Civil Remedy Notice of Insurer Violations
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Filing Number:     785511
Filing Accepted:  10/2/2024
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Complainant
Last/Business Name *  
EUGENE   First Name   FRANCISQUE
Street Address * 3892 NW 165 STREET
City, State Zip * MIAMI GARDENS, FL 33054
Email Address * LSTEPHAN@MINEOLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   EUGENE   First Name   FRANCISQUE
Policy # * 05046295 Claim #* CH0524423986
Attorney
Attorney is Applicable
Last Name* STEPHAN First Name * LANCE Initial
Street Address* 5600 DAVIE ROAD
City, State Zip* DAVIE , FLORIDA 33314
Email Address * LSTEPHAN@MINEOLAW.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):* ALL ADJUSTERS, SUPERVISORS, MANAGERS, ATTORNEYS, AND INDIVIDUALS ASSOCIATED WITH AND/OR RETAINED BY MONARCH NATIONAL INSURANCE COMPANY CONCERNING THE CLAIM AT ISSUE; CONSTANCE RUSHDI.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : VIOLATION OF CODE OF ETHICS
* 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)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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)(1) Attempting to settle claims on the basis of an application, when serving as a binder or intended to become a part of the policy, or any other material document which was altered without notice to, or knowledge or consent of, the insured.
626.9541(1)(i)(2) A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
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)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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.

In addition to the breach of the above statutory duties, see Coverage A and Loss Payment Provisions.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Monarch National Insurance Company (the “Insurance Company”) issued a homeowners’ insurance policy to its insured, Francisque Eugene (the “Insured”), for the insured property located at 3892 NW 165th Street, Miami Gardens, FL 33054. The subject Policy afforded various types of coverages including coverage for damage to dwelling, other structures, personal property, and for loss of use. On or about November 15, 2023, while the subject Policy was in full force and effect, the Insured’s home was damaged as a result of a sudden accidental discharge of water from a plumbing system / appliance within the home. The Insured subsequently notified the Insurance Company of the loss. Thereafter, the Insurance Company acknowledged the loss and assigned claim number CH0524423986 to the loss. The Insured complied with all policy conditions and cooperated with the Insurance Company’s investigation efforts. The Insurance Company has inspected the property and conducted its investigation of the claim. The Insured has fully complied with all policy conditions and requests made to the Insured by the Insurance Company, though the Insured does not believe that the Insurance Company has conducted a full investigation and/or accurately conducted its investigation. After completing its investigation, the Insurance Company wrongly denied the Insured’s claim and failed to issue any payment for the claim whatsoever. Accordingly, the Insurance Company has misrepresented facts and policy language related to the coverages provided under the policy, and has accordingly collected a premium for insurance that has not been provided in full. The obligation to pay the full value of Insured's claim has been made clear based on the facts and evidence available, yet the Insurance Company has failed to pay the full value of the Insured’s claim. This is caused in part by the Insurance Company’s failure to adopt and implement standards for the proper investigation of claims. The Insurance Company retained an engineering company to conduct an inspection of the property and prepare a report detailing its findings. The Insurance Company sent denial correspondence to the Insured, and based its coverage decision on the report prepared by its paid engineer. However, the Insurance Company did not provide the Insured with a copy of the engineering report upon which the denial was based. The Insurance Company’s actions are in direct violation of section 626.9541(1)(i)(3)(f), Florida Statutes (i.e., 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). The Insured provided the Insurance Company with documentation evaluating the loss, and rather than issuing the proper payment or attempting to reach an agreement with its Insured, the Insurance Company is delaying and denying the claim. Upon information and belief, the Insurance Company performs the subject actions as a business practice, including delaying the claim and/or denying the claim in an attempt to dissuade its insureds from pursuing the claim to the detriment of its insureds to increase financial profits. In order to remedy the above defects, the Insurance Company must do the following: 1. Immediately admit coverage and pay the Insured the full value of the claim (i.e., $58,622.11, less applicable deductible). 2. Pay statutory interest on the amount of unpaid damages from the date of loss. 3. Act fairly and honestly toward its Insured with due regard for her interests in attempting to resolve the claim. 4. Cease and desist all present and future bad faith actions with regard to this claim. 5. Implement standards for the property investigation of claims. 6. Stipulate to the Insured’s entitlement to attorney’s fees and court costs pursuant to section 627.428, Florida Statutes, and/or Section 627.70152, Florida Statutes, and pay the amount of fees and costs incurred.
Comments
User Id Date Added Comment
aabell@kirwanspellacy.com 11-27-2024 Dear Mr. Stephan: We represent Monarch National Insurance Company (hereinafter “MONARCH”) regarding the claim presented by the insured, Francisque Eugene (hereinafter “Complainant”), for alleged damages sustained to the property located at 3892 NW 165th Street, Miami, FL 33054 (hereinafter the “subject property”), on or about November 15, 2023 as a result of a reported HVAC leak. On October 2, 2024, the DFS accepted the filing of a Civil Remedy Notice of Insurer Violation (hereinafter “CRN”), as submitted by the Complainant through their attorney under filing number 785511. This will serve as Monarch’s response to said CRN. Monarch welcomes the opportunity to respond to this Civil Remedy Notice and specifically denies each and every allegation contained in the CRN. The Civil Remedy Notice fails to comply with the specific notice and information requirements as set forth in Florida Statute §624.155 and Florida case law. Julien v. United Prop. & Cas. Ins. Co, 311 So.3d 875 (Fla. 4th DCA 2021). As a preliminary matter, Monarch notes that the proper purpose for submitting a valid CRN to the Florida Department of Financial Services, as set forth in Fla. Stat. § 624.155, is to provide detailed notice of specific, factually supported statutory bad faith violations along with an opportunity to cure any such violations. The proper purpose is not to dispute coverage decisions or estimates of covered damages. The instant CRN provided no specificity of any purported bad faith allegations and is deficient on its face. The CRN alleges that Monarch violated Florida Statute Sections 624.155(1)(b)(1), 624.155(1)(b)(2), 624.155(1)(b)(3), 626.9541(1)(i)(1), 626.9541(1)(i)(2), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(d), 626.9541(1)(i)(3)(e), 626.9541(1)(i)(3)(f), 626.9541(1)(i)(3)(g), 626.9541(1)(i)(3)(h) and 626.9541(1)(i)(4) as the basis for filing the instant notice. Monarch specifically denies that it has violated any of these sections and any other allegations of bad faith or improper claims handling in this matter. Monarch maintains that it has acted promptly, fairly and honestly with the insureds at all times in the handling of this claim. Further, many of the sections the Complainant cites to are wholly inapplicable to this matter on their face. Specifically, Monarch explicitly denies violation of any applicable Florida Statute in the evaluation and adjustment of the referenced claim. Monarch denies that it did not, in good faith, attempt to settle the claim and asserts that it acted fairly and honestly toward its insureds with due regard for their interests. Monarch denies that it made claims payments to insureds or beneficiaries not accompanied by a state setting forth the coverage under which payments are being made. Monarch denies that it failed 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. Monarch denies it has attempted to settle claims on the basis of an application, when serving as a binder or intended to become part of the policy, or any other material document which was altered without notice to, or knowledge or consent of, the insured. Monarch denies that it made a material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy. Monarch denies that it failed to adopt and implement standards for the proper investigation of claims. Monarch denies that it misrepresented pertinent facts or insurance policy provisions relating to coverages at issue. Monarch denies that it failed to acknowledge and failed to act promptly upon communications with respect to the claim. Monarch denies that it is denying claims without conducting reasonable investigations based upon available information. Monarch denies that it failed to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed. Monarch denies that it failed to promptly provide a reasonable explanation in writing to the insured for 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. Monarch denies that it failed to promptly notify the insured of any additional information necessary for the processing of a claim. Monarch denies that it failed to clearly explain the nature of the requested information and the reasons why such information is necessary. Monarch denies 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). Monarch explicitly denies violation of any applicable Florida statute in the evaluation and adjustment of the referenced claim. Monarch denies that it did not, in good faith, attempt to settle the claim and asserts that it has acted fairly and honestly toward its insureds with due regard for their interests. Monarch denies that it failed to adopt and implement standards for the proper investigation of claims. Monarch denies that it denies claims without conducting reasonable investigations based upon available information. The CRN fails to comply with the very statute the Complainant is seeking to invoke. Contrary to the specific requirements of Section 624.155(3)(b)(4), the CRN fails to identify the specific policy language that is relevant to the purported violation(s). Section 624.155 states, in pertinent part, as follows: b. notice shall be on a form provided by the department and shall state with specificity the following information, and such other information as the department may require: 2. The facts and circumstances giving rise to 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. § 624.155(3)(b)(2)&(4), Fla. Stat. (2015) [emphasis added]. Instead of citing actual facts and policy language, where the CRN form requires the Complainant to do so, the Complainant provides absolute zero recitation of the actual facts of this claim, omitting pertinent facts, and misstating others. This lackadaisical approach in completing a CRN not only is non-conforming to the requirements of Florida law, but it also fails to place Monarch on notice as to what the Complainant contends Monarch has or has not done to the insureds’ satisfaction. The CRN fails to provide any policy language in support of these allegations, nor does it provide how Monarch has violated any specific terms of the subject policy of insurance. Monarch also objects to the CRN, as it lacks sufficient specificity, as required by §624.155, Fla. Stat., in addition to other defects. As filed, the CRN fails to accurately and specifically describe the facts and circumstances of Monarch’s alleged statutory violation. Instead, the insureds’ recitation of “facts” presents mere conclusory statements and offers no support as to the acts and/or omissions purportedly taken by Monarch which substantiate the insureds’ allegations. The Insureds’ assertions are vague, baseless, and contrary to Florida law. Furthermore, the allegations contain sweeping summaries of conversations that purportedly occurred without any support for the same. Section 624.155(2)(d) “requires that the civil remedy notice state with specificity the facts and circumstances giving rise to the violation.” Lane v. Westfield Ins. Co., 862 So.2d 774, 778 (5th DCA 2003). The purpose of a civil remedy notice is to give the insurer one last chance to settle a claim with the Insured, and not to give the Insured a right of action to proceed against the Insurer. Lane, 862 So.2d at 779; see also Talat Enterprises, Inc. v. Aetna Casualty & Surety Co., 952 F.Supp. 773 (M.D. Fla. 1997) (holding that a claimant must give the Florida Department of Insurance and the insurer sixty days written notice of a violation so that the insurer may cure any violation) and Julien v. United Prop. & Cas. Ins. Co., 46 Fla. L. Weekly D486 (Fla. 4th DCA March 3, 2021). Without such notice, Monarch is unable to cure any alleged defect, if warranted. Instead of citing actual facts and policy language, where the CRN form requires the Complainant to do so, the Complainant provides a vague, inaccurate, and misleading recitation of the facts of this claim, omitting pertinent facts, and misstating others. This approach in completing a CRN is not only non-conforming to the requirements of Florida law, but it also fails to place Monarch on notice as to what the Complainant contends Monarch has or has not done to the insured’s satisfaction. Stripped of its purpose to give Monarch notice of potentially applicable cures, the CRN is entirely deficient with respect to the explicit requirements of Section 624.155, and should be rejected as being non-compliant with the statute. Due to the lack of specificity and other defects, the CRN is invalid and cannot serve as a condition precedent to any action for alleged bad faith under §624.155, Fla. Stat., or otherwise under Florida law. Despite the allegations made by the Complainant, Monarch diligently and thoroughly complied with guidelines throughout its investigation of the alleged loss once it was reported on January 10, 2024. The investigation included but is not limited to, performing a Field Adjuster (“FA”) inspection which was performed on February 2, 2024. The Complainant indicates in the CRN that the reason for the notice is due to unfair trade practice, claim denial, claim delay, not treating the policyholder with good faith claims conduct, looking for ways to deny full recovery to the insureds, looking for ways to delay full recovery to the insureds, not training, supervising, or managing adjusters properly so that prompt and full payments are made, and failing to provide the insureds with the full benefits award to him under the contract of insurance. Monarch further objects to the CRN, and the CRN is defective, additionally because it neither provides a general description, nor references to the specific policy language at issue in the alleged violations, as required by Florida Statute §624.155(3)(b)4. Rather, the CRN merely uses boilerplate language as to Monarch’s actions, which fails to explain how Monarch was wrong in its assessment of coverage. The subject policy issued by Monarch is governed by the policy’s terms, conditions, and exclusions together with any endorsements. Monarch, being the maker of the policy is very familiar with its language and what losses are afforded coverage. This CRN response does not waive any such provisions of the policy. Lastly, because no specific facts or remedies are referenced, Monarch cannot be expected to investigate the Complainant’s allegations and determine whether any corrective measures are warranted. As such, the CRN is defective and must be rejected. Section 624.155, of the Florida Statutes sanctions recovery of extra-contractual damage in insurance disputes when the insurance carrier fails to attempt in good faith to settle a claim. The statute requires the Insured to file a Civil Remedy Notice of Insurer Violation as a condition precedent to the bad faith cause of action. The Statute demands strict compliance and lays out specific notice requirements the Insured’s CRN has to meet for it to be legally sufficient. The filing of a legally sufficient CRN is not only a condition precedent but is essential to the procedural integrity of an action for bad faith. See Allstate Ins. Co. v. Clohessy, 32 F. Supp. 2d 1328 (M.D. Fla. 1998); see also Talat Enters. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278 (Fla. 2000). The statute’s clear and unambiguous standards for proper notice require the claimant to state with specificity the facts and circumstances giving rise to the violation and to reference the policy language relevant to such alleged violations. The Complainant has failed to comply with the above authority for this subject CRN. The CRN alleges that Monarch violated Florida Statute Sections 624.155(1)(b)(1), 626.9541(1)(i)(3)(a), and 626.9541(1)(i)(3)(i) as the basis for filing the instant notice. However, the CRN (i) fails to reference the proper policy language relevant to such alleged violations; (ii) fails to state with specificity any facts and circumstances giving rise thereto; and (iii) fails to state, with specificity, the cure sought by the insured. The CRN is facially deficient and fails to comply with current Florida case law, as stated above. The purpose behind the notice requirement of the Civil Remedy Statute is to give an opportunity to the insurer to remediate the alleged statutory violation. The statute provides a sixty day cure period during which an insurer may avoid bad faith litigation by (i) paying the contractual amount due under the policy or (ii) by correcting the circumstances giving rise to the violation. The CRN provides no such opportunity to Monarch as the CRN does not specify the circumstances giving rise to Monarch’s alleged violations. The Complainant does not indicate how the cited policy language is relevant to any violations alleged and do not state with specificity any facts or circumstances giving rise to any violation. As such, the Complainants’ CRN does not afford Monarch adequate notice or an opportunity to cure any alleged violation, if warranted. The CRN is deficient and should be rejected. Monarch denies violation of Florida Statute Sections 624.155(1)(b)(1) and 626.9541(1)(i)(3)(a). Monarch has acted promptly, fairly, in good faith, and in the best interest of the Insured at all times during the claims process. Monarch does not intend by this letter or any aspect of its investigation to waive any of its rights afforded either under the contract of insurance or at law. Monarch explicitly reserves all rights.
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