Civil Remedy Notice of Insurer Violations
Login

Filing Number:     708669
Filing Accepted:  8/1/2023
         Print Filing
Complainant
Last/Business Name *  
SANCHEZ   First Name   DAVID
Street Address * 5240 WATERVISTA DRIVE
City, State Zip * ORLANDO, FL 32821
Email Address * CLAY@THEKRFIRM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   SANCHEZ   First Name   DAVID
Policy # * AL01-159958-02 Claim #* SWYCBHO29003
Attorney
Attorney is Applicable
Last Name* CLARK First Name * PAMELA Initial
Street Address* 2110 WEST PLATT STREET
City, State Zip* TAMPA , FLORIDA 33606
Email Address * CLAY@THEKRFIRM.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   CLEAR BLUE INSURANCE COMPANY
NAIC Company Code 28860
 
Name of individual responsible for violation (if any):* ANY AND ALL PERSONS ASSOCIATED WITH THE CLAIMS HANDLING FROM CLEAR BLUE INSURANCE COMPANY
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
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.
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)(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.

THE POLICY LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE LOSS PAYMENT AND COVERAGE PROVISIONS OF POLICY NUMBER AL01-159958-02, INCLUDING THE DECLARATIONS PAGE AND ALL ENDORSEMENTS TO THE POLICY, WITH RESPECT TO COVERAGES A, B, C, AND D. ADDITIONALLY, ANY SECTIONS RELIED UPON BY THE INSURER IN ITS DENIAL TO FULLY PAY THE CLAIM, INCLUDING THE DUTIES IN THE EVENT OF LOSS PROVISIONS AND THE POLICY'S EXCLUSION OF COVERAGE PROVISIONS.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

David Sanchez (hereinafter “Insured”) is a homeowner insured with an all-risks policy issued by Clear Blue Insurance Company (hereinafter “Carrier”). On or about September 28, 2022, Insured’s home located at 5240 Watervista Drive, Orlando, Florida 32821 sustained significant damage as a result of windstorm. Specifically, Hurricane Ian created multiple openings to the roof of Insured’s property. This resulted in interior water damage to various areas of the interior of Insured’s property including but not limited to, the dining room, living room, staircase ceiling, kitchen, family room, and hallway. The Loss is covered under Insured’s policy issued by Carrier. Insured promptly reported the claim and fully cooperated with all requests for inspections. Carrier assigned Claim No. SWYCBHO29003 to the loss. The Insured has fully cooperated with Carrier’s investigation of the claim, including providing all requested documentation and complying with all post-loss policy conditions. Specifically, the Insured, with assistance from their public adjuster, submitted an estimate for $117,338.85, which is a fair and reasonable assessment for the repair/replacement of damages. After reporting the claim, Carrier retained an unqualified and biased engineer, Allan Varnes with Root Cause Consulting, to adjust the loss. This engineer had a financial incentive to adjust the loss in a manner that would minimize Carrier’s losses. This engineer performed a mere cursory inspection of the property on December 14, 2022. Instead of adjusting the claim fairly, honestly, in good faith, and with due regard for the Insured’s interests, this adjuster made a conscious effort to ignore evidence of covered losses to the property. Despite Insured providing Carrier with a detailed estimate, Carrier failed to pay Insured the amount necessary to repair/replace the damaged property, less the applicable deductible. Instead, Carrier wrongfully denied full coverage for the loss. This has become a common business practice for Carrier. Under the circumstances surrounding this claim, had Carrier acted fairly and honestly toward the Insured and with due regard for the Insured’s interests, Carrier could and should have attempted in good faith to settle this claim. Carrier did not and, instead, dishonestly, and unfairly placed its own interests well ahead of those of the Insured. In doing so, Carrier violated Section 624.155(1)(b)(1), Florida Statutes. Carrier’s use of unqualified and biased adjusters, and failure to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to adopt and implement standards for the proper investigation of claims in violation of Section 626.9541(1)(i)(3)(a), Florida Statutes. Carrier’s use of unqualified and biased adjusters necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to conduct a reasonable investigation based upon available information. In denying full coverage for this claim without conducting reasonable investigations based upon available information, Carrier has violated Section 626.9541(1)(i)(3)(d), Florida Statutes. By representing to Insured that the Policy does not afford full coverage for this loss, Carrier is misrepresenting pertinent facts and/or insurance policy provisions relating to coverages at issue, in violation of Section 626.9541(1)(i)(3)(b), Florida Statutes. When applying the facts present here to Florida law, it is clear that Carrier is acting in bad faith. Florida Statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit based on determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. Carrier has breached this duty by refusing to properly and timely adjust the loss. Moreover, Section 69B-220.201 of the Florida Administrative Code defines Carrier’s adjusters conduct here as an unfair claims settlement practice. Specifically, Section 69B-220.201(3) provides that “[a]n adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured” and that “[a]n adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.” As detailed above, Carrier’s investigation and adjustment of this claim was done in a manner prejudicial to Insured, was incomplete, and lacked truthful and unbiased reports of the facts. Carrier has more than enough information and is still refusing to accept coverage for the Insured’s claim. This continued and repeated reckless claim delay and denial of coverage will result in a significant punitive damage award if a bad faith lawsuit is filed. Carrier can cure the defects outlined in this Civil Remedy Notice and avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy for this claim and by paying Insured’s estimate of damages $117,338.85, less applicable deductible, which is the reasonable amount of the covered loss pursuant to the policy. A copy of this form has been submitted to the Florida Department of Financial Services who has transmitted the same to the following parties providing them notice of the filing of this Civil Remedy Notice: Clear Blue Insurance Company
Comments
User Id Date Added Comment
dshead@glasgowlawfirm.com 09-01-2023 September 1, 2023 VIA ELECTRONIC FILING Department of Financial Services Bureau of Consumer Assistance Civil Remedy Department State of Florida 200 East Gaines Street Tallahassee, Florida 32399 Re: Response to Civil Remedy Notice of Insurer Violation Complainant: David Sanchez Insureds: David Sanchez Insurer: Clear Blue Insurance Company Policy No.: AL01-159958-02 Claim No.: SWYCBHO29003 DFS File No.: 708669 File Acceptance Date August 1, 2023 To Whom It May Concern: Please allow this correspondence to serve as Clear Blue Insurance Company formal response to Complainant David Sanchez (“Complainant”) Civil Remedy Notice of Insurer Violations (“CRN”), which was filed with the Florida Department of Financial Services on August 1, 2023. At the outset, please be advised that Clear Blue Insurance Company denies each allegation set forth in the CRN, either explicitly or implicitly, and denies any wrongdoing in the handling of Claim No. SWYCBHO29003. At all times relevant to this matter, Clear Blue Insurance Company has acted fairly and with due diligence in its handling of this claim. In the instant CRN, the Complainant alleges that Clear Blue Insurance Company violated the several Florida statutes during its handling of Claim No. SWYCBHO29003. However, the instant CRN does not identify any specific acts or omissions by Clear Blue Insurance Company. Further, the instant CRN does not identify any specific acts or omissions by Clear Blue Insurance Company which allegedly constitute a violation of the listed statutes. In Florida, a civil remedy notice must state the facts and circumstances that give rise to an alleged violation with sufficient specificity to allow an insurer to cure the alleged violation within the sixty-day statutory period. Lane v. Westfield Insurance Company, 862 So.2d 774 (Fla. 5th DCA 2003), Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278 (Fla. 2000). As the instant CRN fails to meet this threshold, it must fail. Furthermore, the instant CRN does not identify any provisions of the applicable Clear Blue Insurance Company insurance policy which were allegedly violated and it does not identify what specific acts or omissions by Clear Blue Insurance Company which allegedly constitute a violation of the applicable insurance policy. Florida law requires that a complainant identify any specific policy language relevant to a claimed violation as well as any specific acts which purportedly violate said policy provisions. Id. As the instant CRN fails to identify any provisions of the applicable Clear Blue Insurance Company insurance policy which were allegedly violated, it does not meet the requirements set forth under applicable Florida law, and must fail. As noted above, Clear Blue Insurance Company maintains that it complied with all applicable Florida statutes in its investigation and/or adjustment of this claim and would deny all allegations to the contrary. Because Clear Blue Insurance Company has acted in good faith at all times during the investigation and/or adjustment of the subject claim, and because it wishes to dispel even the inference of any violation, it felt it instructive to provide a brief summary of the pertinent claim history below. The Complainant reported that the subject property sustained damage as a result of Hurricane. Following its investigation of the claimed damage, Clear Blue issued its coverage position in accordance with the terms and conditions of the subject policy. As demonstrated in this recitation of the pertinent claim history, Clear Blue Insurance Company acted in good faith and complied with all applicable Florida statutes in its investigation and/or adjustment of Claim No. SWYCBHO29003. To the extent that this reply does not fully address or respond to the allegations set forth in the CRN, such deficiency is a direct result of the lack of specificity and the overall vague nature of the allegations contained therein. Notwithstanding, Clear Blue Insurance Company states that the above facts demonstrate that it has at all times acted in good faith and wholly denies that it acted otherwise at any time during the investigation and/or adjustment of the subject claim. To the extent that the additional information regarding this matter is required, please do not hesitate to contact us. Thank you. Very truly yours, /s/ Gina S. Glasgow Gina S. Glasgow GSG/ds
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