Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 774775

Filing Accepted: 7/25/2024

Print Filing

Complainant

Last/Business Name *

KABDEBO

First Name

DANIELLE AND SIMON

Street Address *

6179 57TH COURT

City, State Zip *

VERO BEACH, FL 32967

Email Address *

STRADEBO1@GMAIL.COM

Complainant Type: *

Insured

Last/Business Name*		KABDEBO		First Name		DANIELLE AND SIMON
Policy # *		FPH3-000112616		Claim #*		01000108418

Attorney

Attorney is Applicable

Last Name*	GELBER First Name * MATTHEW Initial
Street Address*		2385 NW EXECUTIVE CENTER DRIVE, SUITE 100
City, State Zip*		BOCA RATON , FL 33431
Email Address *		MATT@GELBERLAWGROUP.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		FIRST PROTECTIVE INSURANCE COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 10897

Name of individual responsible for violation (if any):* TRAVIS CLINE; BILL PETERS; YVONNE SAMUELS; EVELYN MERCHANT, ESQ.
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Denial
	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.

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

§627.70152 (4)(b) - If an insurer is responding to a notice provided to the insurer alleging an act or omission by the insurer other than a denial of coverage, the insurer must respond by making a settlement offer or requiring the claimant to participate in appraisal or another method of alternative dispute resolution. The time limits provided in s. 95.11 are tolled as long as appraisal or other alternative dispute resolution is ongoing if such time limits expire during the appraisal process or dispute resolution process. If the appraisal or alternative dispute resolution has not been concluded within 90 days after the expiration of the 10-day notice of intent to initiate litigation specified in subsection (3), the claimant or claimant’s attorney may immediately file suit without providing the insurer additional notice. §627.70131(7)(a) - Within 90 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer which reasonably prevent such payment. The insurer shall provide a reasonable explanation in writing to the policyholder of the basis in the insurance policy, in relation to the facts or applicable law, for the payment, denial, or partial denial of a claim. If the insurer’s claim payment is less than specified in any insurer’s detailed estimate of the amount of the loss, the insurer must provide a reasonable explanation in writing of the difference to the policyholder. Any payment of an initial or supplemental claim or portion of such claim made 90 days after the insurer receives notice of the claim, or made more than 15 days after there are no longer factors beyond the control of the insurer which reasonably prevented such payment, whichever is later, bears interest at the rate set forth in s. 55.03. Interest begins to accrue from the date the insurer receives notice of the claim. The provisions of this subsection may not be waived, voided, or nullified by the terms of the insurance policy. If there is a right to prejudgment interest, the insured must select whether to receive prejudgment interest or interest under this subsection. Interest is payable when the claim or portion of the claim is paid. Failure to comply with this subsection constitutes a violation of this code. However, failure to comply with this subsection does not form the sole basis for a private cause of action. §627.70131(3)(d) Within 7 days after the insurer’s assignment of an adjuster to the claim, the insurer must notify the policyholder that he or she may request a copy of any detailed estimate of the amount of the loss generated by an insurer’s adjuster. After receiving such a request from the policyholder, the insurer must send any such detailed estimate to the policyholder within the later of 7 days after the insurer received the request or 7 days after the detailed estimate of the amount of the loss is completed. This paragraph does not require that an insurer create a detailed estimate of the amount of the loss if such estimate is not reasonably necessary as part of the claim investigation. Agreement: We will provide the insurance described in this policy in return for the premium and compliance with all applicable provisions of this policy… SECTION I - PROPERTY COVERAGES COVERAGE A – Dwelling: 1. We cover: a. The dwelling on the "residence premises" shown in the Declarations, including structures attached to the dwelling; b. Materials and supplies located on or next to the "residence premises" used to construct, alter or repair the dwelling or other structures on the "residence premises;"… 1. Debris Removal b. We will also pay your reasonable expense, up to $1,000, for the removal from the “residence premises” of: (1) Your trees felled by the peril of Windstorm or Hail or Weight of Ice, Snow or Sleet… (3) Damage a covered structure;… COVERAGE B – Other Structures: 1. We cover other structures on the “residence premises” SECTION I. PERILS INSURED AGAINST COVERAGE A - DWELLING and COVERAGE B - OTHER STRUCTURES We insure against risk of direct loss to property described in Coverages A and B only if that loss is a Physical loss to property… A. Coverage A – Dwelling And Coverage B – Other Structures 1. We insure for sudden and accidental direct physical loss to covered property described in Coverages A and B unless the loss is otherwise excluded or limited in this policy… SECTION I- CONDITIONS… D. Loss Settlement We will settle covered property losses according to the following, unless otherwise stated in this policy… In this Condition D., the terms “cost to repair or replace” and “replacement cost” do not include the increased costs incurred to comply with the enforcement of any ordinance or law, except to the extent that coverage for these increased costs is provided in E. 11. Ordinance Or Law under Section I – Property Coverages. Covered property losses are settled as follows: … 2. Coverage A – Dwelling, at the actual cost to repair or replace. We will initially pay the actual cash value of the loss, less any applicable deductible. We will then pay any remaining amounts necessary to perform the actual repair or replacement as work is performed and expenses are incurred… a. If, at the time of loss, the amount of insurance in this policy on the damaged building is 80% or more of the full replacement cost of the building immediately before the loss, we will initially pay the actual cash value of the loss, less any applicable deductible. We will then pay any remaining amounts necessary to perform the actual repair or replacement as work is performed and expenses are incurred, but not more than the least of the following amounts: (1) The limit of liability under this policy that applies to the building; (2) The replacement cost of that part of the building damaged with material of like kind and quality and for like use; or (3) The necessary amount to repair or replace the damaged building… b. If, at the time of loss, the amount of insurance in this policy on the damaged building is less than 80% of the full replacement cost of the building immediately before the loss, we will pay the greater of the following amounts, but not more than the limit of liability under this policy that applies to the building: (1) The actual cash value of that part of the building damaged; or (2) That proportion of the cost to repair or replace, without deduction for depreciation, that part of the building damaged, which the total amount of insurance in this policy on the damaged building bears to 80% of the replacement cost of the building. d. We will pay no more than the actual cash value of the damage until actual repair or replacement is complete. Once actual repair or replacement is complete, we will settle the loss as noted in 2.a. and b. above. However, if the cost to repair or replace the damage is both: (1) Less than 5% of the amount of insurance in this policy on the building; and (2) Less than $2,500; we will settle the loss as noted in 2.a. and b. above whether or not actual repair or replacement is complete…

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

The Complainants and Insureds, Danielle Kabdebo and Simon Kabdebo (collectively referred to as “Insureds” or “Complainants”), file this Civil Remedy Notice (“Notice”) in order to perfect the right to pursue the civil remedy authorized by this section. The Complainants maintained a homeowner’s policy of insurance (“Policy”) with First Protective Insurance Company DBA Frontline Insurance (“INSURER”) to the insured property located at 6179 57th Ct, Vero Beach, FL 32967 (“Property”), which provided coverage for their sudden and accidental damages associated with the direct physical loss caused by hail/wind, which resulted in ensuing damages and losses (“Loss”) on or about April 21, 2023. The Loss caused substantial, direct, and consequential damages, and INSURER’s general business practice of willful, wanton, immoral, deceptive and bad faith claim handling policies, procedures, guidelines, protocol, adjusting, investigating, drawing valuations and issuing payment (or lack thereof) has caused the Insureds to suffer further harm and extra-contractual damages which have accrued, and will continue to accrue. The stated misconduct is collectively referred to as “Bad Faith”, and the specific factual and/or legal consideration in relation thereto are further outlined below for their consideration in accordance with Fla. Stat. Sec. 624.155 and the cited legal authorities associated therewith. The INSURER has breached this duty by its adjustment of its Insureds’ claim of loss. The Insurer’s handling and adjustment of its Insureds’ claims of loss and the conduct of the adjusters, supervisors, management and individuals associated with or retained by the Insurer in this claim to date evidences that the Insurer has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees resulting in statutory violations set forth above. The Insurer has also failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim for damages. To date, notwithstanding the Insureds’ pleas for assistance, the Insurer has refused to pay the full amount of its Insureds’ claim. On or about January 16, 2024, the Complainants realized they had damage to the Subject Property caused by a wind/hail storm. They were able to make this determination because the Insureds saw staining to the ceiling of many areas of the home. It was at this point that they immediately hired a public adjuster to assist them with reporting the claim to the Insurer, and the Insurer assigned an independent adjuster by the name of Travis Cline to inspect the Subject Property. Mr. Cline is a young and inexperienced adjuster, who received his 6-20 All Lines license around June of 2022 – just eighteen months prior to inspecting this loss. On January 24, 2024, Mr. Cline inspected the property and on or about the same date finalized an estimate for damages in the amount of $378.07 prior to application of the Policy’s $1,000.00 all other perils deductible and removal of depreciation. Mr. Cline has acted in bad faith due to his inability to address glaring damages, likely due to his inexperience, or, even worse, taking directives from the Insurer to avoid including scope for covered damages. On February 24, 2024, the Insurer preformed another inspection of the Subject Property by an outcome-oriented engineer whose sole client-base is similar Insurers. The Public Adjuster provided the Insurer with an Estimate of Damages in the amount of $181,756.68 Replacement Cost Value and $181,199.08 Actual Cost Value prior to application of the Policy’s deductible. On or about March 7, 2024 the Complainants submitted a Sworn Proof of Loss in the amount of $180,756.68 to the Insurer. On May 31, 2024, one hundred and thirty-five (135) days after the claim was reported, the Insurer sent written correspondence with the coverage determination partially denying the claim due to the damages being under the applicable deductible, authored by Bill Peters. It is worth noting that the May 31st partial denial letter contained the wrong Insureds’ name in the opening sentence (It addressed a “David Hillaker and Cheryl Hillaker” and not the named Insureds), which appears to be a boilerplate denial letter used to deny many similar claims. Mr. Peters has acted in bad faith by copy and pasting boilerplate denials and failing to further investigate the loss, as well as failing to provide the engineer report he references in this denial letter. This excessive delay in paying or denying such claim is a violation of Florida Statute Section 627.70131(7)(a) delineating the Insureds’ right to receive a determination or payment within 90 days of making claim. In its determination, the INSURER failed to cover substantial areas of clearly delineated Loss and relied upon its own estimate for damages totaling $378.07, which conveniently fell short of the Policy’s $1,000 all other perils deductible, and dramatically underestimated the Insureds’ Sworn Proof of Loss as well as estimates and invoices provided by the Insureds, stating that “the loss of $378.07 is less than the policy deductible of $1,000.00. As a result, we are not able to extend payment at this time and will take no further action on your claim.” Nevertheless, it is abundantly clear that as of this May 31, 2024 correspondence, the Insurer had completed its investigation of the loss and prepared an estimate in accordance with its coverage position. It is also abundantly clear that the Insurer had all of the documentation it needed in its possession in order to make its final coverage decision for this Claim, and that no pending investigation was required at this time. Accordingly, on June 12, 2024, the Complainants were forced to file a Notice of Intent to Initiate Litigation (“NOIL”) in an attempt to have the Insurer properly perform under the Policy and fully pay for the damages due to the covered loss. However, the Insurer has refused to pay for the ensuing losses. On June 21, 2024, after receiving this NOIL, the Insurer issued a Reservation of Rights letter to the Insureds asking for additional information and clarification for documents that were sent by the Insureds’ public adjuster back in February 21, 2024, authored by Yvonne Samuels. Notably, Florida Statute Section 627.70152(4)(b) only allows for three responses to this NOIL: making a settlement offer or requiring the claimant to participate in appraisal or another method of alternative dispute resolution. In fact, the lead-in language of said statute says that the Insurer “must” respond in the aforementioned manner, which would necessarily indicate that no other response would be appropriate. On June 25, 2024, in response to the June 12th NOIL, the Insurer requested the Complainants attend mediation – which is one of the prescribed responses to the NOIL – but also required the Complainants attend an Examination Under Oath prior to said mediation – which is not one of the prescribed responses to the NOIL, authored by Yvonne Samuels and subsequent correspondence supporting same by attorney Evelyn Merchant. Further, on June 28, 2024, the Insurer sent additional correspondence to the Insureds requesting a reinspection of the Subject Property with a General Contractor, Ed Andrie authored by Yvonne Samuels. As mentioned previously, this is not one of the prescribed responses to the NOIL. All these extra steps have been taken by the Insurer post coverage decision and should have been performed during the initial adjustment of the claim prior to making its final coverage decision. Ms. Samuels has acted in bad faith by taking direction to further investigate the loss after the coverage investigation has concluded for this Claim. She is doing so by the bad faith conduct and instruction of attorney Evelyn Merchant, who should know that Florida Statute 627.70152 does not allow for the Insurer to act in this regard. The Insurer is acting in bad faith by requiring the Insureds to go through these additional processes. The Insurer had all the information necessary to fully adjust the claim and, in fact, afford coverage to the Insureds for the loss, albeit less than the amount that should have been issued. The legislative intent of Florida Statute Section 627.70152 was merely to provide the Insurer for one last opportunity to pay the claim before a lawsuit was served – it was not enacted to allow the Insurer to continue to adjust the claim, especially considering the fact that the Insurer had issued its coverage decision in this case. This Insurer has engaged in a business practice of continuing to force the Insureds to participate in post-coverage decision requests, or risk forfeiting coverage. This Insurer has been acting in this manner on nearly every single NOIL served upon it by requesting Examination Under Oaths, re-inspections for covered losses, requiring Sworn Proofs of Loss, and requiring the Insureds to provide documentation despite the fact that the adjustment has been concluded. The Complainants plead with the State to open an investigation into this Insurer on similar Civil Remedy Notices where these types of allegations have been made. It took the Insurer one hundred and thirty-five (135) days to make this measly coverage decision, but now that it is faced with litigation, it realized it needs more information to continue to support its wrongful partial denial. This cannot and will not be tolerated. The INSURER’s “tool box” of Bad Faith claims handling practices as described above leaves insureds, the insured’s counsel, the INSURER’s counsel, and even the judiciary, guessing as to when and how the INSURER will duly perform. The continuously vacillating positions and cherry picking of the generally described Bad Faith claims handling practices not only serves as vehicle of maximizing the INSURER’s prospective financial gains by being able to avoid paying benefits owed in full to insureds such as the Complainant, it also serves to minimize the INSURER’s overall loss adjusting expense as they see fit and to the invariable detriment of its insureds, the Complainant, and ultimately the tax paying Citizens of this State that bear the expense and burden upon the judicial system which needs to unravel the tangled web created by INSURER. The INSURER’S refusal to properly investigate, adjust, and fully compensate the Complainant for its claim undoubtedly evidences the INSURER’S violation of section 626.9541(1)(i)(3)(a), Florida Statutes, which requires the INSURER to “adopt and implement standards for the proper investigation of claims.” All available information leads to one conclusion—the Insureds’ property was damaged by a covered cause of loss for which the Insureds are entitled to full and complete compensation. The INSURER’S obligation to promptly settle the Insureds’ claim is undeniable, and therefore, the INSURER has also violated section 624.155(1)(b)(1), Florida Statutes. In taking one-hundred and thirty-five days to make its coverage decision for this claim without advising what additional documentation it needed to do so, the Insurer violated Florida Statute Section 627.70131(7)(a), which states that within 90 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer which reasonably prevent such payment. The actions taken by the INSURER in the handling and adjustment of the Insured’s claim are willful, wanton, and in disregard for the rights of the Insured. The Insurer, in issuing correspondence requesting documentation, a re-inspection, and an Examination Under Oath, citing to the Conditions and Duties After Loss sections of the Policy, is violating Florida Statute Section 626.9541(1)(i)(3)(b), in misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. The INSURER’S actions amount to, but are not limited to: A. “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 the insured and with due regard for her or his interests;” B. “Failing to adopt and implement standards for the proper investigation of claims;” C. “Denying claims without conducting reasonable investigations based upon available information;” D. “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;” E. Claim Delay; F. Claim Denial; and G. Unfair Trade Practices. In Florida, the work of adjusting insurance claims engages the public trust. During the adjustment of the Insureds’ claim, the INSURER breached this duty by failing to adhere to and comply with the above referenced obligations. To cure the defects outlined above, the INSURER must: A. Act fairly and honestly towards the Insureds and with due regard for its interests; B. Hire a fair an unbiased adjuster to properly assess the Insureds’ damages; C. Tender all insurance proceeds due and owing to the Insured that would reasonably place the Insureds back into a pre-loss condition; D. Immediately issue payment for statutory interest for the late payments and owed profit and overhead; E. Timely adjust the claim with the Insureds and avoid/limit any additional delay, costs, and prejudice that the INSURER’S conduct above has caused and continues to cause the Insured; including providing a copy of the Insurance Company’s estimate; and F. Create and implement adequate guidelines for the proper investigation and evaluation of Hail/Wind claims, and for the training and supervision of employees with regard to these claims to ensure that the insurer’s claims handling procedures are adequate to stop further insureds from being treated unfairly and wrongfully. To further cure the above stated general business practices of Bad Faith claims handling practices that are willfully, wantonly and/or with a reckless disregard for the Insureds’ interests being implemented as a general business practice, the INSURER must immediately agree to the appraisal process and immediately tender all payments in accordance with the appraisal award upon receipt. In Florida, the work of adjusting insurance claims engages the public trust. During the adjustment of the Insured’s claim, the INSURER breached this duty by failing to adhere to and comply with the above referenced obligations. To further cure the above stated immoral, deceptive, unlawful and collectively defined general business practice of Bad Faith claims handling practices that are knowingly, willfully, wantonly and/or with a reckless disregard for the Insureds’ interests being implemented as a general business practice, the INSURER must immediately cancel the Examination Under Oath and any pending re-inspection and/or document requests, and pay the actual cash value for all covered damages, within 60 days of receiving this Complaint, which is the total of the public adjuster’s estimate.

Comments

User Id		Date Added		Comment
emerchant@berklawfirm.com		08-27-2024		First Protective Insurance Company d/b/a Frontline Insurance denies any and all allegations of wrongful conduct and statutory violation alleged in the CRN. A detailed response to the CRN was sent via e-mail to the Insureds c/o counsel of record. The Department may contact us for further details.

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