Civil Remedy Notice of Insurer Violations
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Filing Number:     699456
Filing Accepted:  6/9/2023
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Complainant
Last/Business Name *  
GRACIELA HARRIS AND ERNEST LAWRENCE HARRIS V   First Name  
Street Address * 16307 SW 48TH ST
City, State Zip * MIRAMAR, FL 33027
Email Address * GRACE.TERE@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   GRACIELA HARRIS AND ERNEST LAWRENCE HARRIS V   First Name  
Policy # * 80CPP3557 Claim #* 59-36Q6-59X
Attorney
Attorney is Applicable
Last Name* GIBBONS ESQ. First Name * SHAWN Initial
Street Address* 925 S. FEDERAL HWY
City, State Zip* BOCA RATON , FL 33432
Email Address * SGIBBONS@KPATTORNEY.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):* ANTHONY HATCHER
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
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.

It is clear that the carrier is not treating the insured 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 insured; 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 insured 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 insured, 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 $75,783.52; 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 Madeline Batista at (561) 892-9831 if you have any questions or concerns. Sincerely, Shawn Gibbons, Esq. Attorney at Law
Comments
User Id Date Added Comment
admin@bernstein-chackman.com 08-01-2023 Dear Mr. Gibbons: This letter is to advise you that my firm represents State Farm Florida Insurance Company (hereinafter “State Farm”) in the matter referenced above. This shall serve as State Farm’s response to civil remedy notice number 699456, which was submitted to the Department of Financial Services on behalf of Graciela and Ernest Lawrence Harris which was submitted to the department on June 9, 2023. The civil remedy notice states that State Farm violated §624.155 and §626.9541 by doing the following: not attempting in good faith to settle claims; failing to promptly settle claims; failing to adopt standards for proper claim investigation; and other alleged wrongdoings. State Farm denies all allegations of wrongdoing or violation of Florida Law. State Farm has acted in accordance with Florida law and the subject policy in its handling of this claim. Additionally, the civil remedy notice fails to comply with the requirements of Florida Statute §624.155. State Farm does not waive any deficiencies in the civil remedy notice with the filing of this response. The notice neglects to include facts which demonstrate that State Farm violated Florida law, fails to identify the specific policy language that was allegedly violated, or include a reasonable cure for the alleged violations. The purpose of the civil remedy notice is to grant the insurer an opportunity to cure the alleged violations of Florida law. Therefore, complainants must identify the specific policy provisions and statutory language that were violated. In addition, complainants must identify what actions the insurer did that violated such provisions and identify what actions must be taken to cure the violations. As such, Florida Statute §624.155(3)(b) states: 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: 1. The statutory provision, including the specific language of the statute, which the authorized insurer allegedly violated. 2. The facts and circumstances giving rise to the violation. 3. The name of any individual involved in the violation. 4. 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 insurer has not provided a copy of the policy to the third party claimant pursuant to written request. 5. A statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. In this instance, civil remedy notice 699456 does not include specific facts and circumstances that demonstrate a violation as required by §624.155(3)(b)(2). The notice contains conclusory allegations that State Farm improperly and insufficiently adjusted the claim. As such, the notice fails to comply with §624.155(3)(b)(4). See Talat Enters. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278 (Fla. 2000) & Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). This claim was reported to State Farm on July 14, 2021 with an alleged date of loss of July 12, 2021. Your clients are claiming that they need a complete roof replacement. Cristian Cortes initially inspected the property on August 29, 2022. The first inspection related to the interior of the home since it was raining. Cortes observed a small spot in the 2nd floor bedroom that appeared to be mold. He observed prior repairs in the master bedroom with no water stains noted. He noted damage to other portions of the ceiling that were not consistent with water. He noted water damage to the entry ceiling. On September 19, 2022 he was able to inspect the roof. He noted that the home is 2 stories and that the roof is 19 years old. He did not observe any storm related damage. He observed normal wear/tear, damages from footfall, thermal expansion, and contraction. He also observed prior repairs to the roof. This claim was denied by letter dated September 21, 2022. The denial letter mentions the above observations. The claim determination letter states: “Based upon the results of our discussions, site inspection, and investigation, it was determined no storm related damage was observed to the roof or elevations of your home. Therefore, coverage will not be extended for the roof or elevations. Inspection of the interior revealed long term, repeated water leaks and mold. At the inspection, we observed prior repairs, wear, tear, and deterioration from exposure to sunlight, heat, thermal expansion/contraction, foot fall, and normal weather conditions over time to the roof and elevations of the dwelling.” Subsequent to the denial of the claim, you submitted this Civil Remedy Notice and a Notice of Intent to Initiate Litigation to the department. However, you have not provided anything that would change State Farm’s position of the claim. State Farm denies all allegations of non-compliance with Florida law or the subject policy. Furthermore, the civil remedy notice is deficient in that it does not comply with the requirements of Florida Statute §624.155(3)(b). State Farm does not waive any such deficiencies in the filing of this response. Regardless, the accusations raised within the notice are devoid of merit. Thank you for your attention to the above. Very truly yours, /s/ Brian A. Chackman Brian A. Chackman
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