Civil Remedy Notice of Insurer Violations
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Filing Number:     785230
Filing Accepted:  10/1/2024
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Complainant
Last/Business Name *  
ALEXER PARDO AND LUCIA RODRIGUEZ   First Name  
Street Address * 2701 GREEN MEADOW CIRCLE
City, State Zip * KISSIMMEE, FL 34741
Email Address * CLAY@THEKRFIRM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   ALEXER PARDO AND LUCIA RODRIGUEZ   First Name  
Policy # * 80-Q0-6091-5 Claim #* 59-65X7-25V
Attorney
Attorney is Applicable
Last Name* KUHN First Name * CLAYTON 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*   STATE FARM FLORIDA INSURANCE COMPANY
NAIC Company Code 10739
 
Name of individual responsible for violation (if any):* ANY AND ALL PERSONS ASSOCIATED WITH THE CLAIMS HANDLING FROM STATE FARM FLORIDA 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 80-Q0-6091-5 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.

Alexer Pardo and Lucia Rodriguez (hereinafter “Insureds”) are homeowners/property owners with an all-risk policy issued by State Farm Florida Insurance Company (hereinafter “Carrier”). On or about September 28, 2022, Insureds’ home located at 2701 Green Meadow Circle, Kissimmee, Florida 34741 sustained significant damage as a result of a windstorm. Specifically, Hurricane Ian created multiple openings to the roof of Insureds’ property. This resulted in interior water damage to various areas of the interior of Insureds’ property including but not limited to, the living room, kitchen, dining room, multiple bedrooms, and the garage. The Loss is covered under Insureds’ policy issued by Carrier. The Insureds mitigated damages by contacting Loss Restorations LLC who performed mitigation services on the subject property. All of the relevant documents were provided to Carrier. Insureds promptly reported the claim and fully cooperated with all requests for inspections. Carrier assigned Claim No. 59-65X7-25V to the loss. The Insureds have fully cooperated with Carrier’s investigation of the claim, including providing all requested documentation and complying with all post-loss policy conditions. Specifically, the Insureds, with assistance from their public adjuster, submitted an estimate for $54,289.59, which was a fair and reasonable assessment for the repair/replacement of damages. Loss Restorations LLC has an outstanding balance in the amount of $12,144.28 for their mitigation services. After reporting the claim, Carrier retained an unqualified and biased field adjuster to adjust the loss. This adjuster had a financial incentive to adjust the loss in a manner that would minimize Carrier’s losses. This adjuster performed a mere cursory inspection of the property on January 21, 2024. Instead of adjusting the claim fairly, honestly, in good faith, and with due regard for the Insureds’ interests, this adjuster made a conscious effort to ignore evidence of covered losses to the property. Worse still, Carrier failed to retain qualified experts necessary to identify the repairs necessary to restore the property to its pre-loss condition. Despite Insureds providing Carrier with a detailed estimate, Carrier failed to pay Insureds the amount necessary to repair/replace the damaged property, less the applicable deductible. Instead, Carrier 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 Insureds and with due regard for the Insureds’ 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 Insureds. In doing so, Carrier violated Section 624.155(1)(b)(1), Florida Statutes. Carrier’s use of unqualified and biased adjusters, and failure to retain experts necessary 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, and failure to retain experts 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 Insureds 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 Insureds, 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 Insureds’ 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 $54,289.59, and Loss Restorations LLC in the amount of $12,144.28, 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: State Farm Florida Insurance Company
Comments
User Id Date Added Comment
Nick@thekrfirm.com 05-14-2025 Please consider this CRN withdrawn as of May 14, 2025.
jgroves@conroysimberg.com 11-19-2024 Dear Sir/Madam: This correspondence shall serve as a formal response on behalf of State Farm Florida Insurance Company (hereinafter “State Farm”) to the Civil Remedy Notice of Insurer Violation (hereinafter “Notice”) filed by Clayton Kuhn, Esq. on behalf of Alexer Pardo and Lucia Rodriguez (hereinafter “Insured”). The Notice (Department Filing No.: 785230) was accepted by the Department of Financial Services on 10/1/24. I. The Notice fails to satisfy the requirements of Florida law and should be rejected As to the content of the Notice itself, it is important to note that the Notice is a nullity and should be rejected. The Notice fails to comply with the specific requirements mandated by Florida Statutes §624.155. Specifically, the Notice fails to comply with §624.155(3)(b)(2) and (4), Florida Statutes, which requires that the Notice state, with specificity, the facts and circumstances giving rise to the alleged violation(s), and reference the specific Policy language that is relevant to the violation. Rather than complying with this requirement, the Notice merely utilizes general and vague boilerplate language in an attempt to support various allegations that are factually unsubstantiated and taken together or individually, contradict the violations alleged in the Notice, failing to provide any support for the same. It is of the utmost importance to State Farm that it is provided an opportunity to respond to the concerns of its policyholders. However, the Notice provides nothing more than general statements regarding the rules and regulations governing insurance practice, and a lengthy list of statutes alleged to have been violated, but fails to allege any specific facts that demonstrate the alleged violations complained of by the Insured. The absence of specifics, presented for the first time in the Notice, precludes an appropriate response as provided for in Florida Statute 624.155. As a result, State Farm respectfully requests that the Department reject the Notice based upon the deficiency noted herein. II. Despite the deficiency, State Farm denies all allegations contained in the Notice. Notwithstanding the deficient Notice, State Farm denies it committed any of the alleged wrongful acts or violated the statutes and/or administrative rules cited in the Notice. State Farm hereby denies each and every allegation of wrongdoing contained in the Notice, either explicitly or implicitly, and denies any wrongdoing in the handling of the Insured's claim. Further, State Farm asserts that none of the allegations complained of by the Insured amount to a violation of any of the Florida Statutes or Administrative Rules cited by the Insured in the Notice. State Farm has acted fairly and with due diligence throughout the handling of the Insured’s claim. 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 allegations contained therein. FACTS This matter arises out of a claim (Claim No.: 59-65X7-25V) for loss and damage that allegedly occurred at the insured property located at 2701 Green Meadow Circle, Kissimmee, FL 34741 on 9/28/22, as a result of Hurricane Ian. The Insured's claim was reported to State Farm on 4/12/24, under Policy No.: 80-94-1469-1. After the claim was reported, State Farm conducted an investigation that included discussions with the insured regarding the claimed damages, review of documentation submitted in support of the claim, and an inspection of the property. Subsequently, State Farm denied the claim pursuant to the outcome of its investigation and sent the insured a denial letter explaining the basis thereof. REASONS FOR NOTICE State Farm summarily denies each and every allegation of wrongdoing contained within the Notice, and hereby responds to the alleged Reasons for the Notice individually as follows: 1. Claim Denial This allegation is without basis, false and therefore, denied. State Farm did deny the Insured’s claim. But it did so in good faith based on the outcome of its investigation. The mere fact that State Farm denied the claim does not mean it did so in bad faith. Further, the Notice fails to allege any specific facts or circumstances supporting the Insured’s allegation that State Farm engaged in bad faith claim denial. State Farm has handled the Insured’s claim in good faith with the goal of prompt and fair resolution pursuant to the policy and applicable laws. 2. Unfair Trade Practice This allegation is without basis, false and therefore, denied. State Farm did not commit any unfair trade practices or perform any conduct in violation of the Unfair Trade Practices Act in its dealings with the Insured. Further, the Notice fails to allege any specific facts or circumstances supporting the Insured’s allegation that State Farm engaged in unfair trade practices or any conduct in violation of the Unfair Trade Practices Act. State Farm has conducted itself according to insurance laws, regulations, standards, and ethics required by the State of Florida, and all actions taken have been in conformity with the Insured’s policy and applicable law. ALLEGED STATUTORY VIOLATIONS The Insured asserts numerous statutory violations pursuant to Fla. Stat. 624.155 against State Farm in the Notice, most of which are typically found in virtually every Civil Remedy Notice of Insurer Violation regardless of the specific facts and circumstances of the individual case. State Farm denies each and every allegation of statutory violation alleged by the Insured in the Notice, and individually as follows: 1. Fla. Stat. §624.155(1)(b)(1): State Farm denies any violation of Fla. Stat. §624.155(1)(b)(1), which provides as follows: 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 towards its insured and with due regard for her or his interests. State Farm has acted fairly and honestly towards its Insured at all times. At no time has State Farm acted dishonestly or unfairly towards its Insured. All of State Farm’s actions have been performed in good faith and for the purpose of moving the Insured’s claim towards a just and proper determination of coverage under the Insured’s policy. The mere fact that State Farm denied the claim does not support the Insured’s allegation that State Farm failed to settle the claim in good faith. Absolutely no facts or circumstances supporting this allegation have been provided by the Insured in the Notice. As a result, there is no evidence that State Farm violated Fla. Stat. §624.155(1)(b)(1), that it did not act in good faith to settle the Insured’s claim, or that it did not act fairly and honestly towards its Insured and with due regard for the Insured’s interests. 2. Fla. Stat. §626.9541(1)(i)(3)(a) State Farm denies any violation of Fla. Stat. §626.9541(1)(i)(3)(a), which provides as follows: Failing to adopt and implement standards for the proper investigation of claims. This allegation is without basis, and the Notice again fails to allege any facts or circumstances whatsoever that would provide any support for this allegation. State Farm has adopted and implemented standards for the proper investigation of insurance claims and has complied with the same at all times during the investigation of the Insured’s claim. The standards and methods utilized by State Farm in examining its claims have met and exceeded its obligations and industry standards. State Farm has conducted the handling of this claim according to such standards and the Insured has failed to allege absolutely any factual support or evidence to substantiate the Insured’s allegation that State Farm has failed to adopt and implement standards for the proper investigation of insurance claims. The mere fact that State Farm denied the claim does not support the Insured’s allegation that State Farm failed to adopt and implement standards for the proper investigation of claims. 3. Fla. Stat. §626.9541(1)(i)(3)(b) State Farm denies any violation of Fla. Stat. §626.9541(1)(i)(3)(b), which provides as follows: Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. State Farm has at no time acted in violation of the above-referenced statute. Further, there are absolutely no facts or evidence contained in the Notice to substantiate the Insured’s allegation that State Farm has acted in violation of this section. The mere fact that State Farm denied the claim does not support the Insured’s allegation that State Farm misrepresented pertinent facts of insurance policy provisions relating to the coverages at issue. 4. Fla. Stat. §626.9541(1)(i)(3)(d) State Farm denies any violation of Fla. Stat. §626.9541(1)(i)(3)(d), which provides as follows: Denying claims without conducting reasonable investigations based upon available information. This allegation is without basis, and the Notice again fails to allege any facts or circumstances whatsoever that would provide any support for this allegation. As noted above, State Farm conducted a reasonable investigation in relation to the subject claim. The mere fact that the claim was denied does not mean that State Farm failed to conduct a reasonable investigation. The Insured has failed to allege absolutely any factual support or evidence to substantiate the Insured’s allegation that State Farm denied the claim without conducting a reasonable investigation. VIOLATIONS OF POLICY OF INSURANCE The Notice requires the Complainant/Insured to reference the specific policy language that is relevant to the violation, if any. In this regard, the Notice fails to cite to any specific policy language, instead referring only to general portions of the policy. Such reference to general portions of the policy constitutes a failure to comply with the Notice requirements. Julien v. United Property & Casualty Insurance Company, 311.So.3d 875 (Fla. 4th DCA 2021). Nevertheless, State Farm specifically denies having violated any portion of the Insured’s policy, including any of the terms, conditions, exceptions, exclusions, endorsements, limitations and coverages of the policy referenced generally by the Insured in the Notice. Further, absolutely no facts or circumstances supporting this allegation have been provided by the Insured in the Notice. FACTUAL AND CIRCUMSTANTIAL SUPPORT FOR THE INSUREDS’ NOTICE The Notice requires the Complainant/Insured to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time.” The Notice filed by the Insured incorporates vague, unsubstantiated, and boilerplate allegations that provide no specific facts related to the claim and no specific allegations to support the alleged violations. Therefore, this Notice should be dismissed for failure to properly complete the form pursuant to Florida Statute §624.155. Nevertheless, State Farm disputes all wrongful facts alleged by the Insured and denies all allegations of wrongdoing by the Insured. Additionally, State Farm asserts that all actions it has taken in response to the Insured’s claim have been done entirely in good faith and for the purpose of fair, just and timely disposition of the same. CURE Finally, the Notice presumes to state what State Farm must do to cure these alleged defects. However, the methods for curing the violations alleged in a Civil Remedy Notice are not determined by the Complainant/Insured. In Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So. 2d 1278 (Fla. 2000), the Florida Supreme Court accepted and quoted the reasoning of the Court below in its opinion, which stated in relevant part, as follows: Section §624.155 does not impose on an insurer the obligation to pay whatever the insured demands. . . . Section §624.155(2)(d) would have no effect or purpose under such an interpretation. The law does not support such an expansive and illogical reading of Fla. Stat. Ann. §624.155(2)(d). Talat, 753 So. 2d at 1282 citing Talat Enterprises Inc. v. Aetna Cas. & Sur. Co., 952 F. Supp. 773, 777-778 (M.D. Fla. 1996). CONCLUSION State Farm immediately undertook a timely investigation of the Insured’s claim for loss and damages, and promptly sent the Insured its denial letter based on the outcome of such investigation. State Farm denies all allegations of wrongdoing contained in the Insured’s Notice. Due to the lack of factual and circumstantial basis to support such allegations, State Farm requests that the Department of Financial Services return the Notice to the Insured for lack of specificity pursuant to Florida Statute. State Farm has attempted in this correspondence, by and through their undersigned counsel, to fully and adequately respond to the allegations in the Notice. Should the Insured or the Department have any questions regarding this response, please do not hesitate to contact the undersigned. Very truly yours, /s/ Jesse C. Groves Jesse C. Groves
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