Civil Remedy Notice of Insurer Violations
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Filing Number:     785713
Filing Accepted:  10/3/2024
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Complainant
Last/Business Name *  
BARRETT   First Name   KATYA
Street Address * 1770 SW 119 TERRACE
City, State Zip * MIRAMAR, FL 33025
Email Address * GAL@GALSINCLAIRLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   BARRETT   First Name   KATYA
Policy # * GD-0000008463-05 Claim #* DF024426076
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*   MONARCH NATIONAL INSURANCE COMPANY
NAIC Company Code 15715
 
Name of individual responsible for violation (if any):* TONYA JOHNSON, CLAIMS 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, KATYA BARRETT DAMAGES AS A RESULT OF A COVERED WIND 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 DENIED 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
tacham@hpmanaging.com 12-02-2024 December 2, 2024 Via E-mail & Posting on DFS Website Gal Sinclair, Esq. 7950 W. Flagler St., Suite 107 Miami, Florida 33144 gal@galsinclairlaw.com RE: Complainant(s): Katya Barrett Insured(s): Katya Barrett Claim No: DF024426076 Policy No: GD-0000008463-05 DFS Filing Number: 785713 Acceptance Date: October 3, 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.

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