Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 785468

Filing Accepted: 10/2/2024

Print Filing

Complainant

Last/Business Name *

SOUTH FLORIDA MOLD EXPERTS INC

First Name

Street Address *

PO BOX 560027

City, State Zip *

MIAMI, FL 33256

Email Address *

JENNY@SOUTHFLORIDAMOLDEXPERTS.COM

Complainant Type: *

Third Party

Insured

Last/Business Name*		NELSON TUMA		First Name
Policy # *		HCPCHO34952964		Claim #*		922859

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
Insurer Name*		HOMEOWNERS CHOICE PROPERTY & CASUALTY INSURANCE COMPANY, INC.
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 12944

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 May 21, 2020, Nelson Tuma suffered a loss due to covered perils contemplated under thePolicy; and timely reported the damage to Defendant. Nelson Tuma contracted South FloridaMold Experts Inc in order to perform services to the Insureddirectly relating to the loss. Inexchange for South Florida Mold Experts Inc's services Nelson Tuma executed an assignment ofbenefits. On or about August 15, 2022, South Florida Mold Experts Inc provided HomeownersChoice Property & Casualty Insurance Company, Inc. with notice of the Assignment of Benefits.Within the statutory period, South Florida Mold Experts Inc provide Homeowners ChoiceProperty & Casualty Insurance Company, Inc. with a copy of its invoice, assignment agreement,demand for payment of insurance benefits and supporting documentation. During theinvestigation of the claim, Homeowners Choice Property & Casualty Insurance Company, Inc.sent an unqualified person to make determinations of causation of damage in violations of626.9541(1)(i)(3)(d). After completing its deficient investigation Homeowners Choice Property& Casualty Insurance Company, Inc. should have provided coverage for the loss. HomeownersChoice Property & Casualty Insurance Company, Inc. 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, Homeowners Choice Property & CasualtyInsurance Company, Inc. failed to promptly provide a reasonable explanation in writing to theinsured of the basis in the insurance policy, in relation to the facts or applicable law, for denial ofa claim or for the 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).Homeowners Choice Property & Casualty Insurance Company, Inc. has been provided sufficientevidence to support coverage for the subject claim and services. Despite making numerouspayments in the past for these types of services which were performed in relation to validinsurance claims, Homeowners Choice Property & Casualty Insurance Company, Inc. hassubsequently made it a business practice to deny these services irrespective of the facts for eachclaim in direct violation of 626.9541(1)(i)(3)(a) and 626.9541(1)(i)(3)(b).Homeowners Choice Property & Casualty Insurance Company, Inc. has repeatedly andcontinuously acted in bad faith in this matter and others like it. Despite the fact that theseservices are directly related to covered losses and not excluded under the policy of insurance,Homeowners Choice Property & Casualty Insurance Company, Inc. refuses to pay insurancebenefits for same. In order to cure Homeowners Choice Property & Casualty InsuranceCompany, Inc.’s continuous acts of bad faith, Homeowners Choice Property & CasualtyInsurance Company, Inc. must issue payment for the invoiced amount of $ 2,500.00 and whichhas a current balance of $ 1,244.00; as well as, statutory interest. In addition, HomeownersChoice Property & Casualty Insurance Company, Inc. must cease its unfair trade practice ofciting to irrelevant policy provisions in order to misrepresent the coverages afforded under itspolicies of insurance.PDC22-137284

Comments

User Id		Date Added		Comment
Legal@hcpci.com		11-21-2024		This is Homeowners Choice Property & Casualty Insurance Company’s (“HCPCI”) response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed on behalf of South Florida Mold Experts Inc. After reviewing the CRN, HCPCI conducted a thorough review of the subject claim (“claim”) and confirmed it has handled the claim properly. Overall, HCPCI has handled the claim in accordance with the subject insurance contract and all statutory and regulatory requirements. HCPCI denies each allegation of bad faith and improper conduct in the CRN. At all times, HCPCI has acted in good faith, fairly and honestly toward the Insured and with due regard for the Insured’s interests. However, the CRN is deficient. Generally, CRNs must set forth with specificity relevant insurance contract language, statutory provisions and facts and circumstances to provide insurers with a meaningful opportunity to cure statutory violations alleged in CRNs. Here, Instead of complying with Florida Statutes, Section 624.155, South Florida Mold Experts Inc.’s attorney in the CRN contained an inaccurate recitation of the facts, failed to reference specific, relevant insurance policy language; cited irrelevant statutes; failed to identify any person or persons representing HCPCI who is most responsible for/knowledgeable of the facts giving rise to the allegations in the CRN notice; failed to offer a valid cure, and relied on inaccurate and conclusory statements. South Florida Mold Experts Inc.’s laundry list of inapplicable statutes is insufficient. Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). The CRN cannot serve as the basis of a bad-faith action against HCPCI. Further, South Florida Mold Experts Inc. does not have standing to have filed the CRN. For instance, HCPCI has never provided insurance to South Florida Mold Experts Inc. and moreover, South Florida Mold Experts Inc. has no cause of action against HCPCI for extra-contractual damages or otherwise under Florida law. Finally, upon request by the Department of Financial Services, HCPCI will provide to the Department of Financial Services detailed correspondence HCPCI provided to the Insured regarding HCPCI’s obligations for the claim under the insurance contract and the facts of the claim.

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