm “has misrepresented the terms of the policy.” Even further, your Notice requests that State Farm cure your allegations by admitting “full coverage” and tendering “full benefits owed to Claimants under the insurance contract.” Clearly, these allegations do, in fact, rely on policy language which your Notice was required, by law, to specifically refer to. Your Notice’s failure to do so renders it invalid as it does not meet the strict compliance requirement under Florida Law. Julien v. United Prop. & Cas. Ins. Co., 2021 Fla. App. LEXIS 3131 (Fla. 4th DCA 2021). On October 26, 2022, you submitted the subject storm damage claim to State Farm with a reported date of loss of March 16, 2022. The same day, State Farm Representative Andres Giraldo spoke with you, at which time you confirmed the date of loss. The same day, State Farm sent you correspondence advising you of your Duties After Loss and the Homeowner Claims Bill of Rights. (Please see attached Exhibit B and Exhibit C). State Farm also sent you correspondence, reserving its rights under the policy due to the late reporting of the loss. (Please see attached Exhibit D). An inspection of your property was scheduled to occur on November 23, 2022. On November 23, 2022, Mr. Giraldo only inspected the interior of your property, as he was unable to inspect the roof due to tarps installed by vendor Best Choice Roofing not yet being removed. The exterior inspection of your property was rescheduled for December 1, 2022. On December 1, 2022, Mr. Giraldo performed an inspection of the exterior of the property with you present. On December 5, 2022, State Farm sent you its coverage determination letter explaining that no covered damages were observed. The letter notes pre-existing damage from prior claim number 59-5462-M78, as well as wear, tear, and deterioration present. (Please see attached Exhibit E). The same day, State Farm sent you correspondence advising you of your right to participate in the Florida Department of Financial Services Mediation Program. (Please see attached Exhibit F). On January 30, 2023, State Farm received a public adjusting contract from Ask an Adjuster, LLC executed by you on January 23, 2023. (Please see attached Exhibit G). On February 17, 2023, State Farm received a Letter of Representation from Grant Krapf, Esq. of Krapf Legal, requesting, among other things, a certified policy and a Loss Run Statement. (Please see attached Exhibit H). The same day, State Farm sent a certified copy of the subject policy to Ask an Adjuster, LLC. (Please see attached Exhibit I). On March 10, 2023, Mr. Krapf filed the first Civil Remedy Notice on your behalf. On March 16, 2023, Mr. Krapf filed a Notice of Intent to Initiate Litigation (“NOIL”) on your behalf in the amount of $104,507.00 and attaches an estimate prepared by Ask an Adjuster, LLC. (Please see attached Exhibit J). The next day, on March 17, 2023, State Farm sent correspondence to Krapf Legal, containing instructions on how to access the requested “Loss Run Statement.” (Please see attached Exhibit K). On March 20, 2023, Mr. Krapf filed a second Civil Remedy Notice on your behalf. The next day, on March 21, 2023, State Farm sent a certified copy of the subject policy to Krapf Legal. (Please see attached Exhibit L). On March 27, 2023, State Farm responded to your NOIL, maintaining its coverage determination. (Please see attached Exhibit M). The same day, State Farm sent confirmation of its coverage determination to you under separate cover. (Please see attached Exhibit N). On April 18, 2023, Mr. Krapf filed a Breach of Contract lawsuit against State Farm, on your behalf. On May 3, 2023, State Farm responded to your first Civil Remedy Notice. On May 15, 2023, Mr. Krapf filed the attached third Notice on your behalf. On May 17, 2023, State Farm responded to your second Civil Remedy Notice. As the above-referenced facts demonstrate, there is no support for your allegations against State Farm, and State Farm has properly handled this claim and treated you fairly in its adjustment. Florida Statute §624.155 requires specificity in Civil Remedy Notices. Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So. 2d 1278 (Fla. 2000); Julien v. United Prop. & Cas. Inc. Co., 2021 Fla. App. LEXIS 3131 (Fla. 4th DCA 2021). Your Notice lacks any specific information in support of any of its allegations. For example, your Notice alleges that State Farm has “committed the following: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of insurer before that of the policyholder and Claimant; 3) not adjusting the claims promptly and fairly; 4) not attempting in good faith to settle claims; 5) looking for ways to delay benefit payments; 6) requesting a re-inspection only after the Claimants retained a public adjuster; 7) shifting the burden of investigating the loss onto the Claimants; 8) conducting inadequate investigations; 9) making material misrepresentations of the coverage afforded under the insurance policy; 10) denying a claim which it knew or should have known the policy and Florida law provide coverage for; and 11) failing to timely provide a loss run statement.” After providing this laundry list of allegations, you provide no information whatsoever to show how State Farm possibly performed these behaviors. State Farm appropriately and in good faith handled your claim. As you provide no information to the contrary, your Notice fails to meet its statutory purpose of providing an insurer with the opportunity to resolve legitimate disputes. Lane v. Westfield Ins. Co., 862 So. 2d 774, 779 (Fla. 5th DCA 2003); Julien v. United Prop. & Cas. Inc. Co., 2021 Fla. App. LEXIS 3131 (Fla. 4th DCA 2021). Accordingly, State Farm denies these unfounded allegations. In another long laundry list of allegations, you allege that State Farm’s actions “amount to but are not limited to the following: claim denial; not treating the policyholder with good faith claims conduct; looking for ways to reduce recovery to the Claimant; looking for ways to deny recovery to the Claimant; not adjusting claims and evaluating the loss properly, promptly, and fairly to provide full and prompt indemnity to the Claimant; not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interest before the policyholders interests; conducting inadequate investigations; ” After listing these bold allegations, you, again, fail to provide any information to support any of them. As such, your Notice again fails to meet its statutory purpose of providing an insurer with the opportunity to resolve legitimate disputes. Lane, 862 So. 2d 774; Julien, 2021 Fla. App. LEXIS 3131. Additionally, the facts shown above contradict most of these claims specifically, as State Farm did not delay your claim, did not cause you to investigate your own loss, did not look for ways to reduce your recovery, etc. State Farm denies each and every one of these unsupported allegations. You also allege that State Farm sent Claimant, “a wrongful denial letter” and “wrongfully stating that the roof was not caused by a covered cause of loss.” The facts above and exhibits attached clearly debunk these false allegations and demonstrate the boilerplate nature of this filing. Moreover, you have not demonstrated how or why you believe State Farm’s determination was incorrect. Your Notice further states that State Farm “intentionally ignored covered damage to deny the reported loss and wrongfully failed to pay the Claimant. This is an underhanded attempt to place the financial interests of the Insurer over those of the Claimant and to delay and frustrate the Claimants ability to have his claim adjusted promptly to begin restoring his property.” Incredibly, you provide no information whatsoever to support your allegation that State Farm has conspired against you and produced an inaccurate estimate. The facts of your claim clearly show that was not the case, as State Farm completed a full investigation of your claim, reviewed the documents submitted by your public adjuster, and fairly determined that there was no coverage for your claim. Considering you provide no support for this allegation; your Notice fails to meet its statutory purpose of providing an insurer with the opportunity to resolve legitimate disputes. Lane, 862 So. 2d 774; Julien, 2021 Fla. App. LEXIS 3131. Accordingly, State Farm denies this allegation. Your Notice also alleges that State Farm “failed to conduct an adequate investigation”. However, you do not explain how State Farm somehow failed to conduct a thorough investigation or what parts of the investigation were not adequate, other than suggesting that “the adjuster failed to use a water meter”. Additionally, you claim that State Farm “significantly underestimated the scope of the loss to the Insureds’ property.” But the facts show that State Farm completed its handling of your claim in good faith and investigated all claimed damages to the best of its ability. The coverage determination correspondence was clear as to the reasons why the claimed damages were not covered under your policy. Considering you provide no support for these allegations related to your claim in any way, besides plainly stating damages to your property were due to wind, your Notice fails to meet its statutory purpose of providing an insurer with the opportunity to resolve legitimate disputes. Lane, 862 So. 2d 774; Julien, 2021 Fla. App. LEXIS 3131. State Farm denies these allegations. Lastly, you allege that State Farm violated Florida Statutes §§ 624.155(1)(b)(1); 624.155(1)(b)(3); 626.9541(1)(i)(2); 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b); 626.9541(1)(i)(3)(g) and 626.9541(1)(i)(3)(h). As has already been a problem with your Notice, you provide no information to support State Farm having violated these statutes, including how it somehow made material misrepresentations about your claim. Your Notice fails to meet its statutory purpose of providing an insurer with the opportunity to resolve legitimate disputes. Lane, 862 So. 2d 774; Julien, 2021 Fla. App. LEXIS 3131. State Farm denies violating any Florida Statutes in its adjustment of your claim. There is no support for your allegations against State Farm and State Farm denies that this claim has been handled in bad faith or unfairly. State Farm hereby denies each and every allegation against it as put forth in your Notice. State Farm has in the past, and is still continuing at the present time, to make all efforts to promptly resolve this claim in a fair and reasonable fashion and in full accord with the insurance policy and Florida law.
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