Civil Remedy Notice of Insurer Violations
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Filing Number:     786297
Filing Accepted:  10/9/2024
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Complainant
Last/Business Name *  
SANCHEZ   First Name   MIGUEL
Street Address * 9121 SANDCROFT CT.
City, State Zip * TAMPA, FL 33615
Email Address * SDC@WEKLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   SANCHEZ   First Name   MIGUEL
Policy # * SFLH0366040 Claim #* 58265
Attorney
Attorney is Applicable
Last Name* CHOKSHI First Name * SAURIN Initial
Street Address* 800 EAST BROWARD BLVD., SUITE 510
City, State Zip* FORT LAUDERDALE , FLORIDA 33301
Email Address * SDC@WEKLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   SAFEPOINT INSURANCE COMPANY
NAIC Company Code 15341
 
Name of individual responsible for violation (if any):* JOHN DONADIO
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
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)(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)(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)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The Loss Payment provision found in the homeowner's policy authorizes payment in the event of a covered loss to insured property.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

At all times material hereto, Safepoint Insurance Company insured Juana Pena and Miguel Sanchez’s home under a policy of insurance. The subject policy provides coverage for sudden and accidental losses and damages arising from windstorms/hurricanes. The loss payment provision and governing law provides that the insurer has a fiduciary duty to in good faith promptly investigate, adjust, and issue payment of the undisputed amount of the loss and damages. See Doe v. Allstate Ins. Co., 653 So. 2d 371, 374 (Fla. 1995) (stating that the obligation of insurance company toward insured is a "fiduciary duty requiring the exercise of good faith"). Safepoint Insurance Company failed to pay the insureds’ claim under the homeowner's insurance policy when, under all of the circumstances, it could and should have done so, had it acted fairly and honestly and with due regard for the interests of insured. Safepoint Insurance Company failed to act with diligence and thoroughness in investigating the facts specifically pertinent to coverage. Safepoint Insurance Company failed to attempt to settle the liability claim in the face of the coverage dispute. Safepoint Insurance Company failed to assess the substance of the coverage dispute or the weight of legal authority on the coverage issue. Safepoint Insurance Company has a regular business practice of failing to adequately evaluate its policyholder’s claims and undervalues the claims to save itself money. It is clear that the insurer’s general business practice of willful, wanton, immoral, deceptive and bad faith claim handling policies, procedures, adjusting, investigating has caused the insured to suffer further harm and extra-contractual damages which have accrued, and will continue to accrue. That said, and even though Safepoint Insurance Company knows that it has a fiduciary duty to promptly adjust insurance claims, it failed to institute the necessary policies, procedures, guidelines and protocols to adjust insurance claims promptly and pursuant to the policy’s Loss Payment Provision. By way of the cited legal authorities and considerations, Safepoint Insurance Company knew that it had an obligation to treat all insureds equally and honestly. However, and for their own financial interest, they will only start to fully consider their obligations as stated herein if the insured retains legal representation and pursues a legal action which exposes them to liabilities and costs. Even then, they will withhold monies owed in an unjust effort to limit/delay their liabilities in relation to the statutory considerations and otherwise. To cure the above stated immoral, deceptive, unlawful and generally described bad faith conduct which is part of a general business practice that is knowingly being utilized by Safepoint Insurance Company for self-gain, Safepoint Insurance Company must: (1) accept coverage for the subject claim; (2) promptly make payment pursuant to the policy’s Loss Payment Provision for covered damages in the amount of $58,836.00 (3) tender interest on any overdue payments; and (4) acknowledging liability for taxable cost and reasonable attorneys in the pending lawsuit.
Comments
User Id Date Added Comment
mbakas@safepointins.com 12-06-2024 December 6, 2024 VIA EMAIL: SDC@WEKLAW.COM Saurin Chokshi, Esq. 800 East Broward Blvd., Suite 510 Fort Lauderdale, Florida 33301 RE: Insured: Miguel Sanchez Claim Number: 58265 Policy: SFLH0366040 Date of Loss: 9/27/2022 CRN Filing Number: 786297 Dear Sir/Madam: This is the formal response of SafePoint Insurance Company (“SafePoint”) to the purported Civil Remedy Notice of Insurer Violations (“Purported Notice”) that was filed on behalf of Miguel Sanchez (“Complainant” / “Insured”). The Florida Department of Financial Services accepted the Purported Notice, in form only, on October 9, 2024. The Purported Notice was filed in connection with Complainant’s insurance claim for property damage. The Purported Notice names SafePoint and alleges Claim Denial, Claim Delay and Unsatisfactory Settlement Offer, supposedly in violation of Sections 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)(f) and 626.9541(1)(i)(3)(h), Florida Statutes. The Purported Notice is a legal nullity for the reasons discussed below. ^ 1 SafePoint specifically denies each and every allegation contained in the Purported Notice. Additionally, SafePoint denies that it violated these or any statutes, Florida law or policy provisions regarding the claim adjustment of this matter. ^ 1 SafePoint reserves all (and waives none) of its rights or defenses, including its right to assert additional deficiencies in the Purported Notice. Under Section 624.155(3), Florida Statutes, a claimant must file a notice with the Florida Department of Financial Services (“the Department”) at least 60 days before filing a Statutory “bad faith” lawsuit. This notice is commonly referred to as a “civil remedy notice” (“CRN”). Section 624.155(3), Florida Statutes sets out five pieces of information which must be included in a CRN: 1. The statutory provision, including the specific language of the statute, which the authorized insurer allegedly violated; 2. The facts and circumstances giving rise to the violation; 3. The name of any individual involved in the violation; 4. Reference to specific policy language that is relevant to the violation, if any. If the person bringing the civil action is a third party claimant, she or he shall not be required to reference the specific policy language if the authorized insurer has not provided a copy of the policy to the third party claimant pursuant to written request; and 5. A statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. The statute also provides that, in addition to these five requirements, the CRN shall be “on a form provided by the [Department] and shall state with specificity . . . such other information as the department may require.” (emphasis added); The Florida Supreme Court has held that Section 624.155, Florida Statutes “must be strictly construed.” Talat Enterprises, Inc. v. Aetna Cas. and Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Strict construction is appropriate as “this statute is in derogation of the common law.” Id. When interpreting a statute in derogation of the common law, “[a] court will presume that such a statute was not intended to alter the common law other than as clearly and plainly specified in the statute.” Time Ins. Co., Inc. v. Burger, 712 So. 2d 389, 393 (Fla. 1998). Accordingly, such an interpretation would mean that statutory bad faith cases cannot proceed unless the claimant has specifically complied will all statutory requirements. After the promulgation of this statute, the Department created a CRN form: Form DFS-10-363. Form DFS-10-363 lays out 15 requirements: 1. Complainants Name; 2. Complainants Address; 3. Complainants E-mail address; 4. Complainant type (Insured or otherwise); 5. Insured’s Name; 6. Insurance Policy Number; 7. Insurance Claim Number; 8. Attorney’s Name; 9. Attorney’s Address; 10. Attorney’s E-mail Address; 11. Type of Insurer (authorized or otherwise); 12. Name of Insurer; 13. Address of Insurer; 14. Type of Insurance (Commercial Property & Casualty or otherwise); and 15. Reason for Notice. As these requirements are all information required by the Department, according to Section 624.155, Florida Statutes, they each must be stated with specificity. The Purported Notice fails to meet the requirements of Fla. Stat. § 624.155 on several grounds. Deficiency #1 The Purported Notice lists the Insured as “MIGUEL SANCHEZ” and fails to list the additional Insured on the property, “JUANA PENA”. Thus, the CRN is invalid for noncompliance with Section 624.155(3)(b)(3), Florida Statutes. Deficiency # 2 Section 624.155(3)(b)(4), Florida Statutes, requires the CRN to reference specific policy language that is relevant to the violation, if any. If the person bringing the civil action is a third- party claimant, she or he shall not be required to reference the specific policy language if the authorized insurer has not provided a copy of the policy to the third-party claimant pursuant to written request. The Complainant is the Insured and not a third-party claimant; therefore, the Purported Notice must include specific language from the subject policy that is relevant to the alleged violations. It does not. Rather, the Purported Notice lists a vague heading from an unknown insurance policy, “The Loss Payment provision found in the homeowner's policy authorizes payment in the event of a covered loss to insured property.” Thus, the Purported Notice is invalid for noncompliance with Section 624.155(3)(b)(4), Florida Statutes. This deficiency applies to all allegations in the Purported Notice, including but not limited to Claim Denial, Claim Delay and Unsatisfactory Settlement Offer, supposedly in violation of Sections 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)(f) and 626.9541(1)(i)(3)(h), Florida Statutes. On March 3, 2021, the Fourth District Court of Appeal issued a relevant opinion in Junior Julien v. United Property and Casualty Insurance Company, No. 4D19-2763. In Julien, the insured appealed the circuit court’s dismissal of his lawsuit against his insurer, finding that the insured’s Civil Remedy Notice (“CRN”) failed to satisfy the statutory requirement that an insured “state with specificity” the policy language and the statutory provisions at issue. In his CRN, the insured cited numerous statutory provisions and listed nearly every provision in the insurance policy. On appeal, the Fourth District affirmed the dismissal and agreed with the circuit court that the CRN failed to specify the statutory and policy provisions at issue. Like the CRN in Julien, the Purported Notice fails to “state with specificity” the policy language at issue. Deficiency # 3 Section 624.155(3)(b)(2), Florida Statutes, requires that the CRN state with specificity the facts and circumstances giving rise to the violation. The Purported Notice does not supply specific facts or circumstances that explain the allegations. Rather, the Purported Notice asserts general allegations consisting of conclusory and inaccurate statements rather than specific allegations of fact regarding any alleged misconduct or statutory violations. For example, the Purported Notice states, “Safepoint Insurance Company failed to act with diligence and thoroughness in investigating the facts specifically pertinent to coverage.” However, these statements are conclusory, inaccurate and without factual basis. This is a claim for roof and interior damage to the property allegedly caused by Hurricane Ian, that was late reported by Claimant’s attorney, Weisser Elazar & Kantor, PLLC on June 27, 2023, two hundred and seventy-three (273) days after the alleged date of loss, September 27, 2022. On July 7, 2023, SafePoint timely inspected the subject property and documented any visible damage. The inspection report noted, “…we observed a roof that was significantly worn and well past its useful life. The 3-tab shingles exhibited heavy granule loss due to age and prolonged exposure to the elements.” Further, recent repairs made to the rear corrugated metal roof revealed additional signs of wear and tear. Wind speeds recorded at the nearby Tampa International Airport Station did not exceed 12 mph on the reported date of loss. Such wind speeds were insufficient to damage the roof shingles. Additionally, SafePoint inspected two rooms with mitigation holes drilled into the ceilings, which showed no signs of elevated moisture or staining to the drywall or roof sheathing to validate a roof leak. The damages at the property were found to be caused by wear/tear, wet and/or dry rot, and faulty/inadequate construction/repairs/maintenance. The Policy does not provide coverage for roof damage due to age, wear and tear, wet &/or dry-rot, defects in construction and/or maintenance methods, materials and/or designs, and/or deferred maintenance. As such, on July 17, 2023, contrary to the Purported Notice erroneous assertion, “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[.]” the Complainant was timely notified in writing and provided a detailed explanation as to why there was not a covered peril under the Policy in accordance with the investigation and the Policy terms and conditions. In the coverage determination letter, SafePoint advised Complainant, if there was additional information to consider, to provide that information in writing. To date, nothing was provided to support a reconsideration of the claim determination. Further, it is SafePoint’s position that Insured failed to comply with their post-loss duties as required under the Policy including but not limited to the failure to provide requested documents and records, failure to provide prompt notice, and failure to protect the property and late reporting the claim as previously noted above. Finally, the Notice makes boilerplate recitations of statutes and conclusory statements without the requisite specificity. Specificity is of particular importance for this Notice as Complainant generally alleges that SafePoint “[m]isrepresent[ed] pertinent facts or insurance policy provisions relating to the coverages at issue.” However, the Notice does not set forth any facts regarding any misrepresentations made by SafePoint and does not identify the person or persons who made such misrepresentations. It is evident that the statement of facts falls short of the specificity required by Fla. Stat. §624.155. The above noted deficiencies apply to all allegations in the Purported Notice, including but not limited to Claim Denial, Claim Delay and Unsatisfactory Settlement Offer, supposedly in violation of Sections 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)(f) and 626.9541(1)(i)(3)(h), Florida Statutes. Deficiency # 4 The Purported Notice does not supply necessary information that would allow SafePoint to “cure” the alleged violations without paying benefits which are not due and owing to the Complainant, as required by Florida law. The purpose of a Civil Remedy Notice is to provide the insurer an opportunity to “cure” the alleged wrongdoing. Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278 (Fla. 2000). However, Section 624.155, Florida Statute, does not impose on an insurer the obligation to pay whatever an insured demand. Talat, 753 So. 2d at 1282. To the contrary, the Florida Supreme Court holds that the scope of what can be “cured” in responding to a Civil Remedy Notice, is limited to contractual amounts due to the insured. See Talat, 753 So. 2d at 1281. Here the Complainant seeks extracontractual damages including but not limited to, “acknowledge liability for taxable cost and reasonable attorneys in the pending lawsuit.” Consequently, the Purported Notice is deficient as it fails to afford SafePoint the opportunity to cure the alleged violations without incurring extracontractual damages. SafePoint is only obligated to pay contractual amounts owed to cure a civil remedy. See id. at 1278. Deficiency #5 Finally, the Complainant failed to respond to each of the fields set forth on the DFS Form with the requisite specificity and as outlined herein as well as including but not limited to, the use of the attorney’s firm’s email address, “SDC@WEKLAW.COM” for that of the Complainant. Therefore, the Purported Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. See Pin Pon, 2020 WL 6588379; 2021 WL 824438. STATUTORY ALLEGATIONS 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. SAFEPOINT 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. SAFEPOINT denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. SAFEPOINT denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. SAFEPOINT denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims. SAFEPOINT denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(d): Denying claims without conducting reasonable investigations based upon available information. SAFEPOINT denies the allegation that it violated the above referenced statute. 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. SAFEPOINT denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(h): Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. SAFEPOINT denies the allegation that it violated the above referenced statute. The allegations set forth in the Purported Notice are denied as they are mere conclusory allegations unsupported by facts, devoid of logic and intended solely to tarnish SafePoint’s name and reputation. SafePoint has at all times, acted fairly, honestly and in good faith in its dealings with the Complainant. While an insurance carrier is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested. SafePoint unequivocally denies each and every allegation asserted in the Purported Notice. At no time has SafePoint breached any duty to the Complainant. An insurer is not required to pay whatever amount the Insured demands. Finally, SafePoint retained a field adjuster conducted an inspection of the subject property to investigate the Insured’s claim. Thereafter, Safepoint made a coverage decision pursuant to all applicable policy language and statutes. Please be advised, by this letter, SafePoint neither waives, nor is estopped, from asserting any and all rights it may have in law, or, under the terms of the Policy. In fact, SafePoint hereby again, expressly, and specifically, reserves all of its rights, without exception or limitation. If you have any questions or concerns with this response, or, regarding any other matter, please contact me in writing. Sincerely, /s/ Ari A. Zeltzer Ari A. Zeltzer, Esq. Staff Counsel SafePoint Insurance Cc: Florida Department of Financial Services
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