Civil Remedy Notice of Insurer Violations
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Filing Number:     785365
Filing Accepted:  10/2/2024
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Complainant
Last/Business Name *  
LIRIANO   First Name   RAYSELL
Street Address * 11265 BLYTHVILLE ROAD
City, State Zip * SPRING HILL, FL 34608
Email Address * CDP@WEKLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   LIRIANO   First Name   RAYSELL
Policy # * 06920866 Claim #* CH0524425388
Attorney
Attorney is Applicable
Last Name* PAGAN First Name * CHRISTOPHER Initial D
Street Address* 800 EAST BROWARD BOULEVARD, SUITE 510
City, State Zip* FORT LAUDERDALE , FL 33301
Email Address * CDP@WEKLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   MONARCH NATIONAL INSURANCE COMPANY
NAIC Company Code 15715
 
Name of individual responsible for violation (if any):* ROSMEY HONDARES
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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

SECTION I – PROPERTY COVERAGES Coverage A – Dwelling. We cover: 1. The dwelling on the “residence premises” shown in the Declarations, including structures attached to the dwelling; and 2. 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.” SECTION I – PERILS INSURED AGAINST A. Coverage A – Dwelling and Coverage B – Other Structures We insure for sudden and accidental direct loss to covered property described in Coverages A and B only if that loss is a physical loss to property. SECTION I – CONDITIONS C. Loss Settlement. Covered property losses are settled as follows: b. Buildings under Coverage A or B at replacement cost without deduction for depreciation, subject to the following: (2) 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: (a) The actual cash value of that part of the building damaged; or (b) That proportion of the cost to repair or replace, after application of deductible and 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.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Raysell Liriano ("Insured") purchased an insurance policy ("Policy") from Monarch National Insurance Company ("MONARCH" or “Carrier”) with effective coverage on the date of loss, on or about January 9, 2024, and Policy number 06920866 to insure his property located at 11265 Blythville Road, Spring Hill, FL 34608 (the "Property").?? On or about January 9, 2024, the Property suffered severe damage as the result of a windstorm event, which caused ensuing damages to the Property including but not limited to the roof and interior of the property ("Loss"). MONARCH was notified of the Loss and was granted access to the property in order to complete their inspection. MONARCH acknowledged the claim and assigned claim CH0524425388 ("Claim") to the Loss. MONARCH sent an adjuster to inspect the subject property. The adjuster confirmed water damage to the property as claimed; however, the adjuster prepared a purported estimate that failed to account for several necessary repairs. On May 30, 2024, Rosmey Hondares, the claims examiner on behalf of MONARCH, authored a letter to counsel for the Insured (“Coverage Letter”) stating that the damages were covered under the policy and that no payment was forthcoming because they believe the cost of the repairs fell below the applicable deductible. Nowhere in the letter does MONARCH state that they were unable to conduct or complete an investigation of the damages and necessary repairs to the Property, nor does it mention any reason why MONARCH would have been prejudiced in its investigation. After being provided plenty of evidence (including photos, estimates, and immediate access to the property upon discovery) showing that damage from a windstorm event occurred at the property that will require extensive repairs, MONARCH continues to refuse to provide additional money in order to complete these repairs. MONARCH also has the ability to determine the costs needed to fully repair this property but has not attempted to discover this information and has instead forced the Insured to pursue legal recourses for the money due and owing under the contract of insurance. MONARCH is trying to avoid finding any further information that would increase the amount of coverage available on this claim despite being aware that additional costs would need to be incurred by the Insured to repair his home. The Insured has fully complied with all applicable Policy provisions requiring cooperation with the?investigation;?however, MONARCH has unequivocally failed to properly adjust this Claim, as elaborated above. MONARCH has not attempted, in good faith, to settle this claim when, under the circumstances, it could and should have done so had it acted fairly and honestly toward the policyholder and with due regard to the policyholder's interests.? Rather, MONARCH has acted with only its own profit and shareholders in mind. As a direct consequence of MONARCH’s failure to adjust this Loss in good faith and make any additional supplemental payment, the Insured continues to be without adequate compensation for the damages sustained at the Insured’s Property months ago.?? By stating the above detailed?facts,?it is clear that MONARCH has violated the following Florida statutes:? • 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 Insureds and with due regard for their interest. • 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)(c) Failing to acknowledge and act promptly upon communications with respect to claims; • 626.9541(1)(i)(3)(i) Unfair claim settlement practices. To date, MONARCH has in bad faith failed to provide sufficient coverage under the Policy to the Insured. As a direct result of MONARCH’s underpayment of the Claim and breach of the Florida Statutes, the Insured was?forced to seek the?help of licensed professionals to assist him, including legal counsel.?Due to the amount of time that has passed since the date of loss and the information discussed above, there is irrefutable evidence that MONARCH knowingly and intentionally, and in bad faith delayed the settlement process in order to further disadvantage the Insured. The financial detriment caused to the Insured is a direct result of MONARCH’s reckless treatment of the claims process. The Insured submitted all documents requested in a timely fashion, made the property available for inspection immediately after the discovery of the loss, submitted an estimate, and satisfied all requests. However, MONARCH failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim.? To deny the Insured the benefits clearly due and owing under the Policy, for which he has been making premium payments for and after he has satisfied all of his obligations is morally and ethically reprehensible and reeks of Unfair Claims Practice and Bad Faith. Upon information and belief, the aforementioned actions complained of, among others, were made by MONARCH so often?as to constitute a general business practice, evidencing a motive to enhance MONARCH’s profits, and designed to cause a detrimental effect to its policyholders. The above clearly depicts that MONARCH adjusted this claim in bad faith, continue to act in bad faith towards its Insureds and that MONARCH is in direct violation of Unfair Claims Practices.?? This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should MONARCH fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, MONARCH must: (1) Immediately tender all proceeds due and owing to the Insured that are fairly owed under the insurance policy that would reasonably compensate them in order to put the loss property back to its pre-loss condition ($71,031.00 less any applicable deductible); (2) Immediately afford coverage for the repairs to the subject property necessary to put the property back into its pre-loss condition and reimburse for the work already performed (3) Agree to reimburse the Insured’s reasonable attorneys’ fees and costs for having to become involved to resolve the claim; and (4) Agree to reimburse the Insured for interest on the amount of benefits that was found to be?due and owing to the Insured, relating back to the date of loss.
Comments
User Id Date Added Comment
fede@becklawpa.com 11-27-2024 Department of Financial Services Civil Remedy Section 200 East Gaines Street Tallahassee, FL 32399-0322 Re: Civil Remedy Notice of Insurer Violation Complainant : Raysell Liriano Insureds : Raysell Liriano Policy Number : 06920866-2 Claim No. : CH0524425388 DFS File Number : 785365 Acceptable Date : October 2, 2024 Insurer : Monarch National Insurance Company To Whom It May Concern: Please be advised that we represent Monarch National Insurance Company (“Monarch”) in the above-referenced matter. Kindly consider this to be Monarch’s report to the Department on the disposition of the alleged violations. Monarch maintains that it has not been in any violation of the law and that the Civil Remedy Notice of Insurer Violation (“CRN”) filed by Raysell Liriano (“Insured”) is defective on its face and it fails to comply with the specificity requirements under Florida Statute 624.155. By way of background, this matter involves alleged property damage that purportedly occurred as a result of wind, with an alleged date of loss of January 9, 2024, and first reported on or about April 30, 2024, approximately 112 days after the loss. Prior to reporting the claim to Monarch, the Insured executed a contract with Best Quality Pro Restoration (“Best Quality”) on April 29, 2024, to perform water mitigation services along with placing a tarp on the property for both services totaling $12,826.78. On or about April 30, 2024, the Insured executed a public adjuster agreement with Pacific Public Adjuster, LLC, who reported the claim to Monarch the same day. According to the public adjuster the property suffered wind damage causing creased and lifted shingles on the roof and water stains in ceiling in guest bathroom. On or about May 4, 2024, Monarch’s field adjuster inspected the property and noted creased and torn shingles on the rear and left slope of the roof along with damage due to wear and tear and mechanical damage. During the interior inspection the field adjuster noted cabinet damage under the kitchen sink that was being handled under another loss. The living area, bedroom and second bedroom had mitigation holes in the ceiling and cracks and/or failed tape joints on the ceiling and walls. There was no staining found near or at the mitigation holes. On or about May 4, 2024, Monarch sent the Insured a Reservation of Rights letter advising that coverage was pending an expert inspection to determine the cause of loss and damage to the roof, interior, fence, and shed. On or about May 13, 2024, Monarch’s expert, ProNet Group, Inc., inspected the property and noted a few damaged field shingles and some additional torn and creased shingles that were the result of mechanical damage consistent with manual manipulation. As for the interior, there was no water damage near or at the moisture mitigation holes created by the mitigation company in the master bedroom, dining room, or northwest bedroom ceilings and no storm created openings in the roofing system. The drywall crack and previous wall repair in the dining room, were consistent with thermal expansion and contraction, differential settlement of the structure, and/or the quality of materials and workmanship during construction. Unbeknownst to Monarch, Best Quality completed a second re-tarping of the property for an invoice of $3,845.48. On or about May 29, 2024, the Insured’s public adjuster emailed Monarch a copy of a Replacement Cost Value (“RCV”) estimate totaling $68,426.75. On or about May 30, 2024, Monarch issued a coverage determination extending coverage for five creased and torn roof shingles which fell under the policy’s applicable $1,000.00 deductible. The coverage letter went on to state that the remaining damaged shingles were the result of age-related deterioration and/or mechanical damage from manual manipulation, and there was no coverage for the interior damage as there was no water damage due to a storm created opening. On or about June 13, 2024, the Insured filed a Notice of Intent to Initiate Litigation (“NOI”) with an attached the same public adjuster estimate from the public adjuster in RCV. At no point did the Insured submit an estimate for Actual Cash Value (“ACV”) to Monarch. On or about June 17, 2024, Monarch received an email from Best Quality with an invoice for tarp and water mitigation services. The same day, Monarch responded that since the interior portion of the claim was denied, Monarch would not be issuing a payment for the water mitigation services; however, Monarch would cover the tarping expenses, which would need to be billed separately. On or about June 18, 2024, Monarch responded to the Insured’s NOI standing by its previous coverage decision. On or about June 29, 2024, the Insured executed a contract with The World Mold who took testing samples on or about July 1, 2024, and found no mold at the property. On or about July 2, 2024, Monarch received the mold testing invoice from The World Mold requesting payment for $2,500.00. The same day, Monarch responded that since the interior portion of the claim was denied, Monarch would not be issuing a payment. On or about July 2, 2024, the Insured filed a lawsuit against Monarch for Breach of Contract. On or about July 6, 2024, the Insured signed a Direction to Pay and Letter of Protection with Florida Restoration 101, LLC who completed a shrink wrap of a portion of the Insured’s roof for $5,850.00. On or about July 15, 2024, Monarch received an email from National Claims Funding based on a Secondary Direction to Pay from Florida Restoration 101 to collect the shrink wrap invoice. To date, the Insured has failed to provide any documentation supporting wind damage to the non-covered portion of the roof or a causation report from the Insured concerning the cause of the alleged damage. Moreover, the Insured has never submitted an estimate disputing Monarch’s ACV estimate. In addition, Monarch maintains that no payment is owed until the costs are incurred and repairs are made pursuant to the policy's Loss Settlement Provision and Florida Statute 627.7011. The Insured has not provided any evidence that she’s incurred expenses or made any repairs beyond what was included Monarch’s estimate. Lastly, the Insured purchased the subject property on or about May 9, 2022, and the roof was last replaced on or about September 4, 2020, making the roof less than 2 years old on the alleged date of loss. Thus, based on the Insured’s new roofing system, the alleged damages to the roof does not require a full roof replacement. On or about October 2, 2024, the Insured, through their legal counsel, filed a CRN against Monarch, which is a pre-requisite to a bad faith lawsuit under Florida Statute 624.155. This CRN alleges that Monarch engaged in “Claim Denial, Claim Delay, Unsatisfactory Settlement Offer, and Unfair Trade Practice”. Additionally, the CRN alleges that Monarch has violated several Florida Statutes. On the face, this CRN merely contains accusations without any factual specificity. Florida Statute 624.155 expressly requires factual specificity. In addition, the instant CRN merely contains boilerplate broad language used routinely in a litany of other filings submitted by the Insureds’ legal counsel. These CRNs largely include the same generic language, many use the same sentences throughout, and include largely the same allegations. With regards to this CRN, it contains the same generic improper and legally insufficient allegations that are contained within almost every CRN filed by the Insureds’ legal counsel. Moreover, the Complainant should not be able to simply file the same lengthy generic CRN without containing the requisite specificity. The purpose of a CRN is to place the carrier on notice of specific violations so that they can be corrected during the statutory “cure” period. This CRN fails to meet this requirement and as such, should not be able to proceed on such a defective and improper CRN that contains nothing but accusations and conclusions without any specificity. The CRN also fails to set forth specific policy language alleged to have been violated in accordance with Florida Statute §624.155(3)(b)(4). The copy of the CRN simply refers to the sections of the insurance policy but not specific policy language. This failure to identify any specific language within the policy provision allegedly relevant to the purported violations prevents Monarch from addressing any issues regarding the policy and is another reason why it does not comply with F.S. § 624.155. Further, the Civil Remedy Notice requires the Complainant "pursuant to section 624.155, F.S. please indicate all statutory provisions alleged to have been violated." The notice filed in this matter includes statutory provisions that could be claimed against any insurance company, regardless of whether they are relevant or applicable to the alleged facts contained in the CRN. Because the CRN fails to identify any specific statutes, it does not comply with F.S. § 624.155, and Monarch is unable to properly respond. The CRN alleges that Monarch’s “under payment” prejudiced the insured from completing repairs and that Monarch’s failure to pay is an intentional delay, without including any specificity as to what delays were made by Monarch. The facts are clear that Monarch acknowledged coverage for a portion of the roof shingles and there was no evidence of water intrusion to the interior from a storm created opening. The CRN goes on to allege that the Insured provided Monarch with “plenty of evidence” showing damage from windstorm, yet there was zero evidence submitted to Monarch to substantiate a full roof replacement of a two-year-old roof or that water entered the interior of the property from a storm created opening. It’s clear that the Monarch policy requires a storm created opening in the roofing system for ensuing water damage to be covered. The CRN further claims that Monarch’s underpayment of the claim forced the Insured to seek help from licensed professional to assist, including legal counsel; however, prior to filing the CRN the Insured hired a public adjuster from the inception of the claim and had an ongoing lawsuit against Monarch. The CRN also claims that Monarch “knowingly and intentionally” in bad faith delayed the settlement process to further disadvantage the Insured but does not provide specific facts as to how Monarch acted “knowingly and intentionally”. What is clear is that Monarch acknowledged damage to less than 1% of the Insured’s roof shingles (ACV) and the damages fell under the wind deductible. Thus, based on Monarch’s determination, the Insured is required to complete repairs and incur the expenses for additional payment to be made under RCV. All of the above allegations and those included in the CRN are mere conclusory statements, which lack even minimal specificity and/or lack the underlying factual basis to support it. In response to each statutory violation alleged, Monarch maintains that it attempted to conduct a complete, thorough, and timely investigation of the loss and that it handled the subject claim in accordance with the insurance policy and all statutory and regulatory requirements. Therefore, no violations of § 624.155 or § 626.9541 occurred. Finally, the CRN also contains “cures” that are not available under the policy of insurance or under the Civil Remedy Statute. The CRN alleges that in order to “cure” the Insured, Monarch must “Immediately tender all proceeds due and owing to the Insured that are fairly owed under the insurance policy that would reasonably compensate them in order to put the loss property back to its pre-loss condition ($71,031.00 less any applicable deductible); (2) Immediately afford coverage for the repairs to the subject property necessary to put the property back into its pre-loss condition and reimburse for the work already performed (3) Agree to reimburse the Insured’s reasonable attorneys’ fees and costs for having to become involved to resolve the claim; and (4) Agree to reimburse the Insured for interest on the amount of benefits that was found to be due and owing to the Insured, relating back to the date of loss.” First and foremost, Monarch has not received any documentation to support this payment and/or cost for a full roof replacement of a two-year-old roof as part of the Insured’s claim and as such, Monarch is unable to properly respond and evaluate such allegation. Additionally, there has been no showing of a storm created opening for which water enters for coverage to be afforded to the alleged interior damage. Further, the “cures” stated in this CRN improperly include attorneys’ fees and interest. As such, Monarch maintains that the “cures” requested in the CRN are improper and impossible for Monarch to complete. Based on the information outlined above, Monarch requests that the DFS re-consider its acceptance of the above-referenced CRN and further requests that the DFS provide Monarch a list of the guidelines and requirements utilized by the DFS in determining to accept this defective CRN. As outlined above, Monarch maintains that it has not acted in bad faith in handling the Insured’s claim, has not been in violation of any law, and has properly attempted to adjust the Insured’s and/or Complainant’s claim pursuant to the terms, conditions, exclusions, and exemptions of the Policy regarding coverage for the claimed loss. Monarch 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. Should the Department require additional information, please do not hesitate to contact us. Sincerely, GRACE FEDE, ESQ.
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