Civil Remedy Notice of Insurer Violations
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Filing Number:     785251
Filing Accepted:  10/1/2024
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Complainant
Last/Business Name *  
EULIARTE AND CIULLA   First Name   GONZALO AND YAMILA
Street Address * 4730 SELMA ST
City, State Zip * SARASOTA, FL 34232
Email Address * ELFACHA10@HOTMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   EULIARTE AND CIULLA   First Name   GONZALO AND YAMILA
Policy # * PFL371411-04 Claim #* CFL22585618
Attorney
Attorney is Applicable
Last Name* STRUBLE First Name * MATTHEW Initial
Street Address* 325 5TH AVE., SUITE 103
City, State Zip* INDIALANTIC , FLORIDA 32903
Email Address * SERVICE@STRUBLECOHEN.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   PEOPLE'S TRUST INSURANCE COMPANY
NAIC Company Code 13125
 
Name of individual responsible for violation (if any):* ALL INDIVIDUALS ASSOCIATED WITH OR RETAINED BY INSURER RELATED TO THIS CLAIM
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
* 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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
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.
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.
626.9541(1)(i)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

There are no policy provision specifically at issue or in dispute, the policy provides coverage resulting from Wind Damage but People's Trust Insurance Company has failed to extend coverage for repairs needed for the insured property.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Insurer issued an insurance policy bearing policy number PFL371411-04 to Gonzalo Euliarte and Yamila Ciulla with effective dates of coverage from April 2, 2022 to April 2, 2023, which insured the property located at 4730 Selma St, Sarasota Florida 34232. The policy was in effect when the property sustained damage on or about September 28, 2022, when damage was caused by Wind Damage. People's Trust Insurance Company (“Insurer”) received notice of the claim for property damage resulting from Wind Damage, and related damages on or about September 28, 2022. The damage was reported to Insurer which assigned Claim Number CFL22585618 to the claim and investigated the claim. Insurer failed to retain the experts needed to perform the inspection and needed to address the damage at issue and determine the repairs needed to restore the property. Insurer has been provided with documents establishing that the claim is covered, despite this being apparent from the condition of the property alone. Insurer has failed to extend coverage for payments owed and has refused to attempt to settle the claim with its insured. Insurer’s delay in issuing payment is causing and will cause the insured to sustain extra-contractual damages not covered by the property, including loss of use and enjoyment of the property and related damages, costs associated with hiring adjusters and experts, among other damages and these uninsured damages would not have occurred but for the insurer ’s failure to timely issue payments owed. In this claim and as a business practice, insurer fails to retain experts needed to investigate claims, ignores evidence establishing coverage and avoids covered repairs to attempt to avoid issuing payments owed pursuant to the insurance policy. Insurer can cure these violations by attempting to settle the claim in good faith and issuing payment for the remaining contractual damages owed. As Insurer is aware, issuing payment for contractual damages owed will preclude recovery of extra-contractual damages already incurred, and that will be incurred, and the contractual damages should immediately be paid and be paid within 60 days from the date of this notice. Due to applicable Florida Statutes, and the insurance policy’s payment provisions, the payment issued should also include interest. If insurer contends there is somehow more information needed that was not already provided, it should immediately advise the insured’s attorney what information is needed. Insurer has been provided with information establishing that the claim is covered but has failed to extend coverage for the claim. Insurer’s denial of the claim and refusal to issue payment is a breach of the insurance policy.
Comments
User Id Date Added Comment
bfrankel@gmail.com 11-14-2024 The Legal Department has been requested by People’s Trust Insurance Company (“PTI”) to assist it in responding to a Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of its Insureds, Yamila Ciulla and Gonzalo Euliarte (“Insureds”). In direct response to the CRN filing, PTI maintains that it has not been in any violation of the law and that the CRN is defective on its face and fails to comply with the specificity requirements under Florida Statute 624.155. As such, PTI objects to the Department’s acceptance of the above-referenced CRN. To be more specific, the CRN requirements set forth by Section 624.155 are that the notice be filed on a form provided by the department stating with specificity the following information, and such other information 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 light of the instant CRN, PTI will provide a simple review of the facts and claims handling in support of its position there was no “bad faith” in the handling of this claim and detail how and why PTI acted property and within the letter of the law while handling the subject insurance claim. Following the claims summary, PTI will then address each respective statutory violation alleged in the Insureds’ CRN and respond accordingly in order to highlight why the CRN fails to perfect the Claimant’s right to pursue civil remedies under Florida Statutes. ? 1) On 9/30/2022, PTI was advised of a Hurricane Ian claim occurring on 9/28/2022. Specifically, there was damage reported to the roofing system, exterior fence, exterior AC unit, floor damage, and ceiling damage in the master bedroom. Thereafter, on 10/11/2022, PTI’s Field Adjuster inspected the home in order to determine the cause of loss and scope of damages. At the time of the inspection, PTI’s Field Adjuster confirmed covered damages to the exterior fence and duct work. 2) Subsequently, on 10/26/2022, PTI issued its coverage determination letter. Within the letter, PTI advised the Insureds that their claim is covered, and the insureds would be indemnified by means of repair, once there was a determination of what those damages were, either by agreement or by submitting the matter to an appraisal panel as set forth in the policy. Accordingly, PTI timely elected its option to effectuate covered repairs through a preferred contractor, Rapid Response Team (“RRT”), pursuant to the terms and conditions of the Policy and its endorsements. The letter goes on to explain all relevant policy language and endorsements, and advised the Insureds to submit a Sworn Proof of Loss (“SPOL”) and supporting estimate of their scope dispute in the event that they were not in agreement with PTI’s assessment. 3) On 12/4/2022, PTI sent the Insured a Claim Settlement Offer Letter reiterating that the claim was covered and PTI elected to repair the covered damages, but was extending the claim settlement offer for consideration should the Insureds prefer to settle the entire claim. The letter enclosed the check for the amount being offered and explained that the check was to settle the entire claim for damages, whether known or unknown, as an alternative to PTI proceeding with its preferred contractor performing the covered repairs. It was explained that endorsing the check would constitute an acceptance of the payment as full and final settlement of the entire claim, meaning nothing further would be owed for the claim. To the extent the Insureds were not willing to accept the offer for any reason, PTI stated its election to repair would remain in effect and PTI would proceed accordingly as set forth in the coverage determination letter. 4) It was not until six (6) months later, on 6/28/2024, that PTI heard from the Insureds in the form of documentation being submitted on their behalf by Hunter Claims, LLC (“Insureds’ Public Adjuster”). In response to their documents, PTI provided the Public Adjuster a certified copy of the policy on 7/3/2024 while inquiring into the status of the claim settlement offer check. 5) On 7/12/2024, PTI sent correspondence to both the Insureds and Public Adjuster office submitting a copy of the previously issued Claim Settlement Offer Letter, a copy of the cashed settlement offer check, along with correspondence confirming that the check was endorsed and cashed constituting a full accord and satisfaction of the disputed loss. As the claim had therefore been brought to a full and final settlement PTI advised the claim would remain closed. 6) The Letter of Representation from Insureds’ counsel was received on 8/12/2024 and PTI acknowledged receipt on 8/19/2024. Within the letter of acknowledgement, PTI informed counsel that in consideration of PTI’s agreement to forego its right to repair covered damages PTI indemnified the Insureds directly in order to bring a full and final settlement to the claim. A copy of the Claim Settlement Offer Letter and endorsed check was enclosed for review. As shown, PTI has not acted in bad faith but has observed the terms and conditions of the Policy and Florida law, and has not engaged in any actions listed under “reasons for notice,” which include claim denial claim delay, and unsatisfactory settlement offer. PTI further maintains that its practices and/or guidelines for response to claims are adequate to provide for the proper investigation and resolution of all claims. Turning to the statutory sections alleged to be violated, PTI responds as follows: GENERAL DENIAL PTI denies of all the statutory violations alleged in the Insureds’ CRN. 1) ALLEGED VIOLATION §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: RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. As stated above, PTI accepted coverage and invoked its election to repair in accordance with the subject policy, prior to extending an alternative option of indemnifying the Insureds directly in order to bring the claim to a full and final resolution. The Insured opted to accept the Claim Settlement Offer and the amount issued as full and final resolution of the claim. 2) ALLEGED VIOLATION §626.9541 (1)(i)(3)(a) – Failing to adopt and implement standards for the proper investigation of claims. RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. PTI advises that this allegation requires specific facts regarding the method of the investigation; the reasons the investigation was improper or otherwise inadequate; the reasons why this alleged inadequacy is due to the failure to adopt and implement standards for the proper investigation of claims, and the facts supporting these conclusions. To allege an inadequate investigation, the Notice must include specific facts regarding the method, rather than merely the results. Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006) As mentioned above, PTI issued a coverage determination letter on 10/26/2022 accepting coverage and communication its election to repair, prior to offering the alternate option of indemnifying the Insureds directly to bring the claim to a full and final resolution. As the Insureds have not advised PTI as to how it failed to investigate the claim and/or what standards were not adopted or implemented, this alleged violation is emphatically denied. 3) ALLEGED VIOLATION §626.9541(1)(i)(3)(b) – Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. As indicated in the claims summary above, PTI has been honest and fair in the evaluation of the claim, and therefore demands that Claimants provide documentation to support this statutory allegation. 4) ALLEGED VIOLATION §626.9541(1)(i)(3)(c) – Failing to acknowledge and act promptly upon communications with respect to claims. RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. As indicated in the claims summary above, all communications were not only promptly responded to but also promptly acted upon. 5) ALLEGED VIOLATION §626.9541(1)(i)(3)(d) – Denying claims without conducting reasonable investigations based upon available information. RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. As mentioned above, the Insureds have not advised PTI as to how it failed to investigate the claim and/or what standards were not adopted or implemented. Furthermore, PTI promptly investigated the claim, and a favorable coverage decision was made within 15 days after the post-loss property inspection. 6) ALLEGED VIOLATION §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. RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. PTI accepted coverage and provided the Insureds with PTI’s estimate and scope of repairs supporting its assessment of covered damages and upon which repairs would be performed in the absence of a scope disagreement. Thereafter, PTI issued the Claim Settlement Offer letter explaining the option to accept the enclosed check as a full and final settlement of the claim in exchange for PTI agreeing to forego its election to repair through its preferred contractor. Each of the aforementioned correspondences explained in writing the relevant policy language and/or provisions in relation to the facts at issue and in support of the amount which repairs were based and alternatively upon which payment was being issued. 7) ALLEGED VIOLATION §626.9541(1)(i)(3)(g) – Failing to promptly notify the insured of any additional information necessary for the processing of the claim. RESPONSE PTI denies this statutory allegation in its entirety and notes that it is completely contradicted by the Coverage Letter dated 10/26/2022 advising the Insureds to submit a Sworn Proof of Loss and supporting estimate in the event there were not in agreement with PTI’s assessment of damages. To the extent the Insureds were not in disagreement then they were to submit a signed work authorization granting permission to PTI’s preferred contractor to start with the permitting process (where necessary) and to have permission to access the property. That said, the coverage letter advised that either a signed Work Authorization or Sworn Proof of Loss was necessary to move the claim forward. Nevertheless, PTI opted to issue payment in lieu of repairs and the Insureds endorsed the check constituting full and final resolution of the claim. 8) ALLEGED VIOLATION §626.9541(1)(i)(3)(h) – Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. RESPONSE PTI denies this statutory allegation in its entirety and notes that it is completely contradicted by the Coverage Letter dated 10/26/2022 explaining that the Sworn Proof of Loss was necessary in order to alert PTI as to the disagreement as the policy provides a method by which the parties could submit the dispute to an appraisal process, and an appraisal panel would make the determination of what would be repaired. This would have resulted in an Appraisal Award specifying what would be repaired, and how much PTI would pay its preferred contractor to make those repairs. To the extent the Insureds were not in disagreement then they were to submit a signed work authorization granting permission to PTI’s preferred contractor to start with the permitting process (where necessary) and to have permission to access the property. That said, the coverage letter advised that either a signed Work Authorization or Sworn Proof of Loss was necessary to move the claim forward. Nevertheless, PTI opted to issue payment in lieu of repairs and the Insureds endorsed the check constituting full and final resolution of the claim. 9) ALLEGED VIOALTION §626.9541(1)(i)(4) – Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5). RESPONSE PTI denies this statutory allegation in its entirety and notes that it is completely contradicted by the Coverage Letter dated 10/26/2024 providing the Insureds with PTI’s estimate and communicating its election to repair in lieu of monetary payment, in accordance with the policy at issue. Nevertheless, PTI opted to issue payment in lieu of repairs and the Insureds endorsed the check constituting full and final resolution of the claim. CONCLUSION /SUMMATION In sum, PTI timely accepted coverage under Florida law and maintains that all alleged violations of Florida Statutes in this CRN are baseless, and the CRN offers no facts in support of the statutory violations alleged. In fact, the CRN broadly, vaguely and without a scintilla of evidence, alleges boilerplate, unsupported false allegations of statutory violations and tracks, in generalities and conclusions only, the language of numerous sections of Florida’s Civil Remedy Statutes without connecting the purported statutory violations to the facts of the claim and the history of the claim investigation. Moreover, the CRN also fails to include specific policy language relevant to the violation(s) and further states “there are no policy provision specifically at issue or in dispute…”. In response to these very general allegations, and to comply with its statutory obligations, PTI responds by denying each and every allegation of misconduct asserted in the CRN, whether expressed and or implied, and by categorically denying each and every alleged statutory violation.?? PTI further maintains that the CRN, as filed, is defective on its face as it fails to meet the specificity requirements of Florida Statute 624.155. As always, PTI is willing to consider any additional information the Insureds can provide in support of their claim. We trust the foregoing fully explains the facts and circumstances of the claim and addresses any concerns raised. If we can provide other information or clarification of information in the claim, please do not hesitate to contact the undersigned. Thank you for your attention to this matter. Very truly yours, /S/ Cosima Ortiz Cosima Ortiz, Esq. Corporate Counsel People’s Trust Insurance Company Cc: Matthew Struble, Esq. 325 5th Avenue, Suite 103 Indialantic, Florida 32903 E-mail: service@strublecohen.com
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