Civil Remedy Notice of Insurer Violations
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Filing Number:     785633
Filing Accepted:  10/3/2024
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Complainant
Last/Business Name *  
MORA   First Name   RAMONA
Street Address * 302 189 TERR
City, State Zip * SUNNY ISLES BEACH, FL 33160
Email Address * RAMONAMORA305@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   MORA   First Name   RAMONA
Policy # * 08706018-2 Claim #* 940011
Attorney
Attorney is Applicable
Last Name* SINCLAIR First Name * GAL Initial
Street Address* 7950 W. FLAGLER STREET, SUITE 107
City, State Zip* MIAMI , FLORIDA 33144
Email Address * GAL@GALSINCLAIRLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   HOMEOWNERS CHOICE PROPERTY & CASUALTY INSURANCE COMPANY, INC.
NAIC Company Code 12944
 
Name of individual responsible for violation (if any):* PAUL HAMILTON, CLAIM EXAMINER
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
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)(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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

THE POLICY PROVIDES COVERAGE FOR DIRECT PHYSICAL LOSS TO PROPERTY. THE POLICY CONTAINS A LOSS PAYMENT PROVISION. THE POLICY PROVIDES THAT THE INSURANCE COMPANY WILL ADJUST ALL LOSSES WITH THE INSURED. ALL APPLICABLE COVERAGES UNDER COVERAGE A, COVERAGE B, COVERAGE C, AND COVERAGE D, APPLICABLE ENDORSEMENTS, TERMS, CONDITIONS, AND DEFINITIONS. VIOLATION OF FLORIDA STATUTE 627.7015, WHICH IS INCORPORATED INTO THE POLICY
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

THE INSURED, RAMONA MORA DAMAGES AS A RESULT OF A COVERED FIRE DAMAGE LOSS. THE INSURED TIMELY NOTIFIED THE CARRIER OF THE LOSS. THE INSURED COMPLIED WITH ALL POLICY CONDITIONS. THE INSURANCE COMPANY FAILED TO PERFORM A PROPER INVESTIGATION AND EVALUATION OF THE CLAIM AND THEREFORE, IMPROPERLY UNDER ESTIMATE FOR PLAINTIFF’S LOSS AND DAMAGES. THE CARRIER HAS BREACHED THIS DUTY IN THE ADJUSTMENT OF THE INSURED’S CLAIM. THE CARRIER HAS FAILED TO CREATE AND IMPLEMENT ADEQUATE GUIDELINES FOR PROPER INVESTIGATION OF CLAIMS HANDLING AND FOR TRAINING AND SUPERVISION OF EMPLOYEES RESULTING IN STATUTORY VIOLATIONS SET FORTH ABOVE. 1. THE CARRIER HAS FAILED AND/OR REFUSED TO THOROUGHLY, ACCURATELY, AND COMPLETELY INVESTIGATE, EVALUATE, AND PAY THE INSURED’S INSURANCE CLAIM FOR DAMAGES. THE CARRIER’S WRONGFUL CONDUCT AND OMISSIONS INCLUDE BUT ARE NOT LIMITED TO. 2. NOT CONDUCTING FULL AND PROMPT INVESTIGATION. 3. INSURANCE CREATED FACT THAT DO NOT EXIST BY DISHONESTLY MISREPRESENTATION FACTS TO FRAME ELDERLY INSURED AS A DISHONEST PERSON. 4. NOT TREATING THE POLICYHOLDERS WITH GOOD FAITH CLAIMS CONDUCT. 5. LOOKING FOR WAYS TO DENY RECOVERY TO THE INSURED. 6. NOT ADJUSTING THE CLAIM AND EVALUATING THE LOSS PROPERLY, PROMPTLY AND FAIRLY TO PROVIDE FULL AND PROMPT INDEMNITY TO THE INSURED. 7. FAILING TO IMPLEMENT PROPER STANDARDS FOR THE ADJUSTMENT AND INVESTIGATION OF CLAIMS. 8. NOT TRAINING, SUPERVISING OR MANAGING ADJUSTERS PROPERLY SO THAT PROMPT AND FULL PAYMENTS ARE MADE, BUT RATHER PLACING THE COMPANY’S INTERESTS BEFORE THE POLICYHOLDER’S INTERESTS. 9. INSURANCE COMPANY REFUSED TO PROVIDE AND/OR FAIL TO PROVIDE AND/OR FAIL TO PROVIDE CERTIFIED COPY OF THE SUBJECT POLICY. THE INSURANCE COMPANY WROTE TWO LETTERS THAT INDICATED DIFFERENT POLICY LANGUAGE. THE INSURED IS UNABLE TO EVALUATE HIS RIGHTS WITHOUT CERTIFIED COPY OF POLICY. 10. ESTABLISHING SEVERITY CONTROL INITIATIVES AND OTHERWISE ESTABLISHING A CULTURE OF NOT FULLY AND PROMPTLY PAYING CLAIMS FOLLOWING LOSSES; AND. 11. FAILING TO PAY THE INSURED’S DAMAGES DESPITE KNOWING IT MUST DO SO. THE CARRIER’S ACTIONS HINDER THE PROPERTY TO BE LIVABLE, CONSEQUENTELY, TO CURE THE DEFECTS OUTLINED IN THIS CIVIL REMEDY NOTICE, THE CARRIER MUST, 12. TENDER PAYMENT FOR THE LEGITIMATE CLAIM ALREADY SUBMITTED IT TO DEFENDANT. 13. CEASE AND DESIST ALL PRESENT AND FUTURE BAD FAITH ACTIONS WITH REGARD TO THE INSURED’ POLICY. 14. THE CARRIER HAS ACCEPTED COVERAGE. 15. THE INSURED REQUEST THE CARRIER TO RE-EVLAUTE THE CLAIM AND MAKE A REASONABLE OFFER TO SETTLE THE CASE.
Comments
User Id Date Added Comment
Legal@hcpci.com 12-01-2024 This is Homeowners Choice Property & Casualty Insurance Company’s (“HCPCI”) response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed on behalf of Ramona Mora (“Insured”). HCPCI reviewed this CRN and conducted a thorough review of the subject claim (“claim”) and confirmed it handled the claim properly. Regarding an aspect of the claim, HCPCI issued payments for it on the information available to HCPCI and the circumstances at the time of such payments. Ultimately, HCPCI handled the claim in accordance with the policy and all statutory and regulatory requirements. HCPCI denies each allegation of bad faith and improper conduct in the CRN. At all times, HCPCI acted in good faith, fairly and honestly toward the Insured and with due regard for the Insured’s interests. Furthermore, the CRN fails to adequately describe the alleged violations and fails to provide sufficient information to have created an opportunity for the alleged violations to be corrected (although no violations exist). Instead of complying with Florida Statutes, Section 624.155, the Insured’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 offer a valid cure, and relied on inaccurate and conclusory statements. The Insured’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. 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.

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DFS-10-363
Rev. 10/14/2008