Civil Remedy Notice of Insurer Violations
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Filing Number:     786039
Filing Accepted:  10/7/2024
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Complainant
Last/Business Name *  
NIEMCZURA   First Name   KAREN
Street Address * 481 TORGIANO DRIVE
City, State Zip * OCOEE, FL 34761
Email Address * WITHHELD
Complainant Type: * Insured
Insured
Last/Business Name*   NIEMCZURA   First Name   KAREN
Policy # * 5824599313 Claim #* 01000115197
Attorney
Attorney is Applicable
Last Name* DANIELS First Name * MONICA Initial
Street Address* 560 VILLAGE BOULEVARD, SUITE 110
City, State Zip* WEST PALM BEACH , FLORIDA 33409
Email Address * MDANIELS@THEDANIELS-LAWGROUP.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   FIRST PROTECTIVE INSURANCE COMPANY
NAIC Company Code 10897
 
Name of individual responsible for violation (if any):* DERRICK COLLINS, AARON FURY AND ANY AND ALL OTHER ADJUSTERS, MANAGERS, SUPERVISORS, AND INDIVIDUALS ASSOCIATED WITH THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unfair Trade Practice
Unsatisfactory Settlement Offer
* 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)(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)(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.

AGREEMENT We will provide the insurance described in this policy in return for the premium and compliance with all applicable provisions of this policy. SECTION I – PERILS INSURED AGAINST We insure for direct physical loss to the property described in Coverages A and C caused by any of the following perils unless the loss is excluded in Section I - Exclusions. J. Loss Payment We will adjust all losses with you. SECTION I – PROPERTY COVERAGES A. Coverage A – Dwelling 1. We cover: a. The alterations, appliances, fixtures and improvements which are part of the building contained within the "residence premises"; b. Items of real property which pertain exclusively to the "residence premises"; c. Property which is your insurance responsibility under a corporation or association of property owners agreement; or d. Structures owned solely by you, other than the "residence premises", at the location of the "residence premises".
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Karen Niemczura (the “Insured”) obtained an insurance policy from First Protective Insurance Company D/B/A Frontline Insurance Company (the “Insurer”), subscribing to policy number 5824599313 (the “Policy”), to cover the property located at 481 Torgiano Drive, Ocoee, Florida 34761 (the “Property”). On or about July 14, 2024, the Property sustained damage due to a windstorm, which caused extensive damage to the roof as well as to various interior rooms within the Property including the garage, closets, living room, office, and powder room. The Insured promptly mitigated the damages, complied with all applicable post-loss obligations, and retained a public adjuster to assist with this claim. In sum, the carrier has had zero reason not to issue coverage for this claim within sixty (60) days. The Insurer acknowledged the loss, which was reported on or about August 5, 2024 and assigned claim number 01000115197 (the “Claim”) to the loss, as well as a claims adjuster, Derrick Collins. The Insurer retained field adjuster Aaron Fry who inspected the Property on August 9, 2024. During that inspection the Insured’s public adjuster showed Mr. Fry water damage to the ceiling of the breakfast nook, and wind damage to the gutters and every elevation to the roofing system. The Insured’s public adjuster also provided a sworn proof of loss, as well as an estimate and other supporting documentation, on August 9, 2024. On August 12, 2024, Desk Adjuster Derrick Collins advised that the carrier would be inspecting the property utilizing the services of Rimkus Engineering. On September 3, Edward Selvaggio from Rimkus inspected the property. Between the dates of September 3, 2024 and September 17, 2024 the Insured’s public adjuster sent numerous communications to the desk adjuster and the carrier for a coverage decision. On September 17, 2024, the Insurer advised that the Insured needed to sit for a recorded statement, which took place on September 30, 2024. After the recorded statement went forward, the Desk Adjuster advised that a coverage decision would be provided by October 4, 2024. On October 3, 2024, the public adjuster e-mailed the desk adjuster requesting an update. On October 4, 2024, the desk adjuster responded and advised that the claim was still being evaluated and that he would let the public adjuster know as soon as the evaluation was completed. As of the date of this notice, no coverage decision has been made in clear violation of Fla. Stat. § 627.70131. The Insured’s public adjuster promptly provided the Insurer with a true and accurate estimate of the damages, photographs of the Property, a properly executed sworn proof of loss, opened the property for multiple inspections, and timely complied with all of the Insurer’s requests. It is clear that the Insured and the Insured’s public adjuster have done everything in their power to comply with all of the Insurer’s requests and all applicable policy obligations. The Insurer has everything in its possession to issue payment to these insureds who have already incurred the costs of making temporary repairs to the roofing system. The Insurer’s refusal to properly investigate, adjust and fully compensate the Insureds for this Claim undoubtedly evidences the Insurer’s violation of Section 626.9541(1)(i)(3)(a), Florida Statutes, which requires the Insurer to “adopt and implement standards for the proper investigation of claims.” All available information leads to one conclusion – the Property was damaged by a covered cause of loss for which the Insureds are entitled to full and complete compensation. The Insurer’s obligation to promptly settle the Insureds’ claim is undeniable, and therefore, the Insurer has also violated Fla. Stat. Section 624.155(1)(b)(1) and 624.155(1)(b)(3). The Insurer’s conduct continues to be egregious because the Insurer retained biased and inexperienced individuals who approached the loss with an eye towards delay and underpayment. The actions taken by the Insurer in the handling and adjustment of the Claim are willful, wanton, and in disregard for the rights of the Insureds, and have occurred with such frequency as to indicate a general business practice in violation of the law. This practice includes the Insurer hiring biased and inexperienced adjusters and failing to properly and timely pay for obvious damages owed to its Insureds. The Insurer’s actions amount to, but are not limited to: A. “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 the insured and with due regard for her or his interests; B. “Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue”; C. “Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear;” D. “Failing to adopt and implement standards for the proper investigation of claims;” E. Claim Delay; F. Unsatisfactory Settlement Offers; and G. Unfair Trade Practices. In addition to the above statutory violations, the Insurer’s adjuster violated the following ethical requirements of the Florida Administrative Code 69B-220.201: (3) Code of Ethics . . . An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance. The following are standards of conduct that define ethical behavior, and shall constitute a code of ethics that shall be binding on all adjusters: (b) An adjuster shall treat all claimants equally. 2. An adjuster shall adjust all claims strictly in accordance with the insurance contract. (c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured. (d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. (e) An adjuster shall handle every adjustment and settlement with honesty and integrity, and allow a fair adjustment or settlement to all parties without any remuneration to himself except that to which he is legally entitled. (f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim. (o) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise. To summarize, the Insured is a dutiful customer who made it a priority to pay the insurance premiums and to ensure that in such an event as the one here, the Property would be covered. The Insured timely filed this Claim and fulfilled all post-loss obligations. The Insurer acknowledged the loss, assigned a claim number, inspected the property, and has since essentially ignored the Insured, ignored the Claim, and ignored its obligations pursuant to the Policy and Florida law. The Insurer has failed to provide the Insured with qualified representatives to ensure the Claim was initially adjusted, evaluated, and paid properly. To deny the Insured the benefit of the bargain after satisfying all obligations is morally and ethically reprehensible, and reeks of Unfair Trade Practice. The Insurer is putting its profits ahead of its contractual and statutory obligations. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has failed to create and implement adequate guidelines for the proper investigation to evaluate claims handling, and for training and supervision of employees. The Insurer has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance Claim and damages. Therefore, the Insurer breached its statutory and ethical duties, and has put profits ahead of the duties it owed to their Insured when she most needed the insurance coverage she had paid for. Florida Statute § 624.02 defines “insurance” as a contract where one undertakes to indemnify another or pay or allow specified amounts, or determinable benefit, upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly. This timely and prompt payment allows the insured to mitigate their damages, repair the damages, and place the Properties back to the position they were in prior to the loss, as quickly as possible. The Insurer breached this duty. The Insurer has refused and failed to tender all insurance proceeds to the Insured upon demand. The Insurer’s refusal and/or failure to settle the insurance Claim when it, under all circumstances, should have done so, is wrongful conduct. The Insurer is failing to promptly settle the Insured’s claim, as it is required to do so by contract. To cure the defects outlined in this civil remedy notice, the Insurer must (1) immediately, and under no circumstances no later than sixty days from the date of this civil remedy notice, tender all insurance monies due and owing to the Insured, specifically $77,715.81 under Coverage A for Dwelling pursuant to the sworn proof of loss submitted; (2) ensure that payment made would be adequate to place the Insured’s Property back in the pre-loss condition; (3) reimburse the insured for any mitigation costs incurred, if any, and (3) reimburse the Insured’s attorneys’ fees and costs, since the Insured was forced to hire legal counsel in order to receive adequate payment. Should the Insurer fail to comply with the demands set forth in this civil remedy notice, the Insurer must prepare to pay the full cost of its failure to rightfully indemnify the Insured, including all future damages that come about as a result of the Insurer’s failure to comply with the demands set forth in this civil remedy notice. This Notice is giving in order to perfect the right to pursue the civil remedy authorized by section 624.155(3)(b), Florida Statutes.
Comments
User Id Date Added Comment
abittner@camboferry.com 11-08-2024 November 8, 2024 VIA E-MAIL Karen Niemczura c/o Monica Daniels The Daniels Law Group 560 Village Boulevard, Suite 110 West Palm Beach, Florida 33409 mdaniels@thedaniels-lawgroup.com Re: Matter: Karen Niemczura v. First Protective Insurance Company Date of Loss: July 14, 2024 Claim Number: 01000115197 Policy Number: 5824599313 DFS Filing Number: 786039 Dear Ms. Daniels: As you know, my firm represents First Protective Insurance Company d/b/a Frontline Insurance (“Frontline”) with respect to the above matter. This correspondence constitutes Frontline’s response to the Civil Remedy Notice of Insurer Violation (“CRN”) with filing number 786039 you filed on behalf of Karen Niemczura. As an initial matter, please note that the CRN names only Karen Niemczura as the complainant, however, the subject policy was issued to Karen Niemczura and Paul Niemczura. I. The Civil Remedy Notice is legally invalid. The filing of a valid Civil Remedy Notice is a condition precedent to an action brought pursuant to section 624.155, Florida Statutes. Talat Enter., Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Because the statute is in derogation of the common law, it must be strictly construed. Id. “[A]ny statute in derogation of the common law requires strict compliance with its provisions by one seeking to avail himself of its benefits.” Florida Steel Corp. v. Adaptable Devs., Inc., 503 So. 2d 1232, 1234 (Fla. 1986). Section 624.155, Florida Statutes, requires a civil remedy notice to provide specific information to put the insurer on notice of the alleged violation. Additionally, a civil remedy notice must be “specific enough to provide insurers notice of the wrongdoing so the insurer can cure the same within sixty days.” Valenti v. Unum Life Ins. Co. of Am., 8:04CV1615T-30TGW, 2006 WL 1627276, at *2 (M.D. Fla. 2006). Here, the Notice is invalid because it does not contain all of the information required by section 624.155. Also, it is invalid because it lacks sufficient specificity to provide notice to Frontline of the alleged wrongdoing, as discussed below. First, the Notice is invalid because it conditions Frontline’s ability to “cure” by requiring Frontline to pay for things and do things that are not required under Talat. In Talat, the Florida Supreme Court said that to “cure” a Notice, an insurer must pay the amount owed pursuant to the express terms and conditions of the policy.” However, the Notice here demands payment of money that is not owed pursuant to the policy, such as attorney’s fees and costs. It is improper to demand such items as a cure for a civil remedy notice. Talat, 753 So. 2d at 1282–83; see also Francois v. Illinois Nat. Ins. Co., 01-CV-8070, 2002 WL 33760405, at *4 (S.D. Fla. 2002) aff'd, 49 Fed. Appx. 290 (11th Cir. 2002) (discussing whether a demand of attorneys’ fees in a civil remedy notice is proper). Second, the CRN does not list the Complainant’s e-mail address. See Pin-Pon Corp., 2020 U.S. Dist. LEXIS 100072, *7 (S.D. Fla., June 5, 2020). Third, the CRN does not list Frontline’s address. See Julien v. United Prop. & Cas. Ins. Co., No. 4D19-2763 (Fla. 4th DCA Sept. 23, 2020); Pin-Pon Corp., 2020 U.S. Dist. LEXIS 100072, *7 (S.D. Fla., June 5, 2020). Fourth, the boilerplate CRN lacks sufficient specificity to provide notice of the alleged bad-faith conduct. The CRN lists seven different statutes which Frontline allegedly violated. However, the CRN fails to provide any relevant facts supporting the alleged violations or relating these alleged violations to the seven cited statutes. Because the Civil Remedy Notice fails to identify any specific statutes or any facts to support why the Insureds believe Frontline violated the statutes, Frontline is unable to properly respond and the Notice is invalid and should be rejected and returned. Frontline denies each and every allegation of bad faith statutory violation individually, as follows. Specifically, the CRN cites to 624.155(1)(b)(1), F.S., pertaining to not attempting in good faith to settle claims, however it fails to acknowledge Frontline’s efforts to obtain information required to investigate the claim and multiple inspections in order to determine available coverage. The CRN cites to 624.155(1)(b)(3), F.S., pertaining to 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 settlement under other portions of the insurance policy coverage, however it again fails to acknowledge Frontline’s attempts to obtain requested records and reinspect the property. The CRN cites to 626.9541(1)(i)(3)(a), F.S., pertaining to failing to adopt and implement standards for the proper investigation of claims, but fails to specify any standards Frontline allegedly did not follow. The CRN cites to 626.9541(1)(i)(3)(c), F.S., pertaining to failing to acknowledge and act promptly upon communications with respect to claims, but fails to specify any communications that were not acknowledged by Frontline. The CRN cites to 626.9541(1)(i)(3)(f), F.S., pertaining to 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, but fails to acknowledge that Frontline provided a coverage determination in writing citing to applicable policy provisions. The CRN cites to 626.9541(1)(i)(3)(g), F.S., pertaining to failing to promptly notify the insured of any additional information necessary for the processing of a claim, but fails to acknowledge that on August 30, 2024, Frontline sent a Reservation of Rights letter to the insured requesting specific records and documents. Finally, the CRN cites to 626.9541(1)(i)(4), F.S., pertaining 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, but fails to acknowledge that Frontline sent a Reservation of Rights letter to the insured on August 30, 2024 and continued its investigation with an engineering inspection and recorded statement. The CRN provides three different reasons for the Notice without providing any basis in fact. Specifically, the CRN alleges claim delay as a reason for the notice, but fails to acknowledge Frontline’s efforts to obtain additional records, conduct an engineering inspection of the property and obtain a recorded statement. The CRN alleges an unsatisfactory settlement offer as a reason for the notice, but does not acknowledge that the coverage was properly extended for interior damages and denied for roof damages pursuant to the terms of the policy and based on the totality of Frontline’s investigation. The CRN alleges unfair trade practice as a reason for the notice, but fails to provide any factual basis for the allegation. Because the CRN fails to comply with the information requirements promulgated by the Department of Financial Services, it is legally invalid. See Pin-Pon Corp. v. Landmark Ins. Co., 2020 U.S. Dist. LEXIS 100072, *7 (S.D. Fla., June 5, 2020); Julien v. Family Security Insurance Company, 4D19-2763 (September 23, 2020). Again, in serving this response, Frontline reserves all rights under Florida law to be served with a properly completed and statutorily compliant CRN. As the CRN fails to strictly comply with the requirements of section 624.155, Florida Statutes, it is legally insufficient and should be rejected. II. The Civil Remedy Notice Lacks Merit The Notice also lacks merit. The subject claim was reported on July 14, 2024 with a reported date of loss of August 5, 2024 for alleged wind and hail damage at the subject property located at 481 Torgiano Drive, Ocoee, Florida 34761. On the same day that Frontline received the first notice of loss, Frontline attempted to reach the insured to discuss the claim. One day later, on August 6, 2024, Frontline received a letter of representation from the insured’s public adjuster, Five Star Claims. Thereafter, on August 9, 2024, Frontline received a Sworn Proof of Loss and an estimate from the public adjuster for a full roof replacement and interior painting of the ceiling in entry, front hall, family room and kitchen in the amount of $78,715.81. Also on August 9, 2024, the property was inspected by an independent adjuster on behalf of Frontline. On August 12, 2024, Frontline sent correspondence to the insured confirming receipt of the Sworn Proof of loss. On August 30, 2024, Frontline sent a Reservation of Rights to the insured along with a request for information, specifically seeking all photographs and videos taken at the time of loss and of the damage being claimed; attendance at an engineering inspection of the subject property; a recorded interview of the insured; and all related estimates, invoices, contracts, work authorizations, photos and supporting documentation from all repairs firms and mitigation contractors. On September 4, 2024, the property was inspected by Edward Selvaggio, PE on behalf of Frontline. Mr. Selvaggio did not observe any evidence of wind or hail damage to the roof. He observed short term interior damages to the ceiling. Thereafter, on September 30, 2024, Frontline obtained a recorded statement of the insured. On November 1, 2024, Frontline sent the coverage determination letter to the insured enclosing a payment in the amount of $1,605.14 for interior damages and denying coverage for the roof. In light of Frontline’s investigation, coverage was properly accepted and payment was issued for covered interior damages in the amount of 1,605.14 under the subject claim, pursuant to the terms, conditions, exclusions, limits and deductible of the subject policy. Additionally, coverage was properly denied for the roof damages, pursuant to the terms, conditions, exclusions, limits and deductible of the subject policy. Accordingly, Frontline denies any and all allegations of bad faith in connection with the claim submitted by Karen Niemczura. If you have any questions, please do not hesitate to contact me. Sincerely, /s/Anita Bittner Anita Bittner, Esq.
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