Civil Remedy Notice of Insurer Violations
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Filing Number:     785824
Filing Accepted:  10/4/2024
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Complainant
Last/Business Name *  
WEGER   First Name   WESLEY
Street Address * 6137 HEDGESPARROWS LANE
City, State Zip * SANFORD, FL 32771
Email Address * WESLEY
Complainant Type: * Insured
Insured
Last/Business Name*   WEGER   First Name   WESLEY
Policy # * 80-CT-J674-8 Claim #* 59-69B0-23D
Attorney
Attorney is Applicable
Last Name* KRAPF First Name * GRANT Initial W.
Street Address* 2790 SUNSET POINT ROAD
City, State Zip* CLEARWATER , FLORIDA 33579
Email Address * ASSIST@KRAPFLEGAL.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   STATE FARM FLORIDA INSURANCE COMPANY
NAIC Company Code 10739
 
Name of individual responsible for violation (if any):* JAMES DARBY, BELINDA BYRD, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, STATE FARM FLORIDA INSURANCE COMPANY, WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unfair Trade Practice
Claim Denial
Claim Delay
Other : Not treating the Insured with good faith claims conduct
Other : Looking for ways to deny full recovery to the Insured
Other : Looking for ways to delay full recovery to the Insured
Other : Failing to properly investigate the Insured’s loss
Other : Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made,
Other : Not adjusting claims and evaluating loss properly
Other : Shifting the burden of insuring the loss to the Insured
Other : Failing to implement proper standards for the adjustment and investigation of claims
* 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)(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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language. “It is an accepted principle of law that when parties contract upon a matter which is the subject of statutory regulation, the parties are presumed to have entered into their agreement with reference to such statute, which becomes a part of the contract, unless the contract discloses a contrary intention.” Westside EKG Assocs. v. Found. Health, 932 So. 2d 214, 216 (Fla. 4th DCA 2005), aff’d, 944 So. 2d 188 (Fla. 2006).
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

State Farm Florida Insurance Company (the “Insurer”) has committed the following in handling the Insured’s claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the policyholder and the Insured; 3) looking for ways to deny benefit payments and otherwise “low ball” or “stone wall” claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; 9) shifting the burden of investigating the loss onto the Insured; 10) failing to respond to or acknowledge correspondence within statutory time period; 11) failing to provide a loss run statement; and 12) misrepresenting the terms of the insurance policy. On or about June 6, 2024, while the subject policy was in full force and effect, the Insured’s suffered a loss caused by wind. The areas impacted include but are not limited to the roofing system, exterior surfaces, bedroom, and dining room. The Insured timely submitted a claim on June 10, 2024, to the Insurer for wind damage and the ensuing damage therefrom. Given the scope and nature of the damage, the Insured retained a public adjuster. After assessing the damage and the true scope of repairs, the public adjuster prepared an estimate identifying $56,370.15 in covered damage to the dwelling. The foregoing estimate, photographs, and a letter of representation from the public adjuster were sent to the Insurer who thereafter assigned claim number 59-69B0-23D to the loss and sent a field adjuster to inspect the property. Subsequently, the Insurer notified the Insured that it was denying coverage for the loss. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer’s claim file and standards and procedures for the adjustment and investigation of claims. The Insurer misrepresented the loss and issued a wrongful denial. Although the Insurer and Insured are in dispute about how the dwelling was damaged, the Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697. Furthermore, the Insurer and its agents failed to comply with Fla. Stat. § 627.444 by not providing the Insured and the Insured’s representatives with a loss run statement. On September 5, 2024, the Insured’s legal counsel provided the Insurer with a letter of representation. Within the letter, legal counsel requested a copy of a loss run statement. The Insurer and its agents have not acknowledged the request for a loss run statement nor has a loss run statement been provided. Upon an Insurer receiving a written request for a loss run statement, the Insurer is required, within fifteen (15) calendar days, to provide either a loss run statement or information on how to obtain a loss run statement at no charge through a consumer reporting agency. There has been no response within fifteen (15) calendar days of the Insured’s written request and the Insurer has not provided information on how to obtain a loss run statement at no charge through a consumer reporting agency. This Insurer has breached its duty to settle claims in good faith when, under all the circumstances, it could and should have done so. The Insurer and its agents have not acted fairly and honestly toward the Insured and the Insured’s representative and have moreover failed or refused to promptly acknowledge the Insured’s communications in an attempt to frustrate and delay the resolution of the Insured’s claim. In addition, on September 20, 2024, the Insured, through the public adjuster, asked for the Insurer to confirm receipt of the Letter of Representation that was sent on September 5, 2024. It was not until September 23, 2024, that the Insurer finally responded and said that it had received the Letter of Representation. This shows that Insurer has failed to acknowledge the receipt of communications within seven (7) days in violation of Florida Statute 627.70131(1)(a). Upon an Insurer’s receiving a communication with respect to a claim, the Insurer shall, within 7 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the Insurer which reasonably prevents such acknowledgement. Additionally, Insurer shifted the burden and cost of investigating and insuring the loss onto the Insured. During their investigation, the insurer’s adjuster did not use a moisture meter, despite the presence of interior water damage. A moisture meter can be purchased online from Amazon for around $40 before tax. The Insurer could purchase a moisture meter and assess thousands of properties with one meter. Instead, the Insurer would rather place its financial interests over those of the Insured by failing to provide the adjuster with the necessary tools to correctly inspect the loss. As a result of the inadequate investigation and surrounding circumstances it is apparent that the Insurer significantly underestimated the scope of the loss to the Insured’s property. The Insurer and its adjuster have colluded to misrepresent the true scope of damages to the insured property and the true replacement costs of the damages. In short, the Insurer is not acting with due regard for the Insured’s interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully denied coverage for a loss that should have been covered under the subject policy. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer’s actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer’s actions amount to but are not limited to the following: 1. Claim denial 2. Claim delay 3. Not treating the Insured with good faith claims conduct 4. Looking for way to reduce recovery to the Insured 5. Looking for ways to deny recovery to the Insured 6. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 7. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the Insured's interests 8. Placing the financial interest of the Insurer over that of the health and safety of the Insured 9. Shifting the burden of investigating onto the Insured 10. Conducting inadequate investigations 11. Making material misrepresentations Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1). Admit full coverage for the Insured’s loss. (2). Tender full benefits owed to the Insured under the insurance contract. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. Via E-mail: State Farm Florida Insurance Company P. O. Box 106169 Atlanta, GA 30348 statefarmfireclaims@statefarm.com
Comments
User Id Date Added Comment
lalfano@alfanokingsford.com 11-22-2024 Dear Mr. and Ms. Weger: This letter has been directed to you through your attorney as State Farm Florida Insurance Company’s (“State Farm”) formal response to the allegations set forth in the purported Civil Remedy Notice (“Notice”) of insurer violation dated October 4, 2024. This Notice was filed on your behalf by Attorney Grant Krapf, Esq. of Krapf Legal, P.A. and purports to comply with Florida Statute §624.155. (A copy of the Notice is attached as Exhibit A). In your purported Notice, there is an indication that State Farm did not handle your claim in good faith because State Farm delayed your claim, it denied your claim, it somehow misrepresented the insurance policy to you, it committed some unidentified unfair trade practice, and did not issue payment of benefits you believe are owed to you, along with many other unfounded claims. State Farm denies each of these allegations, and as the facts below will demonstrate, your claim was properly investigated, and State Farm did not treat you unfairly in its adjustment of the claim. Additionally, in the section of the Notice requiring you to refer to specific policy language that is relevant to the violations you allege, the Notice does not contain any policy language whatsoever. Instead, it states that “[t]he violations alleged are statutorily based and do not rely on any specific policy language.” Despite this assertion, your Notice requests that State Farm cure your allegations by admitting “full coverage” and tendering “full benefits owed to Insured under the insurance contract.” Clearly, these allegations do, in fact, rely on policy language which your Notice was required, by law, to specifically refer to. Your Notice’s failure to do so renders it invalid as it does not meet the strict compliance requirement under Florida Law. Julien v. United Prop. & Cas. Ins. Co., 2021 Fla. App. LEXIS 3131 (Fla. 4th DCA 2021). On June 10, 2024, Top Tier Public Adjusting (“Top Tier”) submitted the subject wind and hail damage claim to State Farm on your behalf with a reported date of loss of June 6, 2024. The same day, State Farm received email correspondence from Top Tier attaching a public adjuster contract executed by you on June 8, 2024. (Please see attached Exhibit B). On June 11, 2024, State Farm sent correspondence to you advising you of your Duties After Loss and the Homeowner Claims Bill of Rights. (Please see attached Exhibit C and Exhibit D). On June 12, 2024, State Farm Representative James Darby spoke with you, at which time you advised of wind and hail damage to your roof, as well as water leaks in ceilings of the dining room and garage. The same day, State Farm sent correspondence to Top Tier acknowledging receipt of the public adjuster contract and advising of the public adjuster’s duties under Florida Statute 626.854. (Please see attached Exhibit E). State Farm also sent separate correspondence to Top Tier requesting a written estimate from the public adjuster along with a submitted proof of loss. (Please see attached Exhibit F). On June 14, 2024, State Farm inspected the roof and exterior of your property with you and public adjuster, John Giraldo, present. On June 18, 2024, State Farm inspected the interior of your property with you present. The same day, State Farm received email correspondence from Top Tier attaching an estimate totaling $56,370.15. (Please see attached Exhibit G). On June 26, 2024, State Farm sent you its coverage determination explaining that the reported damage was not caused by a wind or hail event. State Farm advised that it found prior repairs to the roof and that the observed conditions are the result of wear, tear, and deterioration. State Farm further advised that the reported interior damage is consistent with an ongoing leak from multiple weather events over time. The observed damage to the property is not covered by the subject policy. (Please see attached Exhibit H). The same day, State Farm sent correspondence advising you of your right to participate in the Florida Department of Financial Services mediation program. (Please see attached Exhibit I). On August 8, 2024, the parties participated in mediation through the Department of Financial Services, which ended in an impasse. On August 9, 2024, State Farm received email correspondence from Top Tier attaching photographs and a video taken by your neighbor that purportedly shows evidence of a hailstorm on the date of loss. The email also attaches screenshots of an undated tornado warning from a social media post and a weather report for the reported date of loss. (Please see attached Exhibit J). On August 15, 2024, State Farm received email correspondence from Top Tier inquiring whether State Farm was able to review the documentation sent on August 9, 2024. (Please see attached Exhibit K). On August 19, 2024, State Farm sent email correspondence to Top Tier advising that the documentation had been reviewed and that there was no evidence to support the claim that there had been wind or hail damage to your property. (Please see attached Exhibit L). On September 5, 2024, State Farm received a Letter of Representation from Grant Krapf, Esq. of Krapf Legal, P.A., on your behalf. (Please see attached Exhibit M). The letter requested various information and documentation, including a Loss Run Statement. On September 23, 2024, State Farm sent correspondence to Krapf Legal acknowledging its representation of you. (Please see attached Exhibit N). On September 25, 2024, State Farm received email correspondence from Krapf Legal attaching a Sworn Proof of Loss (“SPOL”) in the amount of $50,512.15, executed by you on September 24, 2024. (Please see attached Exhibit O). The email also attaches the estimate prepared by Top Tier totaling $56,370.15. On October 4, 2024, State Farm sent correspondence to Krapf Legal acknowledging receipt of the SPOL and rejecting it as for its untimely submission and disagreement with the amount claimed therein. (Please see attached Exhibit P). The same day, Mr. Krapf filed the subject Notice on your behalf. On November 12, 2024, State Farm sent correspondence to Krapf Legal providing information on obtaining a Loss Run Statement pursuant to Florida Statute §627.444. (Please see attached Exhibit Q). As the above-referenced facts demonstrate, there is no support for your allegations against State Farm, and State Farm has properly handled this claim and treated you fairly in its adjustment. Florida Statute §624.155 requires specificity in Civil Remedy Notices. Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So. 2d 1278 (Fla. 2000); Julien v. United Prop. & Cas. Inc. Co., 2021 Fla. App. LEXIS 3131 (Fla. 4th DCA 2021). Your Notice lacks any specific information in support of any of its allegations. For example, your Notice alleges that State Farm has “committed the following in handling the Insured’s claim: 1) failing to act in due diligence and good faith to resolve claims; 2) placing the financial interest of the Insurer before that of the policyholder and the Insured; 3) looking for ways to deny benefit payments and otherwise “low ball” or “stone wall” claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; 9) shifting the burden of investigating the loss onto the Insureds; 10) failing to respond to or acknowledge correspondence within statutory time period; 11) failing to provide a loss run statement; and 12) misrepresenting the terms of the insurance policy.” After providing this lengthy list of wrongful conduct, you provide no information whatsoever to show how State Farm possibly performed these behaviors. State Farm handled your claim in good faith. Because you cannot provide any information to the contrary, your Notice fails to meet its statutory purpose of providing an insurer with the opportunity to resolve legitimate disputes. Lane v. Westfield Ins. Co., 862 So. 2d 774, 779 (Fla. 5th DCA 2003); Julien v. United Prop. & Cas. Inc. Co., 2021 Fla. App. LEXIS 3131 (Fla. 4th DCA 2021). Accordingly, State Farm denies these unfounded allegations. In another long list of allegations, you allege that State Farm’s actions “amount to but are not limited to the following: Claim denial; Claim delay; Not treating the insured with good faith claims conduct; Looking for ways to reduce recovery to the Insured; Looking for ways to deny recovery to the Insured; Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured; Not training, supervising or managing adjusters property so that prompt and full payments are made, but rather placing the company’s interests before the Insured’s interests; Placing the financial interest of the Insurer over that of the health and safety of the Insured; Shifting the burden of investigation onto the insured; Conducting inadequate investigations; and making material representations.” After listing these bald allegations, you, again, fail to provide any information to support any of them. As such, your Notice again fails to meet its statutory purpose of providing an insurer with the opportunity to resolve legitimate disputes. Lane, 862 So. 2d 774; Julien, 2021 Fla. App. LEXIS 3131. Additionally, the facts shown above contradict most of these claims, as State Farm did not delay your claim, it did not cause you to investigate your own loss, and it did not look for ways to reduce your recovery. As such, State Farm denies each and every one of these unsupported allegations. Your Notice further alleges that State Farm “misrepresented the loss and issued a wrongful denial.” and “knows or should know that when independent perils converge and single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine.” You continue to fail to identify specific information to show that State Farm’s coverage determination was a misrepresentation of the loss. Moreover, the application of the concurring cause doctrine is misused in this instance, as it requires there to be a covered peril that constitutes a cause of loss concurrent to an uncovered peril. As the facts above demonstrate, State Farm did not find that a covered peril occurred at your property. State Farm determined that the conditions of your roof are the result of multiple causes of loss that are not covered by the subject policy. You go on to allege that State Farm and its agents “have not acted fairly and honestly toward the Insured and the Insured’s representative and have moreover failed or refused to promptly acknowledge the Insured’s communications in an attempt to frustrate and delay the resolution of the insured’s claim.” This baseless assertion is made without any factual support aside from your own disagreement with the results of State Farm’s investigation. State Farm completed a prompt investigation of your claim without creating any delay. The above facts show that State Farm inspected your property twice shortly after your claim was submitted and issued a timely coverage determiantion based on its findings. State Farm maintained communication with you and your representatives and issued responses. Additionally, your Notice alleges that State Farm “failed to comply with Fla. Stat. § 627.444 by not providing the Insured and the Insured’s representatives with a loss run statement.” Florida Statute §627.444 provides that an insurer may provide information on how to obtain a loss run statement through a consumer reporting agency in lieu of providing the statement itself. State Farm sent correspondence to Krapf Legal on November 12, 2024, providing said information. Your Notice alleges that State Farm “shifted the burden and cost of investigating and insuring the loss onto the Insured,” and that State Farm’s inspection was somehow inadequate because the adjuster “did not use a moisture meter.” As shown by the above facts, State Farm conducted a complete investigation and was able to determine the cause of water intrusion without such a tool. More importantly, you have not demonstrated how a reading from a moisture meter triggers coverage under the applicable policy; which it does not. You continue by alleging that State Farm “significantly underestimated the scope of the loss to the Insured’s property. Insurer and its adjuster have colluded to misrepresent the true scope of damages to the insured property and the true replacement costs of the damages.” Yet, these allegations are completely baseless, as the issue at hand is not a dispute over the scope of damages, which State Farm has not contested, but rather, has determined that the damage to your property is not covered under the subject policy. To suggest that State Farm and its adjusters have somehow colluded to misrepresent the scope of damages only demonstrates that the allegations in your Notice are not based on the specific facts of your claim and are boilerplate in nature. Moreover, your Notice alleges that State Farm “is not acting with due regard for the insured’s interests or safety,” and ““has engaged in bad faith practices designed to delay claims and prevent the insured from recovering what is rightfully owed under the subject policy of insurance.” You make these bald allegations without providing any information to show how State Farm has acted in accordance with the alleged wrongful conduct during its adjustment of your claim or any other claims. State Farm created no delay in the adjustment of your claim, as it conducted a timely inspection of your property and issued its coverage determination shortly thereafter. Lastly, your Notice alleges that State Farm has violated several Florida Statutes without providing any factual support to demonstrate how State Farm engaged in such behaviors. For instance, your Notice alleges that State Farm violated Fla. Stat. § 624.155(1)(b)(1) by “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” and violated Fla. Stat. § 624.155(1)(b)(3) by “failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear.” However, you have not identified any facts about this claim to show that State Farm should have or was obligated to settle this claim at any time. To the contrary, the facts demonstrate that the subject policy does not provide coverage for the loss, and State Farm is not required to issue payment. Your Notice alleges that State Farm has violated Fla. Stat. § 626.9541 (1)(i)(3)(a) by “failing to adopt and implement standards for the proper investigation of claims.” You have failed to identify any conduct or standards exercised by State Farm during the investigation of your claim that would be considered improper. The facts above show that State Farm completed a prompt and proper investigation of your claim. Your Notice alleges that State Farm has violated Fla. Stat. § 626.9541 (1)(i)(3)(c) by “failing to acknowledge and act promptly upon communications with respect to claims.” However, your Notice does not identify any specific communications from you or your representatives that State Farm has failed to respond to. State Farm made timely responses to all communications and materials received on your behalf during the adjustment of your claim. Your Notice alleges that State Farm has violated Fla. Stat. § 626.9541 (1)(i)(3)(d) by “denying claims without conducting reasonable investigations based upon available information.” This is clearly untrue, and you fail to identify how State Farm’s investigation was unreasonable in any way. The above facts demonstrate that State Farm considered all available information when determining whether the loss was covered by the subject policy, including the photographs that you personally sent to State Farm. Your Notice fails to provide any evidence demonstrating that State Farm violated any of the referenced statutes aside from a mere recitation of the statutory language. State Farm denies that it violated any statutory provisions in its handling of the claim. As has already been a problem with the Notice, it continues to fail to adhere to its statutory purpose of providing an insurer with the opportunity to resolve legitimate disputes. Lane, 862 So. 2d 774; Julien, 2021 Fla. App. LEXIS 3131. State Farm denies that this claim has been handled in bad faith, unfairly, or with delay. State Farm hereby denies each and every allegation against it as put forth in your Notice. State Farm has in the past, and continues at the present time, to make all efforts to promptly resolve this claim in a fair and reasonable fashion and in full accord with the insurance policy and Florida law.
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