Civil Remedy Notice of Insurer Violations
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Filing Number:     785912
Filing Accepted:  10/5/2024
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Complainant
Last/Business Name *  
SIMPSON   First Name   JUNE
Street Address * 11865 FORT KING HIGHWAY
City, State Zip * THONOTOSASSA, FL 33592
Email Address * JUNESIMPSON1@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   SIMPSON   First Name   JUNE
Policy # * 0721743460 Claim #* 01000113217
Attorney
Attorney is Applicable
Last Name* KARKATSELOS First Name * E. TIM Initial
Street Address* 5331 PRIMROSE LAKE CIRCLE SUITE 207
City, State Zip* TAMPA , FLORIDA 33647
Email Address * TIM@YOURPROPERTYADVOCATE.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   FRONTLINE INSURANCE UNLIMITED COMPANY
NAIC Company Code 10074
 
Name of individual responsible for violation (if any):* TRACY CLIFTON
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
* 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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
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.

SECTION I – PERILS INSURED AGAINST A. Coverage A – Dwelling And Coverage B – Other Structures 1. We insure against direct physical loss to property described in Coverages A and B. 2. We do not insure, however, for loss: a. Excluded under Section I – Exclusions; b. Involving collapse, including any of the following conditions of property or any part of the property: (1) An abrupt falling down or caving in; (2) Loss of structural integrity, including separation of parts of the property or property in danger of falling down or caving in; or (3) Any cracking, bulging, sagging, bending, leaning, settling, shrinkage or expansion as such condition relates to (1) or (2) above;
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On June 5, 2024 the insured, June Simpson reported a claim for water damage to the interior of her home as a result of a windstorm that occurred on or about May 15, 2024. Frontline acknowledged the claim and physically inspected the property shortly after. The insured provided the assigned adjuster with a sworn proof of loss along with an estimate of damages and a photo report within a couple of weeks of filing the claim. Frontline proceeded to request an examination under oath on July 11, 2024 and provided the soonest date as September 24, 2024 almost four (4) months after the claim was first made for the examination to take place. While it is within the insurance company’s right to investigate a claim, to delay a claim determination for water damage to a Florida home for approximately four months is egregious. Further, the risk of ensuing damage as a result of humidity that could cause mold and affect the insureds home and health is of utmost importance. The assigned adjuster was communicated with multiple times by the insured's legal representative requesting the claim determination and investigation be expedited due to the lapse in time from when the claim was created. The adjuster's response was that the claim was still being investigated and a coverage decision would not be made until the examination under oath could take place, disregarding the delay it would cause by proposing the soonest date as September 24, 2024. The examination under oath was coordinated and scheduled for October 3, 2024. On the morning of the proceeding the insurance company's legal representative communicated with counsel for the insured stating the examination would not go forward due to insufficient documents being provided by the insured including irrelevant requests that had nothing to do with the claim in question; underwriting records that were already in Frontline's possession; as well the aforementioned estimate, photo report, and sworn proof of loss that had already been submitted by the insured to Frontline in a prompt manner months earlier. Frontline proceeded to request a rescheduling with the soonest date being October 24, 2024, almost five (5) months after the claim was made. Based on the foregoing actions and omissions, Frontline has engaged in wrongful conduct. That wrongful conduct includes, but is not limited to, improper claim delay and not adjusting the claim and evaluating the loss properly, promptly, and fairly so as to provide full and prompt indemnity to its Insured. Therefore, to cure the defects outlined in this Civil Remedy Notice, Frontline must: Tender all insurance monies owed to the Insured for the windstorm/water loss to the insured’s property based on the sworn proof of loss and corresponding estimate submitted.
Comments
User Id Date Added Comment
tsalehi@salehiboyer.com 12-03-2024 VIA ELECTRONIC SUBMISSION: civilremedy@myfloridacfo.com Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Re: Complainant: June Simpson Policyholders: June and Thomas Simpson Filer: E. Tim Karkatselos, Esq. Claim #: 01000113217 Policy #: 0721743460 Date of Loss: September 28, 2022 CRN Filing No.: 785912 CRN Filing Date: October 5, 2024 Notice Against: FRONTLINE INSURANCE UNLIMITED COMPANY To Whom It May Concern at The Department of Financial Services: With this correspondence, First Protective Insurance Company d/b/a Frontline Insurance (“Frontline”) responds to the Civil Remedy Notice of Insurer Violations (“CRN”) filed by Tim Karkatselos, Esq. on behalf of June Simpson (the “Complainant” or “Claimant”) against FRONTLINE INSURANCE UNLIMITED COMPANY. First, the CRN is improperly filed against Frontline Insurance Unlimited Company. Frontline Insurance Unlimited Company did not issue a homeowners insurance policy to the Complainant and at no time was there an insurer-insured relationship between them. Nor was a claim ever submitted to Frontline Insurance Unlimited Company by or on behalf of the Complainant. It appears that the Complainant mistakenly named the wrong insurance carrier in the Civil Remedy Notice. As such, Frontline Insurance Unlimited Company requests the Complainant to immediately withdraw the Civil Remedy Notice. In the alternative, Frontline Insurance Unlimited Company respectfully requests the DFS to reject the Civil Remedy Notice. In addition to the fact that the Civil Remedy Notice names the wrong insurance carrier, the Notice is otherwise statutorily deficient. Section 624.155(3)(b), Fla. Stat., requires a Civil Remedy Notice to provide “with specificity” each of the following: (1) the statutory provision allegedly violated, including the specific language of the statute; (2) the facts and circumstances giving rise to a violation of the statutes referenced in the Notice; (3) the name of any individual involved in the alleged violation; and (4) the specific policy language that is relevant to the alleged violation. Accordingly, to be valid, the Civil Remedy Notice must be specific enough factually so as to provide an insurer with the opportunity to adequately respond to and, if necessary, timely cure the alleged violations within sixty days. See Julien v. United Prop. & Cas. Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2020) (Fla. 4th DCA 2020) (a civil remedy notice is facially invalid where the insured fails to identify the specific statute and specific policy provisions relevant to the alleged violations); Heritage Corp. of S. Fla. v. National Union Fire Ins. Co. of Pittsburgh, 580 F.Supp.2d 1294 (S.D. Fla. 2008). For these reasons, the Civil Remedy Notice filed on behalf of the Complainant fails to comply with the requirements of § 624.155(3)(b). Frontline conducted a thorough review of its handling of the Complainant’s claim. Frontline denies that it has violated any of the statutes referenced in the CRN. At all times, Frontline has acted in good faith, fairly and honestly toward the Complainant and with due regard for their interest. Frontline also argues that the CRN utterly fails to describe any of the alleged violations and fails to provide any information such as facts and circumstances which would allow Frontline to identify and correct the alleged violations. The Complainant alleges violations of the following statutory provisions: 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. Frontline denies the allegation that it violated the above referenced statute. 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. Frontline denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communication with respect to claims. Frontline denies the allegation that it violated the above referenced statute. 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). Frontline denies the allegation that it violated the above referenced statute. Frontline specifically denies each and every one of the Complainant’s allegations that it violated any of the above referenced statutes. In addition to the allegations specifically denied above, Frontline generally denies all allegations presented in this CRN as Frontline has not violated any statute or rule. Finally, Frontline Insurance Unlimited Company is affiliated with First Protective Insurance Company d/b/a Frontline Insurance. While the Civil Remedy Notice is not directed to First Protective Insurance Company in any way, to the extent that the Complainant attempted to assert the alleged violations against First Protective Insurance Company, the allegations are denied in an abundance of caution and without waiver of any of First Protective Insurance Company’s rights to respond upon the filing of a proper, statutorily compliant Notice. CRN MUST BE DISMISSED As noted above, the CRN is improperly filed against Frontline Insurance Unlimited Company. Frontline Insurance Unlimited Company did not issue a homeowners insurance policy to the Complainant and at no time was there an insurer-insured relationship between them. Nor was a claim ever submitted to Frontline Insurance Unlimited Company by or on behalf of the Complainant. It appears that the Complainant mistakenly named the wrong insurance carrier in the Civil Remedy Notice. As such, Frontline Insurance Unlimited Company requests the Complainant to immediately withdraw the Civil Remedy Notice. In the alternative, Frontline Insurance Unlimited Company respectfully requests the DFS to reject the Civil Remedy Notice. Next, because the Civil Remedy Notice fails to allege specific facts and/or circumstances in support of its allegations, Frontline is unable to properly respond; as such, the CRN should be rejected and returned. The CRN is devoid of any factual allegations relating to the monetary amount of any claims. Rather, it merely contains blanket statements with no support. For instance, the CRN alleges “claim delay” without adding any accurate facts to substantiate the allegation. See Rousso v. Liberty Surplus Ins. Corp., No. 10-cv-20554, 2010 WL 7367059, at *4 (S.D. Fla. Aug. 13, 2010) (“In this case, the Plaintiffs do not explain how or identify which claims or suits the Defendant responded to in a manner that was contrary to good faith, unfair, or dishonest.”). This glaring deficiency fails to apprise Frontline of the nature of any purported violation and cannot satisfy the statutory standard of “pleading the facts and circumstances” giving rise to the violation with specificity. The CRN first addresses Section 624.155(1)(b)(1), Florida Statutes, which addresses an insurer’s refusal to attempt to settle in good faith. The CRN, however, does not specify does not specify when any settlement opportunity or proposal existed, the details of the settlement proposal, the nature of the underlying claim(s), or the circumstances supporting the conclusion that the unspecified refusal to settle was not in good faith. To the extent the CRN suggests that Frontline should tender payment due on the claim, the CRN fails to provide any description of the facts and circumstances supporting this contention. Moreover, as to Section 624.155(1)(b)(3), Florida Statutes, the CRN is completely devoid of any facts to support that Frontline failed to promptly settle a claim under one portion of the policy in order to influence settlement under other portions of the policy. Pursuant to Section 626.9541(1)(i)(3)(c), Florida Statutes, the CRN fails to demonstrate, with factual support, Frontline’s failure to act promptly upon communications with respect to claims. Rather, Frontline at all times acted promptly upon communications with respect to the subject claim. Finally, the alleged violation of Section 626.9541(1)(i)(4), Florida Statutes, is inapplicable because on Jule 11, 2024 Frontline requested the Complainant to sit for an Examination Under Oath and provide records and documents for inspection. However, as of the date of this response, the Complainant has failed with her contractual duties under the Policy and therefore, has delayed the investigation of the claim. As such, Frontline denies the allegations raised by the Complainant. The CRN notes that “Frontline proceeded to request an examination under oath on July 11, 2024 and provided the soonest date as September 24, 2024 almost four (4) months after the claim was first made for the examination to take place.” Frontline disagrees with this assertion and allegation, as phrased. It should be noted that a request for the Examination was first sent on July 11, 2024, with dates being offered for September 9th, 10th, and 11th; however, the letter clearly noted that if the above dates do not work, “we will make every effort to make ourselves available so that the EUOs can be completed, and Frontline can complete its investigation as soon as possible.” No response to the first letter was provided. It was not until Frontline’s second letter, dated July 22, 2024 that a response was provided. Counsel for the Insureds chose October 3, 2024, for the Examination to take place. Despite confirming the date, no documents were provided, and the Insured did not appear at the coordinated Examination, further delaying the investigation. The Examination was rescheduled again for October 24, 2024. Counsel for the Insured prematurely and unexpectedly terminated the Examination mid-question, without any explanation. The Examination was not completed on October 24, 2024, and had to be rescheduled for a third time due to Counsel’s delays. The Examination was finally concluded on November 15, 2024; however, the requested documents were never provided. Furthermore, contrary to the requirement to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time,” the purpose of which is “to enable the insurer to investigate and resolve [the] claim,” the CRN itself only provides unsupported, conclusory, and incorrect allegations with no basis in fact or circumstance. Aside from the fact that the allegations are devoid of sufficient facts, the tenor and inferences of the allegations are wholly without merit and Frontline denies each and every one. Additionally, the CRN fails to identify specific policy language relevant to an alleged violation. Specifically, the CRN merely provides a section of Perils Insured Against provision of the Policy and fails to make reference to language in the Policy as it relates to the facts provided by the Complainant to substantiate her allegations. Blanket references to policy provisions and statutes without specification deems the Civil Remedy Notice deficient. See Julien v. United Property and Casualty Insurance Co., 311 So. 3d 875 (Fla. 4th DCA 2021). The allegations set forth in the CRN are denied as they are mere conclusory allegations by unsupported by facts, devoid of logic and clearly intended solely to tarnish Frontline’s name and reputation. Frontline, at all times, acted fairly, honestly and in good faith in its dealings with the Complainant. Frontline at no time misrepresented any pertinent facts or insurance policy provisions. Frontline is conducting a reasonable and prudent investigation of the claim and acted upon all communications from the Complainant. Finally, Frontline promptly and appropriately communicated with the Complainant and provided explanations for the actions and decisions that were made. Frontline retained an independent field adjuster in addition to an engineer who conducted an inspection of the subject property to investigate the Complainant’s claim and is awaiting for the Complainant’s compliance of her duties under the Policy to render a coverage determination. As it relates to the facts of the claim, on June 5, 2024, approximately 21 days after the alleged date of loss, the Complainant reported damages to her property stemming from wind on May 15, 2024. In response, on June 26, 2024, Frontline issued an acknowledgment letter to the Insureds, Thomas Simpson and June Simpson, including a Reservation of Rights. Thereafter, Frontline conducted an inspection of the Property on June 13, 2024, and an engineer inspection on Juily 2, 2024. Pursuant to the investigation of the claim, on July 11, 2024, Frontline issued correspondence to the Insureds requesting an Examination Under Oath. Then, on July 11, 2024 Frontline received a Letter of Representation from Karkateselos Law, PLLC. Given that there was no response to the first EUO request, on July 22, 2024, Frontline send a second request to the EUO and Frontline provided additional dates while reminding the Complainant that the information was needed to complete the investigation promptly. However, the Complainant’s counsel did not respond until July 25, 2024 wherein, the EUO was mutually scheduled to occur on October 3, 2024, which included a document request to be provided three days in advance. Complainant did not provide the requested documents and Frontline followed up on July 26, 2024, August 22, 2024, and October 2, 2024. There was no response or acknowledgement from Complainant’s counsel and on October 3, 2024, approximately an hour before the EUO, Complainant’s counsel responded to Frontline’s correspondence but failed to provide any of the requested documentation and moreover, the Complainant’s failed to appear for her EUO and a Certificate of Non-Appearance was taken. On the same day as the scheduled EUO, the Complainant’s counsel requested an estimate of damages and coverage determination letter. In response, Frontline advised the Complainant’s counsel that no estimate was generated as the claim was still under investigation and advised the Complainant that the delay in the investigation was related to her failure to provide the documentation requested and failure to sit for the previously scheduled EUO. Moreover, Frontline advised the EUO was rescheduled to October 24, 2024. Another Reservation of Rights letter was sent again on October 29, 2024. On October 24, 2024, Frontline’s counsel began to take the Complainant’s EUO but suddenly and without justifiable reason, Complainant’s counsel terminated the EUO and requested to be rescheduled; thereby, delaying the investigation of the claim and requiring Frontline to reschedule the EUO for a third time to take place on November 15, 2024. The Complainant’s delay has prejudiced Frontline’s investigation and adjustment of the reported loss. The above demonstrates quite clearly that Frontline acted in good faith, acted fairly and honestly, acknowledged, and acted promptly upon receipt of the claim, attempted to determine coverage for the claim pursuant to the terms of the policy, took reasonable steps to investigate the claim, communicated reasonably with the Complainant about the claim, and most relevantly, Frontline has been prejudiced by the Complainant’s delay and prejudiced derived therefrom. Additionally, the CRN contains vague and overbroad “cures” for the alleged defects; however, the listed “cures” are improper pursuant to Florida case law, specifically the case of Talat Enterprises, Inc., v. Aetna Casualty and Surety Co., 753 So.2d 1278, 1281 (Fla. 2000). The Talat case provides that the scope of what can be "cured" is limited to the alleged non-payment of the contractual amount due to the insureds. Talat also commented that, “[i]t naturally follows that for there to be a ‘cure,’ what had to be ‘cured’ is the non-payment of the contractual amount due the insured. In the context of a first-party insurance claim, the contractual amount due the insured is the amount owed pursuant to the express terms and conditions of the policy after all of the conditions precedent of the insurance policy in respect to payment are fulfilled....” As a result, only a demanded “cure” relating to the specific amount needed to repair covered damages is proper and legal – any remaining “cures” are improper remedies and contrary to Florida law. In closing, Frontline first believes that the CRN should be rejected and returned by the Department of Financial Services due to its failure to comply with Florida Statute § 624.155, Florida Statute § 626.9541, and Florida case law, fails to name the proper entity, and regardless of the rejection, Frontline denies all allegations contained in the CRN and submits that there are no violations. Again, and as noted above, Frontline Insurance Unlimited Company is affiliated with First Protective Insurance Company d/b/a Frontline Insurance. While the Civil Remedy Notice is not directed to First Protective Insurance Company in any way, to the extent that the Complainant attempted to assert the alleged violations against First Protective Insurance Company, the allegations are denied in an abundance of caution and without waiver of any of First Protective Insurance Company’s rights to respond upon the filing of a proper, statutorily compliant Notice. Please note that Frontline’s response is not necessarily exhaustive and does not preclude the assertion of other valid reasons for seeking rejection and return of the CRN as Frontline has not rendered a coverage determination, pending the Complainant’s compliance of the contractual duties under the Policy. Also, nothing in this letter, or any act or failure to act on the part of Frontline or any agent or representative of Frontline should be construed as a waiver of any rights or defenses available to it by contract or at law as all such rights and defenses are hereby specifically reserved. We trust that this response addresses the allegations of insurer violation alleged in the CRN. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Regards, s/ Tanaz Salehi Tanaz Salehi, Esquire On behalf of First Protective Insurance Company d/b/a Frontline Insurance
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