Civil Remedy Notice of Insurer Violations
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Filing Number:     786438
Filing Accepted:  10/11/2024
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Complainant
Last/Business Name *  
TEJADA DAYEH   First Name   DIANA MARIA
Street Address * 344 BUTTONWOOD DR
City, State Zip * KISSIMMEE, FL 34743
Email Address * DIANATDP@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   TEJADA DAYEH   First Name   DIANA MARIA
Policy # * SFLH3000257 Claim #* 59645
Attorney
Attorney is Applicable
Last Name* BRAZ First Name * TAMARA Initial
Street Address* 8865 COMMODITY CIR. STE. 12
City, State Zip* ORLANDO , FL 32819
Email Address * TBRAZ@THELAWGICALFIRM.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):* ? CAROL GREEN, FIELD SERVICES REPRESENTATIVE ON BEHALF OF SAFEPOINT INSURANCE COMPANY; ? MELANIE FOWLER, PERSONAL LINES PROCESSING MANAGER ON BEHALF OF SAFEPOINT INSURANCE COMPANY;
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Claim Denial
Unfair Trade Practice
* Statutory provision(s) which the insurer allegedly violated.
 
626.9541(1)(i)(2) A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
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)(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.
Enter all words or phrases (one at a time) that should be used to filter.

Policy Form: HO 00 03 10 00 SECTION I - PROPERTY COVERAGES A. Coverage A - Dwelling 1. We cover: a. The dwelling on the "residence premises" shown in the Declarations, including structures attached to the dwelling[;] *** SECTION I – PERILS INSURED AGAINST *** A. Coverage A – Dwelling And Coverage B – Other Structures 1. We insure against risk of direct physical loss to property described in Coverages A and B[.] *** SECTION I - CONDITIONS *** B. Duties After Loss In case of a loss to covered property, we have no duty to provide coverage under this policy if the failure to comply with the following duties is prejudicial to us. These duties must be performed either by you, an "insured" seeking coverage, or a representative of either[:] *** 4. Protect the property from further damage. If repairs to the property are required, you must: a. Make reasonable and necessary repairs to protect the property; and b. Keep an accurate record of repair expenses; 5. Cooperate with us in the investigation of a claim[;] *** 7. As often as we reasonably require: a. Show the damaged property; b. Provide us with records and documents we request and permit us to make copies 8. Send to us, within 60 days after our request, your signed, sworn proof of loss which sets forth, to the best of your knowledge and belief[:] ***
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On or about July 5, 2023, the Diana Maria Tejada Dayeh (Complainant(s)) suffered a loss to their Property, located at the address listed above due to water and wind damages. After discovering the damage, Complainant reported the loss to Safepoint Insurance Company (“Insurer”) on or about October 3, 2023. Throughout the Insurer’s investigation, Complainant has fully cooperated with the Insurer and fully performed all duties and obligations under the policy by providing all information within Complainant’s custody, possession and control. The Insurer, however, has failed to fulfill its duties under the Policy and Florida law. Upon discovering damage, Complainant retained “My Restoration” to install a tarp to the subject property’s roof on or about October 2, 2023. On or about October 3, 2023, Complainant reported the loss to Insurer. Subsequently, upon reporting the claim, Complainant retained Champion Claims LLC, a Public Adjuster (hereinafter “PA” or “Public Adjuster”), to represent the claim on or about October 3, 2023. A Letter of Representation was sent following the submission of the claim. In the email correspondence accompanying the Letter of Representation, a request for the certified copy of the policy (“CCOP”) was submitted to Insurer, with notice that failure to comply with the request may result in further intervention. Insurer acknowledged the reporting of the claim and sent a Homeowner Bill Of Rights on or about the same day. On or about October 10, 2023, Carol Green, a Field Adjuster on behalf of Insurer, (hereinafter “FA”), conducted an inspection of the subject property.. On or about October 18, 2023, the Insurer sent an email correspondence requesting a recorded statement in which the Public Adjuster promptly scheduled for on or about October 23, 2023. On or about October 19, 2023, Insurer requested documentation on the Emergency Water Services and Tarp Installation that was done on the subject property. The Public Adjuster promptly informed Insurer the request will be satisfied upon control and possession of such documentation. On or about October 24, 2023, the Complainant retained “My Restoration” for Water Mitigation services. On or about October 25, 2023, the Public Adjuster sent an email correspondence attaching a Sworn Proof Statement of Loss and the Public Adjuster’s generated estimate of the damages. The Insurer, however, failed to acknowledge the initial correspondence. Due to this lack of communication, the PA sent a follow-up email on or about October 31, 2023, requesting the Insurer’s estimate, findings, and/or coverage determination letter. Despite this effort, the Insurer again neglected to respond. Here, Insurer was in clear violation of Fla. Stat. 627.70131(1)(a) by failing to review and acknowledge receipt of communication with respect to the claim. On or about November 2, 2023, the PA sent an additional follow-up email, requesting a status update on the claim. Despite Complainant and their agents' multiple efforts, beyond their statutory obligation, Insurer failed to provide any meaningful response or acknowledgment. Notably, the Insurer had conducted an inspection approximately 15 days prior to this correspondence and, as of yet, has not provided any written updates regarding the investigation or coverage determination. Although the Insurer is now in possession of the PA’s estimate, it has failed to acknowledge receipt or provide any response to the same. Insurer has clearly violated Fla. Stat. 627.70131(1)(a). It was not until on or about November 10, 2023, that the Insurer sent any written correspondence regarding the claim. However, rather than providing a coverage determination, the Insurer merely stated that the claim remained under investigation and that additional information was being requested from the Complainant. Despite the extended delay, the Insurer failed to offer any substantive updates or conclusions about the status of the claim. On or about November 10, 2023, the Public Adjuster sent an email correspondence attaching the Emergency Mitigation Services, Tarp documents and estimates previously requested by the Insurer. Pursuant to Fla. Stat. 627.70131(1)(a), the Insurer is required to review and acknowledge receipt of a communication regarding a claim through some form of correspondence within 7 days. However, the Insurer failed to acknowledge the Sworn Proof of Loss (SPOL) until 16 days after the Public Adjuster submitted the statement. Although the Insurer eventually acknowledged receipt, it neither agreed nor disagreed with the SPOL. Instead, the Insurer stated the following rationale for its refusal to accept the Proof of Loss: “We are unable to accept your Proof of Loss because the form you submitted is incomplete for the following reasons: 1) By merely stating 'Hail and Wind Damage,' the proof of loss fails to identify the origin of the loss with sufficient specificity.” The Public Adjuster, perplexed by the Insurer’s vague response to the SPOL, sent an email on or about November 14, 2023, requesting clarification regarding the rejection. Despite this request, no written clarification has been provided by the Insurer, again violating Fla. Stat. 627.70131(1)(a). As a result, the Complainant remains unable to resubmit the SPOL. The Insurer’s failure to address how the alleged deficiencies could be corrected has left the claim in an unresolved state, depriving the Complainant of a clear statement of what is owed to them under the policy. On or about November 21, 2023, Precision Claim Solutions, an expert retained by the Insurer, inspected the property and took photographs. On or about December 1, 2023, the Insurer issued a coverage denial letter. However, Insurer still did not provide the requested CCOP, despite the Public Adjuster’s initial request 59 days ago. On or about December 5, 2023, the Public Adjuster sent a follow-up email reiterating the request for the CCOP. The Insurer failed to respond to this correspondence. Consequently, the Public Adjuster sent an additional email on or about December 7, 2023, again requesting the CCOP. Pursuant to Fla. Stat. 627.4137, the Insurer is required to furnish, within 30 days of a written request from the Complainant or their representative, a sworn statement from either a corporate officer or the claims manager. This statement must provide detailed information regarding the policy under which the claim is being handled. The sworn information must include the Insurer’s name, the Complainant’s name, the limits of liability coverage, and a copy of the policy. However, the Insurer did not send the CCOP until on or about December 8, 2023, 66 days after the date to which it was requested initially. This is crucial in the claim process as it hinders the Complainant's ability to fully understand the provisions and policy language necessary to navigate the claims process. The CCOP is crucial in determining the Complainant's rights, obligations, and entitlements under the policy, including specific coverages, limits, and conditions that may directly impact the claim. Without access to this document, the Complainant remains unaware of key aspects of the policy that are essential for effectively pursuing the claim. Insurer has routinely delayed and ignored pertinent information and requests from Complainant and their agents. Upon information and belief, Insurer used such tactics to intentionally delay and deny rightful remedies owed to Complainant. Based on the events described above, it is clear that Insurer has failed to meet the proper standards of an investigation, contrary to the policy and Florida law’s requirements. These tactics are believed to be the general business practices of this Insurer. Insurer can cure its bad faith conduct by: 1) accepting the Insureds’ damage claim as compensable, and agreeing to pay the claim in accordance with the policy in the amount of $68156.48, plus interest, prior to the expiration of the cure period, 2) reviewing and responding to all communications from the Insureds and their agents, including the request for a complete copy of the Policy. PLEASE GOVERN YOURSELF ACCORDINGLY.
Comments
User Id Date Added Comment
mbakas@safepointins.com 12-10-2024 December 10, 2024 VIA EMAIL: TBRAZ@THELAWGICALFIRM.COM Tamara Braz, Esq. 8865 Commodity Cir. Ste. 12 Orlando, FL 32819 RE: Insured: Diana Maria Tejada Dayeh Claim Number: 59645 Policy: SFLH3000257 Date of Loss: 7/5/2023 CRN Filing Number: 786438 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 Diana Maria Tejada Dayeh (“Complainant” / “Insured”). The Florida Department of Financial Services accepted the Purported Notice, in form only, on October 11, 2024. The Purported Notice was filed in connection with Complainant’s insurance claim for property damage. The Purported Notice names SafePoint and alleges Claim Delay, Claim Denial and Unfair Trade Practice, supposedly in violation of Sections 626.9541(1)(i)(2), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(f) and 626.9541(1)(i)(3)(g) 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 Notice fails to meet the requirements of Fla. Stat. § 624.155 on several grounds. Deficiency #1 The Purported Notice lists the Insured as “DIANA MARIA TEJADA DAYEH” and fails to list the additional Insured on the property, “JUAN ISIDRO PENA PEREZ”. 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 numerous provisions from the Policy without any specificity. This deficiency applies to all allegations in the Purported Notice, including but not limited to Claim Delay, Claim Denial and Unfair Trade Practice, supposedly in violation of Sections 626.9541(1)(i)(2), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(f) and 626.9541(1)(i)(3)(g) 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 contains incorrect facts and fails to explain how the purported facts constitute violations of Florida law. 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, “Complainant has fully cooperated with the Insurer and fully performed all duties and obligations under the policy by providing all information within custody, possession and control.” However, these statements are conclusory, inaccurate and without factual basis. This is a claim for roof and interior damage that was late reported, by Claimant’s Public Adjuster, Champion Claims LLC on October 3, 2023, ninety (90) days after the alleged date of loss, July 5, 2023. On October 10, 2023, SafePoint timely inspected the subject property and documented any visible damage. It was noted, there was water related damages to the bedroom and living room ceiling. On November 21, 2023, SafePoint retained Precision Roof Consulting (“PRC”), to inspect the property and determine the cause and origin of the claimed damage. Notably, the inspection did not identify any peril-induced openings, storm created holes or openings or wind damage to the roof. Rather, the PRC report noted, damage consistent to intentional mechanically creased shingles, shingle stair step sealant failure, marring, scuffing, and gouging. Further, PRC reviewed weather related data and wind speed for the subject property and on the reported date showed a maximum wind speed of 40 miles per house which is below design speeds for laminated shingles. The Policy explicitly excludes coverage for roof damage resulting from wear and tear, marring, deterioration, mechanical breakdown, latent defect, inherent vice, or any quality in property that causes it to damage or destroy itself. Further, the Policy excludes coverage for water entering the risk unless due to a direct force of the windstorm damages the building, causing an opening in a roof or wall. As such, on December 1 , 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. Further, SafePoint acknowledges receipt of the Public Adjuster’s additional email dated December 7, 2023, requesting the Certified Copy of Policy (Policy). However, due to unforeseen administrative circumstances, the Policy was provided on December 8, 2023, the very next day, albeit sixty-six (66) days after the initial request. SafePoint regrets any inconvenience this delay may have caused. Nonetheless, we would like to emphasize that this delay does not constitute a breach of our obligations, nor does it impact the validity of the claim process. Furthermore, there was no bad faith in our actions. The Insured had a copy of the Policy from the time it was issued, and the Public Adjuster could have easily obtained it from the Insured. Additionally, the Policy was provided three hundred and eight (308) days—nearly a full year—prior to the filing of the Purported Notice. Therefore, it is clear that there was no prejudice to the Complainant and no bad faith. Finally, the Notice makes boilerplate recitations of statutes and conclusory statement 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 Delay, Claim Denial and Unfair Trade Practice, supposedly in violation of Sections 626.9541(1)(i)(2), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(f) and 626.9541(1)(i)(3)(g) Florida Statutes. STATUTORY ALLEGATIONS 626.9541(1)(i)(2): A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy. 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)(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)(g): Failing to promptly notify the insured of any additional information necessary for the processing of a claim. 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 and roofing consultant and conducted an inspection of the subject property to investigate the Insured’s claim. Thereafter, Safepoint timely 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