Civil Remedy Notice of Insurer Violations
Login

Filing Number:     785425
Filing Accepted:  10/2/2024
         Print Filing
Complainant
Last/Business Name *  
911 MOLD TESTING LLC   First Name  
Street Address * 9600 NW 25TH ST
City, State Zip * MIAMI, FL 33172
Email Address * INFO@911MOLDTESTING.COM
Complainant Type: * Third Party
Insured
Last/Business Name*   GABRIEL MOSCOSO & GABRIELA MOSCOSO   First Name  
Policy # * FE-0000882786-02 Claim #* HO0524424992
Attorney
Attorney is Applicable
Last Name* GONZALEZ ESQ. First Name * ROBERT F. Initial
Street Address* 8950 SW 74TH CT., STE 2267
City, State Zip* MIAMI , FLORIDA 33152
Email Address * INTAKE@FLINSLAW.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):* UNKNOWN
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)(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.

Section 1 - Perlis Insured Against Section 1 - Property Coverages Loss Settlement Provision
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Page 1 of 1On September 27, 2022, Gabriel Moscoso & Gabriela Moscoso suffered a loss due to coveredperils contemplated under the Policy; and timely reported the damage to Defendant. GabrielMoscoso & Gabriela Moscoso contracted 911 Mold Testing LLC in order to perform TARP,DRYOUT services to the Insureddirectly relating to the loss. In exchange for 911 Mold TestingLLC's services Gabriel Moscoso & Gabriela Moscoso executed an assignment of benefits. On orabout April 1, 2024, 911 Mold Testing LLC provided MONARCH NATIONAL INSURANCECOMPANY with notice of the Assignment of Benefits. Within the statutory period, 911 MoldTesting LLC provide MONARCH NATIONAL INSURANCE COMPANY with a copy of itsinvoice, assignment agreement, demand for payment of insurance benefits and supportingdocumentation. During the investigation of the claim, MONARCH NATIONAL INSURANCECOMPANY sent an unqualified person to make determinations of causation of damage inviolations of 626.9541(1)(i)(3)(d). After completing its deficient investigation MONARCHNATIONAL INSURANCE COMPANY should have provided coverage for the loss.MONARCH NATIONAL INSURANCE COMPANY has unduly delayed full payment andcoverage over the claim in violation of the insurance contract and has done so in a manner whichviolates multiple Florida Statutes. Furthermore, MONARCH NATIONAL INSURANCECOMPANY failed to promptly provide a reasonable explanation in writing to the insured of thebasis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or forthe offer of a compromise settlement.The failure to issue payment when there was no applicable exclusion for the type of service orclaim in relation to the covered claim is a violation of 624.155(1)(b)(1) and 624.155(1)(b)(3).MONARCH NATIONAL INSURANCE COMPANY has been provided sufficient evidence tosupport coverage for the subject claim and services. Despite making numerous payments in thepast for these types of services which were performed in relation to valid insurance claims,MONARCH NATIONAL INSURANCE COMPANY has subsequently made it a businesspractice to deny these services irrespective of the facts for each claim in direct violation of626.9541(1)(i)(3)(a) and 626.9541(1)(i)(3)(b).MONARCH NATIONAL INSURANCE COMPANY has repeatedly and continuously acted inbad faith in this matter and others like it. Despite the fact that these services are directly relatedto covered losses and not excluded under the policy of insurance, MONARCH NATIONALINSURANCE COMPANY refuses to pay insurance benefits for same. In order to cureMONARCH NATIONAL INSURANCE COMPANY’s continuous acts of bad faith,MONARCH NATIONAL INSURANCE COMPANY must issue payment for the invoicedamount of $ 24,169.08 and which has a current balance of $ 24,169.08; as well as, statutoryinterest. In addition, MONARCH NATIONAL INSURANCE COMPANY must cease its unfairtrade practice of citing to irrelevant policy provisions in order to misrepresent the coveragesafforded under its policies of insurance.PDC24-001091
Comments
User Id Date Added Comment
pleadings@flinslaw.com 07-29-2025 FLORIDA INSURANCE LAW GROUP LLC., WITHDRAWS CRN NUMBER 785425, SUBMITTED ON 10/2/2024.
tacham@hpmanaging.com 11-26-2024 November 26, 2024 Via E-mail & Posting on DFS Website Robert F. Gonzalez, Esq. 8950 SW 74th Ct., Ste. 2267 Miami, Florida 33152 intake@flinslaw.com RE: Complainant(s): 911 Mold Testing LLC Insured(s): Gabriel Moscoso and Gabriela Moscoso Claim No: HO0524424992 Policy No: FE-0000882786-02 DFS Filing Number: 785425 Acceptance Date: October 2, 2024 Insurer: Monarch National Insurance Company To Whom it May Concern: Please allow this correspondence to serve as Monarch National Insurance Company’s (“Monarch”) official response to the Civil Remedy Notice of Insurer Violations (“Notice”). Monarch maintains that it has not been in any violation of the law and that the Notice is defective on its face and fails to comply with the specificity requirements under Florida Statute 624.155. As such, Monarch objects to the Department’s acceptance of the above-referenced Notice. Monarch has acted in good faith and with due regard for the insured’s interests, and denies each and every allegation contained in the Notice. Monarch denies any wrongdoing in the adjustment and handling of the above-referenced claim, and denies any and all allegations that it committed any acts or violated any Florida statutes or law. Monarch has acted in good faith and in accordance with the terms and provisions of the applicable policy of insurance as well as with the law. Please note that nothing herein should be deemed as a waiver by Monarch. Monarch hereby expressly reserves all rights without exception or limitation. If you require additional information, please contact me. Sincerely, /s/ Tyler Acham, Esq. Tyler Acham In-House Counsel Monarch National Insurance Company
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