Civil Remedy Notice of Insurer Violations
Login

Filing Number:     786085
Filing Accepted:  10/8/2024
         Print Filing
Complainant
Last/Business Name *  
ABELMANN   First Name   MATTHEW
Street Address * 7935 LOWER PERSE CIR
City, State Zip * ORLANDO, FL 32827
Email Address * MTA5BU@VIRGINIA.EDU
Complainant Type: * Insured
Insured
Last/Business Name*   ABELMANN   First Name   MATTHEW
Policy # * 79EDD8992 Claim #* 59-62R0-66X
Attorney
Attorney is Applicable
Last Name* DEMILES First Name * JAMES Initial A
Street Address* 2700 N 29TH AVENUE, STE 106
City, State Zip* HOLLYWOOD , FLORIDA 33020
Email Address * JAMES@DEMILESLAW.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):* FRANK BARCLAY
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Ethical Violations
Other : Failure to Properly Investigate Claim
Other : Failure to Promptly Investigate Claim
Other : Failure to Adjust Loss
Other : Failure to Communicate With Insured in Regards to Claim
Other : Failure to Respond to Communications Regarding Claim
Other : Failure to Make Loss Payment
Other : Placing heavy financial burden on insured due to delay in claim payment
Other : Failure to pay Claim in full
* 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)(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)(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.

See subject policy of State Farm Florida Insurance Company, No. 79EDD8992. Specifically, all relevant language concerning indemnification of the insured for covered losses, included, but not limited to Pg 1-3 of 4 (Declarations), Homeowners Policy HW21-59, Section I Property Coverages, Pg 5-8; Section I Additional Coverages, Pg 8-11; Section I Losses Insured, Pg 12; Section I Loss Settlement, Pg 18-20; The Florida Endorsement (79-ED-D899-2); Option ID; Option OL.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

§624.155 §626.9541 §627.70131. Fla. Admin. Code Rule 69B-220.201 1. Failure to pay claim in full; 2. Failure to promptly investigate claim; 3. Failure to properly investigate claim; 4. Failure to Communicate With Insured in Regards to Claim; 5. Failure to Respond to Communications Regarding Claim; 6. Failure to Adjust Loss; 7. Failure to Act in Due Diligence and Good Faith to Resolve Claim; 8. Placing financial interest of the insurer before that of policy holders and claimants; 9. Looking for ways to deny coverage, pay less, delay payment, and otherwise “low ball” or “stone wall” claim; and/or, 10. Failure to properly train, evaluate, and manage adjusters; The reasons for this may be attributed to improper training, supervision, and/or motivation of adjusters and claim supervisors to promptly and fairly investigate, adjust, and pay full benefits available to all beneficiaries. The insurer may have failed to adopt proper standards of investigation and adjustment of losses or is otherwise not implementing those standards, because, when the Insureds submitted their clearly covered claim based upon a loss from the sudden and accidental discharge or overflow of water into their home, an efficient, timely, and thorough claims investigation did not occur, claims communications were not responded to, no attempt at adjusting this loss was made by the insurer, and full payment and prompt payment for the loss did not occur, and instead the carrier mishandled the claim as detailed below. As a result, the Insureds were forced to retain professional public adjusters to assist them with the clearly covered claim, forcing the Insureds to incur the unnecessary expense of the public adjusters’ percentage/fee out of any future award on this clearly covered claim. The carrier mishandled the claim further after the Insureds retained public adjusters, as detailed below. As a result, the Insureds were forced to retain legal counsel to assist them with the clearly covered claim, forcing the Insureds to incur the unnecessary expense of the attorney percentage/fee out of any future award on this clearly covered claim. This Civil Remedy Notice is related to State Farm Florida Insurance Company’s handling of a sudden discharge of water loss occurring on or about February 1, 2024 and insured under policy number 79EDD8992. At the time of the Insureds loss, the Insureds’ property was insured by State Farm Florida Insurance Company (hereinafter “State Farm”). The Insureds had paid all premiums on the Policy of insurance, and the Policy was in full force and effect at the time of the loss. The claim number related to this Civil Remedy Notice is 59-62R0-66X. A review of the Insureds Policy and the undisputed facts in the Insureds’ case reflects how poorly State Farm handled this claim, to the clear detriment of the Insureds, causing the Insureds to suffer further damages when the mishandling of the Insureds’ claim caused the Insureds to suffer additional unnecessary financial consequences, multiple times over based on their multiple independent acts of mishandling the claim adjustment on this clearly covered claim. Insureds immediately noticed their property suffered a sudden discharge or overflow of water loss when, on February 1, 2024, Insureds woke up from bed to the sound of dripping water, and, when stepping out of bed, Insured Matthew stepped into a half inch puddle of water that pooled in his room while they slept. Insureds turned on their lights and saw the water was all throughout their home. Insured Matthew went outside and immediately turned off the water line to the home. Insureds then immediately began to dry the property themselves and they called Serve Pro. When the Insureds called Serve Pro, the company asked for a claim number to reference, and the Insureds then called to submit their claim to get a claim number to provide to Serve Pro. Insured Matthew is an engineer and estimated his damages in the hundreds of thousands. In addition, the Insureds home was not habitable. Instead of properly and promptly investigating the loss, the assigned adjuster for the carrier determined that it was a subterranean leak contained by the slabs. That opinion by the carrier’s adjuster failed to account for the clear and undeniable facts of a major flood that pooled throughout the Insureds home in this loss just so the carrier can rely upon the misinformed opinion to undervalue this major loss. This was due to the carrier and/or the carrier’s representatives and adjusters failing to properly and promptly investigate this loss and respond to the communications of the Insureds in a timely fashion. Despite the obvious damage to the Insureds’ home and it’s connection to the sudden major water loss, the carrier inexplicably and wrongfully determined that although Insureds’ claim was covered, the Insureds were only owed $41,439.95 for coverage A. No payment was made for coverage C/personal property or coverage D/ALE. The Insureds attempted to communicate with the carrier in relation to the scope of their loss and also about the fact that their home was uninhabitable, and they were forced to live in alternative rental housing and were desperately in need of coverage D funds from the carrier. The carrier failed to answer the Insureds’ communications or respond in a timely fashion, and the Insureds became desperate and concerned and were forced to retain professional public adjusters to assist them with the clearly covered claim, forcing the Insureds to incur the unnecessary expense of the public adjusters’ percentage/fee out of any future award on this clearly covered claim. Insureds submitted their coverage c/personal property loss valuation documents through their public adjusters for a second time, and they submitted their coverage D/ALE documents through their public adjusters as well. In addition, the Insureds submitted their coverage A loss valuation via a rebuild estimate totaling $213,726.80. In response to great efforts to communicate with the carrier on the claim by the Insureds public adjuster, the carrier later made additional small, grossly insufficient undisputed payments, making additional payments under coverage A for $10,257.45 and $12,590.78, and paying the Insureds $7,739.32, $ 4,312.66, $ 129.11, and $82.50 for Coverage D. The Insureds now had to pay their public adjusters a fee/percentage of the recovery from the carrier, unnecessarily, due to the carrier’s previous mishandling of the claim. To make matters worse for the Insureds, following the carriers grossly insufficient undisputed payments to compensate the Insureds on their entire loss, the carrier continued to mishandle the claim. The carrier’s adjuster and the adjuster’s manager both failed to respond to communications from the Insureds’ public adjuster. To date, the carrier has not paid the Insureds anything for their personal property/contents loss. As a result of the lack of responsiveness, failure to adjust, failure to communicate, and unjust claim delay being committed by the carrier following their continued gross mis-undervaluation on the claim, the Insureds were forced to retain legal counsel, forcing the Insureds to incur the unnecessary expense of the attorney percentage/fee out of any future award on this clearly covered claim. After the Insureds retained legal counsel, the Insureds served a Notice of Intent to Initiate Litigation on the carrier, Norice 201234. In response the carrier invoked Appraisal. The invocation of appraisal at this time, after making multiple, slow, undisputed payments, that were all grossly inadequate to compensate the Insureds on their loss, reflects the carrier’s continued intention to delay the processing of this claim to try to “cut their losses” on this claim by trying to pay the Insureds less than they would otherwise have to had they not invoked Appraisal here. That money-saving move of desperation by the carrier cost the Insureds further fees from their already expert-depleted potential recovery, again due to the carrier’s mishandling of their claim, guided by the desire to minimize what is paid out on the claim as opposed to what is in the best interest of the Insureds. The Insured valued her loss at over $200,000, and making the repairs in a reasonable and timely fashion was of upmost importance here, due to the degree of damage and water intrusion and concerns of mold growth and health concerns that can result from mold exposure. Unable to make the repairs due to the high cost of the repairs, the Insured was placed in a position of financial hardship due to the carrier’s mishandling of this claim. If State Farm had properly handled this claim from its inception, they would have covered the related damages and paid an amount of money to the Insureds that was reasonable in relation to the covered loss (coverage A, coverage C, and coverage D), and the carrier would have done this within the time period for providing a coverage determination and payment after the Insureds called in the claim by themselves, without any professional assistance or the requirement of paying any professional fees out of their recovery from the carrier. State Farm failed and/or refused to comply with their obligation to the Insured under the Policy, and the failure and time-delays associated with the carrier’s failures in properly investigating the claim, making a coverage determination, and making full payment for covered damages, caused the Insureds to suffer contractual and extra-contractual financial consequences, and to suffer health consequences related to the loss as well. If State Farm had properly handled this claim from the time the Insureds retained their public adjusters, the carrier would have covered the related damages and paid an amount of money to the Insureds that was reasonable in relation to the covered loss (coverage A, coverage C, and coverage D), and the carrier would have done this within a reasonable time period, without Insureds needing any further professional assistance or the requirement of Insureds having to pay further professional fees out of their recovery from the carrier. As a result of the continued mishandling of the claim by the carrier after the Insureds retained public adjusters, the Insureds was forced to retain the services of counsel for further representation in pursuit of coverage and payment for all of the damages suffered in the major water loss. As a result of the Insureds retaining undersigned counsel, the Insureds must now pay attorney’s fees to counsel amounting to 25 % of any recovered settlement proceeds, plus costs. The unnecessary payment of attorney fees and costs on a clearly covered claim are quantifiable foreseeable consequential damages. State Farm’s conduct in the handling of this loss is very unsatisfactory to the Insureds and was certainly not in the Insureds best interest. State Farm failed to properly and promptly investigate the loss at the time of the Insureds reporting of the loss, as detailed above. State Farm failed to advise or provide the Insureds with additional information that was necessary for the processing of their claim, and instead has caused unnecessary delay and confusion to the Insureds with their conduct, and forced the Insureds to unnecessarily suffer financial hardships, unnecessarily suffer health consequences from delays and unhealthy conditions in the home related to the carrier’s delays, and to unnecessarily hire a public adjuster and incur those fees, and then unnecessarily hire an attorney and incur those fees as well, which must be paid out of the award money the Insured needs to repair their home. Ethical violations have been committed by State Farm: instead of properly and promptly investigating the claim and reasonably covering clearly covered damages, agents of State Farm have engaged in improper tactics to attempt to avoid coverage on the claim, to avoid financial responsibility on the claim, and/or to try to settle the claim for less than it is worth by misrepresenting the facts of the loss, the applicable coverages and the covered water and mold damage to the Insureds’ home. As a result of the bad faith of State Farm, the Insureds home suffered continued water and mold damages that it otherwise would not have, had State Farm acted in the best interest of the Insureds and promptly and properly investigated the clearly covered major water loss. Due to the poor conditions in the home and the delays in the Insured’s ability to make repairs, caused by State Farm’s mishandling of this claim, the Insured incurred continued and unnecessary coverage D expenses. Furthermore the Insureds have already had to sacrifice a portion of their indemnity proceeds to their public adjuster due to the carriers mishandling of the claim prior to the Insureds hiring the public adjuster, and the Insureds will have to sacrifice a portion of any expected indemnity proceeds to both their public adjuster and legal counsel, due to the carriers mishandling of the claim following the Insured’s hiring of the public adjusters until the time Insureds were forced to retain legal counsel. To satisfy this Civil Remedy Notice and alleged bad faith, the Insured will accept the following: $161,669.65 for Coverage A, $79,909.22 for Coverage C, Contents, and $77,787.02 for Coverage D/ALE, bad faith damages of $63,867.20 for public adjuster fees Insureds will have to pay from their award, bad faith damages of $47,904.88 for legal fees Insureds will have to pay from their award, and bad faith damages of the amounts that the Insured must pay to their Appraiser and Umpire, if necessary, as payment in full of the unpaid portion of Insured’s previously demanded loss amount on this Claim.
Comments
User Id Date Added Comment
dwall@kpsds.com 11-14-2024 VIA E-Mail Only James A. Demiles, Esquire 2700 N. 29th Avenue, Ste 106 Hollywood, FL 33020 James@demileslaw.com Re: Insured: Matthew Abelmann & Judith Sanchez Claim No.: 59-62R0-66X DFS Filing No.: 786085 Dear Mr. Demiles: As you know, we represent State Farm Florida Insurance Company (“State Farm”) regarding the above-referenced matter. We are in receipt of the Civil Remedy Notice (“CRN”) you filed on behalf of your client, Matthew Abelmann & Judith Sanchez (collectively the “Insured”), against State Farm on October 8, 2024, with a DFS Filing Number 786085. Please allow this correspondence to serve as State Farm’s response to the CRN. The stated reasons for the CRN are listed as: claim denial; claim delay; unsatisfactory settlement offer; unfair trade practice; ethical violations; failure to properly investigate claim; failure to promptly investigate claim; failure to adjust loss; failure to communicate with insured in regards to claim; failure to respond to communications regarding claim; failure to make loss payment; placing heavy financial burden on insured due to delay in claim payment; and failure to pay in claim in full. The CRN claims State Farm violated Florida Statutes: 624.155(1)(b)(1); 624.155(1)(b)(3); 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b); 626.9541(1)(i)(3)(c); 626.9541(1)(i)(3)(d); 626.9541(1)(i)(3)(e); 626.9541(1)(i)(3)(f); and 626.9541(1)(i)(4). As a preliminary matter, State Farm denies it violated the statutes cited in the CRN. We also note that although we did receive a response from you, you provided no new information regarding these allegations since the time of State Farm’s initial response to the CRN and request for information dated October 11, 2024. Specifically, we had requested that you provide us with any facts to support the allegations in the CRN. We indicated that we would be happy to review any details you may have supporting these allegations. However, we have not received any new information to date. As an initial matter, the CRN is deficient and fails to comply with the requirements of Florida law. The purpose of a Civil Remedy Notice is to provide an insurer with a chance to settle the claim and avoid unnecessary litigation. See Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278 (Fla. 2000); see also, The Heritage Corporation of South Florida v. National Union Fire Insurance Company of Pittsburgh, P.A., 580 F.Supp. 2d 1294 (S.D. Fla. 2008). In furtherance of this purpose, Florida Statute § 624.155(3)(b) requires that a Civil Remedy Notice “state with specificity” the statutory provisions allegedly violated, the facts and circumstances giving rise to the violation, the name of any individual involved in the violation, and the specific policy language relevant to the violation. The CRN is deficient as it fails to specifically state any policy language from the Insured’s policy of insurance. Rather than include the specific policy language relevant to the alleged statutory violations cited in the CRN as required by § 624.155(3)(b), Florida Statutes, the CRN merely states “[s]ee subject policy of State Farm Florida Insurance Company, No. 79EDD8992. Specifically, all relevant language concerning indemnification of the insured for covered losses, included, but not limited to Pg 1-3 of 4 (Declarations), Homeowners Policy HW21-59, Section I Property Coverages, Pg 5-8; Section I Additional Coverages, Pg 8-11; Section I Losses Insured, Pg 12; Section I Loss Settlement, Pg 18-20; The Florida Endorsement (79-ED-D8992); Option ID; Option OL.” Florida courts have held that a Civil Remedy Notice that merely identifies section headings of provisions of the subject policy, rather than identifying the specific policy language at issue, renders the Civil Remedy Notice deficient under § 624.155(3)(b), Florida Statutes. See Junior Julien v. United Property and Casualty Insurance Company, No. 4D19-2763 (Fla. 4th DCA September 23, 2020); Fox v. Starr Indem. & Liab. Co., No. 8:16-CV-3254-T-23MAP, 2017 WL 1541294, at *2 (M.D. Fla. Apr. 28, 2017). The CRN is void of any policy language, breach of policy, or details explaining statutory violations. Further, the CRN fails to provide any explanation as to how State Farm failed to comply with the terms of the policy and/or any specific language in the policy pertaining to the alleged incident. Also, the CRN does not provide an explanation as to how State Farm failed to comply with the terms of the policy or any specific policy language therein by referencing the specific language in the policy pertaining to the alleged statutory violations. In addition, the “facts and circumstances” section of the CRN is not in compliance with Florida law. Contrary to the requirements of Florida Statutes, the CRN makes false, boilerplate accusations, and does not contain any specific facts supporting the violations alleged. For example, the CRN fails to provide any factual support for various allegations regarding State Farm’s alleged claim denial; claim delay; unsatisfactory settlement offer; unfair trade practice; ethical violations; failure to properly investigate claim; failure to promptly investigate claim; failure to adjust loss; failure to communicate with insured in regards to claim; failure to respond to communications regarding claim; failure to make loss payment; placing heavy financial burden on insured due to delay in claim payment; and failure to pay in claim in full, or its alleged violations of those statutory provisions noted above and in the CRN. As more fully discussed below, the allegations contained within the CRN are false, and the CRN contains no facts to support them. Although the CRN alleges that State Farm “poorly” handled the claim, the following summary demonstrates that State Farm has acted responsibly and in good faith during the investigation and handling of this claim. The failure to provide any factual support for the alleged violations of Florida statutes and administrative law renders the CRN deficient and in violation of Florida Statute § 624.155(3)(b). It appears on February 1, 2024, a water loss claim was reported for alleged damage sustained to the interior of the insured property located at 7935 Lower Perse Circle, Orlando, Florida 32827 (the “Property”). A date of loss of February 1, 2024 was provided at the time of reporting. On or about February 6, 2024, State Farm spoke with the Insured regarding his claim. On February 7, 2024, State Farm again spoke to the Insured who stated the supply line to the hot water tank burst in the laundry room, flooding the home. The Insured stated that all the wood flooring in the home was affected and being removed and due to this, the home is inhabitable. State Farm sent the Insured a collaboration link so documents could be uploaded regarding the claim. On February 26, 2024, State Farm and the Insured corresponded regarding additional living expenses, during which time, State Farm approved additional living expenses until June or July 2024, which was 3 or four 4 months from that time. State Farm also informed the Insured of what could and may not be covered under the policy as it relates to this claim. The Insured informed State Farm that he had already selected a home in his neighborhood for a one-year lease and were asking State Farm to pay the lease break, since the Insured would not have to be there for that long. State Farm stated they would approve the current living situation, but cannot agree to approve a 12 month lease when the Insured would only need to be there for 4 months. On February 28, 2024, the Insured’s agent corresponded with State Farm stating the Insured would pay the leak break since this is the property he wanted to stay in. On March 4, 2024, State Farm emailed the Insured requesting the ServPro estimate. State Farm received the same on March 4, 2024. On March 11, 2024, State Farm spoke with the Insureds to discuss the payment being made, which was over $50,000.00. State Farm asked if the Insureds had found a contractor and the Insured stated he had not. At this point, the loss was over a month old, and no contractor had been retained by the Insured. The Insured stated that based upon State Farm’s payment, he did not believe he would be made whole. State Farm informed the Insured that when he receives a line-item estimate from a contractor, State Farm would consider the same if provided by the Insureds. On or about March 21, 2024, State Farm sent a link to the Insured for the Insured to upload and document personal property damages. On or about April 9, 2024, State Farm received a letter of representation from a Public Adjuster. Now, after two months after the loss, with information still outstanding regarding personal property damage, and no contractor chosen by the Insured, a Public Adjuster is retained. On April 17, 2024, State Farm received the Public Adjuster estimate and responded requesting to use the collaboration link for documents and photos of damaged property, once again. On or about April 29, 2024, State Farm received additional living expenses receipts, and stated the same should be paid by the end of that week. State Farm also sent its differences letter to the Public Adjuster. On June 20, 2024, State Farm issued supplemental payment to the Insured which now totaled $112,895.25 for the claim. That same day, State Farm sent a request for information to the Public Adjuster and Insured requesting contractor information, a contract with said contractor, their photographs, and a timeline of the expected repairs to be completed. This is now almost 5 months after the loss occurred, and to State Farm’s knowledge, no contractor has been chosen by the Insured, and no repairs have been started. On July 22, 2024, State Farm received your office’s letter of representation on behalf of the Insured. On July 24, 2024, State Farm extended additional living expenses to the Insured through July 31, although the Insured and/or the Public Adjuster failed to provide the documentation requested regarding the contractor that was to work on the Insured’s home. On July 26, 2024, State Farm sent correspondence to your office requesting the same information. On July 31, 2024, State Farm spoke with you, as the Insured’s attorney, and stated they were concerned that original payment was issued on March 11, and still no work had been done. You stated, on behalf of the Insured, that the plumbing had been rerouted and interior repairs should be done by October 1, 2024. Based upon this information, and the delay on behalf of the Insured to retain a contractor to being performing the work promptly and provide the requested information to State Farm, State Farm responded to the Notice of Intent with an appraisal demand. Throughout the handling of this claim, State Farm fully inspected, evaluated, and communicated the claim with the Insured or their representatives. Based upon the Insured’s statements regarding the alleged loss and Property as well as the investigation conducted by State Farm, the claim was denied based upon the condition of the Property and the exclusions within the Insureds’ policy of insurance. Based upon our review of the facts of this matter, State Farm has fully and properly attempted to adjust the claim in accordance with the insurance policy and Florida law. State Farm has handled this claim in the appropriate manner and in good faith, doing everything it could reasonably do to timely and properly investigate the Insureds’ claim and pay benefits where owed. The allegation that “State Farm failed to advise or provide the Insureds with additional information that was necessary for the processing of their claim, and instead has caused unnecessary delay and confusion to the Insureds with their conduct, and forced the Insureds to unnecessarily suffer financial hardships, unnecessarily suffer health consequences from delays and unhealthy conditions in the home related to the carrier’s delays, and to unnecessarily hire a public adjuster and incur those fees, and then unnecessarily hire an attorney and incur those fees as well…” is malicious and false. Additionally, State Farm has always acted fairly and honestly towards the Insureds. Furthermore, how State Farm evaluates other claims is irrelevant to the subject issue. Specifically, the CRN alleges violation of: 1. FS 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. State Farm denies violation of section 625.155 (1)(b)(1) because it made a good faith effort to appropriately investigate and evaluate the Insured’s claim. State Farm has, at all times, acted in accordance with the terms, conditions, and coverages of the insurance policy. State Farm inspected the subject property, reviewed all the documents and information provided and advised of its evaluation and coverage determination in compliance with the policy. Absolutely no facts or circumstances supporting the Insured’s allegations have been set forth in the Notice. Thus, this allegation of a statutory violation is denied. The CRN fails to provide facts or information to support this alleged violation. 2. FS 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. State Farm denies violation of section 625.155 (1)(b)(3) because it made a good faith effort to appropriately investigate and evaluate the Insured’s claim. State Farm has, at all times, acted in accordance with the terms, conditions, and coverages of the insurance policy. State Farm inspected the subject property, reviewed all the documents and information provided and advised of its evaluation and coverage determination in compliance with the policy. Absolutely no facts or circumstances supporting the Insured’s allegations have been set forth in the Notice. Thus, this allegation of a statutory violation is denied. The CRN fails to provide facts or information to support this alleged violation. 3. FS 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims. State Farm denies violation of section 626.9541(1)(i)(3)(a) because it made a good faith effort to appropriately investigate and evaluate the Insureds’ claim. State Farm has, at all times, acted in accordance with the terms, conditions, and coverages of the insurance policy. State Farm inspected the subject property, reviewed all the documents and information provided and advised of its evaluation and coverage determination in compliance with the policy. Absolutely no facts or circumstances supporting the Insured’s allegations have been set forth in the Notice, thus this allegation of a statutory violation is denied. The CRN fails to provide facts or information to support this alleged violation. 4. FS 626.9541(1)(i)(3)(b); Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. State Farm denies violation of section 626.9541(1)(i)(3)(b) because it made a good faith effort to appropriately investigate and evaluate the Insureds’ claim. State Farm has, at all times, acted in accordance with the terms, conditions, and coverages of the insurance policy. State Farm inspected the subject property, reviewed all the documents and information provided and advised of its evaluation and coverage determination in compliance with the policy. Absolutely no facts or circumstances supporting the Insured’s allegations have been set forth in the Notice, thus this allegation of a statutory violation is denied. The CRN fails to provide facts or information to support this alleged violation. 5. FS 626.9541(1)(i)(3)(c); Failing to acknowledge and act promptly upon communications with respect to claims. State Farm denies violation of section 626.9541(1)(i)(3)(b) because State Farm has, at all times, acted in accordance with the terms, conditions, and coverages of the insurance policy. State Farm inspected the subject property, reviewed all the documents and information provided and advised of its evaluation and coverage determination in compliance with the policy. State Farm also promptly responded and attempted to contact the Insured or her representatives to discuss the claim. Absolutely no facts or circumstances supporting the Insured’s allegations have been set forth in the Notice. Thus, this allegation of a statutory violation is denied. The CRN fails to provide facts or information to support this alleged violation. 6. FS 626.9541(1)(i)(3)(d); Denying claims without conducting reasonable investigations based upon available information. State Farm denies violation of section 626.9541(1)(i)(3)(d) because it made a good faith effort to appropriately investigate and evaluate the Insured’s claim. State Farm has, at all times, acted in accordance with the terms, conditions, and coverages of the insurance policy. State Farm inspected the subject property, reviewed all the documents and information provided and advised of its evaluation and coverage determination in compliance with the policy. Absolutely no facts or circumstances supporting the Insured’s allegations have been set forth in the Notice, thus this allegation of a statutory violation is denied. The CRN fails to provide facts or information to support this alleged violation. 7. FS 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. State Farm denies violation of section 626.9541(1)(i)(3)(e) because it made a good faith effort to appropriately investigate and evaluate the Insured’s claim. State Farm has, at all times, acted in accordance with the terms, conditions, and coverages of the insurance policy. State Farm inspected the subject property, reviewed all the documents and information provided and advised of its evaluation and coverage determination in compliance with the policy. Absolutely no facts or circumstances supporting the Insured’s allegations have been set forth in the Notice, thus this allegation of a statutory violation is denied. The CRN fails to provide facts or information to support this alleged violation. 8. FS 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. State Farm denies violation of section 626.9541(1)(i)(3)(f) because it made a good faith effort to appropriately investigate and evaluate the Insured’s claim. State Farm has, at all times, acted in accordance with the terms, conditions, and coverages of the insurance policy. State Farm inspected the subject property, reviewed all the documents and information provided and advised of its evaluation and coverage determination in compliance with the policy. Absolutely no facts or circumstances supporting the Insured’s allegations have been set forth in the Notice, thus this allegation of a statutory violation is denied. The CRN fails to provide facts or information to support this alleged violation. 9. FS 626.9541(1)(i)(4); Failing to pay undisputed amount of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer received 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). State Farm denies violation of section 626.9541(1)(i)(4) because it made a good faith effort to appropriately investigate and evaluate the Insured’s claim. State Farm has, at all times, acted in accordance with the terms, conditions, and coverages of the insurance policy. State Farm inspected the subject property, reviewed all the documents and information provided and advised of its evaluation and coverage determination in compliance with the policy. Absolutely no facts or circumstances supporting the Insured’s allegations have been set forth in the Notice, thus this allegation of a statutory violation is denied. The CRN fails to provide facts or information to support this alleged violation. 10. FS 627.70131. The CRN alleges the Statute as a whole and not a specific subsection. A general allegation without specificity violates the CRN requirements. State Farm denies violation of section 627.70131 because State Farm has, at all times, acted in accordance with the terms, conditions, and coverages of the insurance policy. State Farm inspected the subject property, reviewed all the documents and information provided and advised of its evaluation and coverage determination in compliance with the policy. State Farm also promptly responded and attempted to contact the Insured or his representatives to discuss the claim. Absolutely no facts or circumstances supporting the Insured’s allegations have been set forth in the Notice, thus this allegation of a statutory violation is denied. The CRN fails to provide facts or information to support this alleged violation. 11. Fla. Admin. Code Rule 69B-220.201 The CRN alleges the Code as a whole and not a specific subsection. A general allegation without specificity violates the CRN requirements. State Farm denies violation of Fla. Admin. Code Rule 69B-220.201 because State Farm has, at all times, acted in accordance with the terms, conditions, and coverages of the insurance policy. State Farm inspected the subject property, reviewed all the documents and information provided and advised of its evaluation and coverage determination in compliance with the policy. State Farm also promptly responded and attempted to contact the Insured or his representatives to discuss the claim. Absolutely no facts or circumstances supporting the Insured’s allegations have been set forth in the Notice, thus this allegation of a code violation is denied. The CRN fails to provide facts or information to support this alleged violation. For the reasons set forth above, State Farm denies the allegations contained in the CRN. However, we would welcome the opportunity to review any additional information you may have that you believe supports your client’s position. Should you have any documents or other information that State Farm has not had the opportunity to review, please provide those at your earliest convenience. Very truly yours, /s/ Danielle M. Wall Danielle M. Wall DMW cc: Client
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