Civil Remedy Notice of Insurer Violations
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Filing Number:     786153
Filing Accepted:  10/8/2024
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Complainant
Last/Business Name *  
METELLUS   First Name   MARIE
Street Address * 3068-3082 FOWLER ST
City, State Zip * FT. MYERS, FL 33901
Email Address * YOLITAINSURANCE@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   METELLUS   First Name   MARIE
Policy # * 2MC21142279023 Claim #* 00201755543
Attorney
Attorney is Applicable
Last Name* CLEMENT First Name * ASHLEY-ANN Initial
Street Address* 2455 E. SUNRISE BLVD.
City, State Zip* FT. LAUDERDALE, FL 33304 , FLORIDA 33304
Email Address * ASHLEY@PALMERSLAWPA.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   AMERICAN SECURITY INSURANCE COMPANY
NAIC Company Code 42978
 
Name of individual responsible for violation (if any):* HEIDI SHERER
Type of Insurance * Commercial 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)(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)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
626.9541(1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
* Specific policy language that is relevant to the violation.
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Loss will be made payable upon the earliest of the following: 11. a. 30 days after we receive your proof of loss; and b. Reach an agreement with the named insured; b. There is an entry of a final judgment; or c. There is a filing of an appraisal with us We will determine the value of the damaged property, or the cost of its repair or replacement, in accordance with the applicable terms of the Limits of Recovery condition in this Certificate. Limits of Recovery: In the event of loss or damage to commercial property covered by this Certificate, we shall not be liable for more than the actual cash value of the damaged commercial property not to exceed the smaller of; a. The net loan balance at time of loss; or b. The Limit of Liability as shown on the individual Certificate.
 
* Facts and circumstances giving rise to the violation.
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Insured properly filed claim and has met all policy requirements and obligations. This includes providing an estimate for repairs, submitting proof of loss cooperating with American Security's investigation and allowing inspections and all other requests. Additionally, Insured provided to American Security a recorded statement on May 10, 2024. To date, one hundred and fifty-one (151) days, American Security has not made any coverage determination (or undisputed payments) thereby violating Fla statutes as indicated in this report and in breach of the policy with the insured.
Comments
User Id Date Added Comment
alaine.greenberg@hklaw.com 12-09-2024 VIA UPLOAD onto DFS website Florida Department of Financial Services Division of Insurance Regulation Consumer Assistance / Civil Remedy Section Larson Building, 200 East Gaines Street Tallahassee, Florida 32399-0322 Re: CIVIL REMEDY NOTICE OF INSURER VIOLATION DOI File No.: 786153 Complainant: Marie Metellus Claim No.: 00201755543 Filed by: Ashley-Ann Clement, Esq. Reported DOL: September 28, 2022 Dear Sir or Madam: American Security Insurance Company (“American Security”) received the Civil Remedy Notice of Insurer Violation (“CRN”) submitted by attorney Ashley-Ann Clement, Esq., on behalf of Marie Metellus (the “Complainant”), that was accepted by the Department of Financial Services (the “Department”) on October 8, 2024. This matter relates to claim number 00201755543 (the “Claim”) reported under certificate number 2MC21142279023 (the “Certificate”) issued by American Security to PHH Mortgage Services, Inc., its successors and/or assigns (the “Lender”) as “Named Insured” and Nardette Take Out Restaurant, Inc. as “Borrower” which insured the commercial property located at 3068 Fowler Street, Fort Myers, Florida 33901 (the “Property”) as more fully set forth therein from September 25, 2022 through September 25, 2023, and provided coverage limits of $500,000.00. As a general matter, American Security objects to the validity of the CRN, as it is deficient on its face. The CRN lacks the specificity required by s. 624.155(3)(a), Florida Statutes. The CRN provides nothing more than vague, ambiguous and conclusory allegations regarding what Complainant believes to be American Security’s motivations, positions and business practices – none of which are true or supported by any facts. Florida law is clear that a claimant is required to state with specificity the “facts and circumstances giving rise to the violation,” to allow the insurer to understand and cure any purported violation. Longpoint Condo. Assn. v. Allstate Ins. Co., 2005 WL 1315810 (N.D. Fla. 2005). A written CRN which is vague and “shotgun” in nature or is written in general terms fails the specificity requirement of the statute. See Heritage Corp. of South Fla. v. National Union Fire Ins. Co. of Pittsburgh, P.A., 580 F. Supp. 2d 1294, 1300 (S.D. Fla. 2008); Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059 (S.D. Fla. 2010); Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006). The very purpose of the civil remedy notice, pursuant to Chapter 624, is to inform the insurer of alleged violations with specific information to encourage settlement of the subject claim. “The sixty-day window [as provided for in F.S. §624.155] is designed to be a cure period that will encourage payment of the underlying claim, and avoid unnecessary bad faith litigation.” Talat Enters., Inc. v. Aetna Cas. & Sur. Co., 753 So.2d 1278 (Fla. 2000). Notice sent to the Department of Insurance concerning settlement violation(s) is intended to serve as a basis for the Department to assist in the settling of claims and to monitor the insurance industry. Id. However, whenever a complainant provides little in the way of adequate notice, the statutory intent of the CRN is frustrated. Moreover, contrary to the information included in the CRN, Complainant, is not the insured. Rather, Borrower under the Declaration is Nardette Take Out Restaurant Inc, which is the owner of a small strip mall. Accordingly, the CRN is a nullity on its face. Notwithstanding the foregoing, and without waiver of the fatal defect in the CRN, American Security addresses the allegations contained therein as follows: On February 5, 2024, more than sixteen (16) months after Hurricane Ian, Complainant’s counsel reported a claim for alleged Hurricane Ian damages to the Property that reportedly occurred on September 28, 2022. American Security promptly acknowledged receipt of the Claim in writing and assigned claim number 00201755543 to the reported loss. American Security also sent a reservation of rights letter due the late reporting of the Claim, as such a delay is a breach an insured “duties after loss.” On February 26, 20241, Complainant provided access to inspect the Property. However, at the time of the inspection, some of the units had been gutted and were in a statement of reconstruction; while other units appeared to be in a state of deterioration without any mitigation during the 16 month interim period in which Complainant had failed to report the Claim. Accordingly, American Security requested a recorded statement and documents to support any mitigation and repair efforts during the 16 months in which the Claim was not reported. At the time of the inspection, there was only a small tarp placed over a small portion of the roof. On May 10, 2024, Marie Metellus on behalf of Complainant appeared, with counsel, to provide a recorded statement. However, Complainant provided little, to no, information related to the repairs, the cost of the repairs and/or mitigation efforts made during the interim period. Complainant repeatedly responded to questions by stating that she “did not know” or “did not remember” much or most of the basic information requested, including information related to the damages sustained to the Property and individual units allegedly cause by Hurricane Ian. When asked about the cost of various repairs or the dates that repairs had been made, Ms. Metellus could not provide the most basic information to assist American Security in its investigation of the Claim. Moreover, although Complainant stated mitigation efforts had been performed immediately after Hurricane Ian, Complainant could not provide any meaningful details regarding same. American Security was also informed that invoices related to water mitigation would be provided, however, American Security never received any documents related to same. Although Complainant did not forward, or otherwise provide, the requested information related to damages or mitigation efforts, notwithstanding the 16 month delay, on June 28, 2024, Complainant sent a Sworn Statement In Proof of Loss for over $550,000.00, based upon an estimate that had been prepared twenty (20) months after the alleged date of loss, which included $127,000 to replace a 70 SQ roof and to repair and replace the entire interior of the building, without any documentation as to the actual damages sustained to the Property almost twenty months earlier or any indication of what mitigation, if any, was performed other than placing a very small tarp on a small portion of the roof. Moreover, because the Certificate is a commercial policy and not subject to Fla. Stat., s. 626.9644, there is no coverage under the Certificate to match undamaged property to damaged property for purposes of matching. American Security continued to investigate the reported loss and wait for requested information to be provided. However, as no additional information had been sent, American Security issued an Explanation of Benefits Letter (“EOB Letter”) and tendered payment to replace the roof and make certain repairs to the interior of the building. Ms. Metellus cites statutory provisions under Fla. Stat. § 624.155 and Fla. Stat. § 626.9541, without any ultimate facts that support the empty and false accusations. As such, American Security responds to the defective CRN as follows: 624.155(1)(b)(1): Denied. Since the filing of the defective CRN, American Security covered the Claim and tendered payment for the Claim in accordance with the terms, conditions and exclusions of the Certificate and in doing so, has acted fairly and honestly. Complainant has provided absolutely no facts or circumstances supporting this allegation in the CRN. 624.155(1)(b)(3): Denied. Since the filing of the defective CRN, American Security covered the Claim and tendered payment for the Claim in accordance with the terms, conditions and exclusions of the Certificate and in doing so, has acted fairly and honestly towards the Complainant with due regard for her interests. 626.9541(1)(i)(3)(a): Denied. American Security has adopted and continues to implement standards for the proper investigation of claims. Moreover, American Security has never failed to adopt and implement these standards in such a way that would constitute a business practice. Absolutely no facts or circumstances supporting this allegation have been provided by Complainant in the CRN. 626.9541(1)(i)(3)(c): Denied. American Security had not failed to acknowledge and act promptly upon communications with respect to the Claim. Absolutely no facts or circumstances supporting this allegation have been provided by Complainant in the CRN. 626.9541(1)(i)(3)(e): Denied. American Security covered the Claim and tendered payment to Complaint with a detailed EOB Letter regarding same. Absolutely no facts or circumstances supporting this allegation have been provided by Complainant in the CRN. 626.9541(1)(i)(3)(f): Denied. American Security covered the Claim and sent correspondence explaining the details of its coverage determination to Complainant in its EOB Letter. Absolutely no facts or circumstances supporting this allegation have been provided by Complainant in the CRN. 626.9541(1)(i)(3)(g): Denied. American Security has not failed to notify Complainant of any additional information necessary for the processing of the Claim. Absolutely no facts or circumstances supporting this allegation have been provided by Complainant in the CRN. American Security denies all the allegations in the CRN as false, unfounded and completely devoid of merit or factual predicate. At no time has American Security ever acted in bad faith. In fact, notwithstanding that this Claim was reported sixteen months late, and was provided no documentation of the scope of the damages at the time of the loss or any documentation related to mitigation efforts, American Security covered the cost to replace the roof and other damages which could be confirmed through other investigative methods. At all times material to this Claim, American Security: (a) acted in good faith to investigate the Claim, acted fairly and honestly in its dealings with the Complainant and her representatives; (b) promptly investigated the Complainant’s Claim; (c) complied with its obligations in accordance with the terms of the subject insurance contract and Florida law. If you are in need of or seek any further information, please feel free to contact the undersigned. Very truly yours, /s/ Alaine S. Greenberg, Esq. cc: Ashley-Ann Clement, Esq. Joseph S. Menniti, 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