Civil Remedy Notice of Insurer Violations
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Filing Number:     786498
Filing Accepted:  10/11/2024
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Complainant
Last/Business Name *  
SIMMONS   First Name   WILLIAM
Street Address * 517 NORTHWEST HORIZON STREET
City, State Zip * LAKE CITY, FL 32055
Email Address * MYA@GREENLAWGRP.COM
Complainant Type: * Insured
Insured
Last/Business Name*   SIMMONS   First Name   WILLIAM
Policy # * 80R921166 Claim #* 5972X518G
Attorney
Attorney is Applicable
Last Name* GREEN First Name * PAUL Initial
Street Address* 8833 PERIMETER PARK BLVD STE 104
City, State Zip* JACKSONVILLE , FL 32216
Email Address * MYA@GREENLAWGRP.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):* ALL SUPERVISORS
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Unfair Trade Practice
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)(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)(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)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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.

See below
 
* 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 August 4th, 2024, William Simmons (hereinafter “INSURED”), suffered property damage at his property located at 517 Northwest Horizon Street, Lake City, FL 32055. The property suffered extensive damage to the roof. State Farm Florida Insurance Company. (hereinafter “State Farm”) issued an insurance policy for the Insured’s property, Policy Number 80R921166, which was in full force and effect on the date of the loss. The loss was the result of a significant windstorm. Shortly following the loss, the Insured retained the Green Law Group (hereinafter “FIRM”) to help expedite the claim to restore the property to its pre-loss condition. FIRM timely notified STATE FARM of the damage sustained to the property and contemporaneously provided an estimate of the damage in the amount of $97,699.99. Despite demand of payment, STATE FARM has failed or refused to pay full value to protect and return property to pre-loss STATE FARM’s refusal to adequately and otherwise make INSURED whole, constitutes a breach of contract. As a result of STATE FARM ‘’forementioned breach of contract, it has become necessary for INSURED to retain the services of FIRM. STATE FARM has engaged in a customary business practice and a deliberate course of conduct to hinder resolution of its claims until they enter litigation STATE FARM regularly and consistently “shuffles” desk adjusters when the undersigned attorney calls to discuss claims. One adjuster will imply he can help on the claim but after several minutes state that he does not have the authority to settle the claim, and another desk adjuster is needed for that claim. This practice is used solely to insulate STATE FARM in litigation by saying that their adjusters are available to adjust and settle claims and are not avoiding settling. However, all is doing is “passing off” a claim from one adjuster to another to delay and frustrate the process. STATE FARM regularly and consistently denies justified claims outright, omits or denies specific line items required to properly repair/replace a homeowner’s roof, and uses deceptive tactics, some, aforementioned, to prolong the process in a hope that the homeowner will cancel his retainer with the FIRM. It has become a pattern of practice for STATE FARM to not settle claims when it has the ability to do so, and these dilatory tactics serve no purpose other than to increase profits. STATE FARM has violated the following statutory provisions: §642.155(1)(b)(1) - Not attempting in good faith to settle claims when, under all circumstances, it could and should have done so, had it acted fairly and honestly towards its insured and with due regards 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 reasonable clear, under one portion of the insurance policy coverage in order to influence settlement under other provisions of the insurance policy coverage; §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) – Committing or performing with such frequency as to indicate a general business practice any of the following: (a) Failing to adopt and implement standards for the proper investigation of claims; (b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; (c) Failing to acknowledge and act promptly upon communications with respect to claims; (d) Denying claims without conducting reasonable investigations based upon available information; (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 with 30 days after proof-of-loss statements have been completed; (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; (g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim; (h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. To remedy this Civil Remedy Notice and to cure the conduct giving rise to the violations described herein, STATE FARM must immediately: (i) tender the full remaining payment to FIRM, on behalf of INSURED; (ii) make payment of any pre-judgment interest owed under Florida law, including §627.70131(5)(a), which is accruing daily; (iii) make payment for the additional expense incurred by the insured in hiring an attorney; and (iv) implement appropriate standards and procedures for claims investigations and resolution in regard to the outstanding amount of this Claim. The aforementioned payments should be tendered to the insured’s attorneys at Green Law Group, 8833 Perimeter Park Blvd., Suite 104, Jacksonville, Florida 32216.
Comments
User Id Date Added Comment
dmontgomery@kelleykronenberg.com 12-04-2024 Dear Mr. Green: Please accept this correspondence as State Farm Florida Insurance Company’s (“State Farm”) response to the Civil Remedy Notice 786498. At the outset, State Farm denies any of its actions taken with regard to the Insureds’ claim has resulted in a violation of Florida’s bad faith laws, including Fla. Stat. 624.155 and Fla. Stat. 626.9541, as alleged in the civil remedy. Rather, State Farm has acted at all times in good faith in its investigation and handling of this claim and with regard to the best interest of the Insured. While State Farm welcomes the opportunity to respond to this civil remedy, and specifically denies each and every allegation contained in the civil remedy referenced above, State Farm requests the civil remedy be rejected as it fails to comply with several of the requirements of the Civil Remedy Notice of Insurer Violation document provisions as set forth in section 624.155, Florida Statutes and Florida case law. Under Florida law, a first-party bad faith action is not recognized at common law. Baxter v. Royal Indemnity. Co., 285 So. 2d 652 (Fla. 1st DCA 1973). In 1982, the Florida Legislature enacted § 624.155, which created a statutory first-party bad-faith cause of action by an insured against the insurance carrier. See § 624.155, Fla. Stat.; State Farm Mut. Auto. Ins. Co. v. Laforet, 658 So. 2d 55, 59 (Fla. 1995). As a derogation of common law, this statute is strictly construed. Nowak v. Lexington Ins. Co., 464 F. Supp. 2d 1248 (S.D. Fla. 2006); Aetna Cas. & Sur. Co. v. Buck, 594 So. 2d 280, 281 (Fla. 1992) (stating that a person seeking the benefit of a statutorily created remedy had to strictly comply with the requirements of the statute because the remedy is “purely a creature of statute”). The Florida Supreme Court has specifically applied this rule of construction to section 624.155. See Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278, 83-84 (Fla. 2000). As stated by the Florida Supreme Court, the purpose of a Notice is to put the insurer on notice of an alleged violation, the circumstances surrounding same, and indicate the details of the alleged violation in order to provide an insurer with 60 days to "cure" the alleged claim defects. See Talat, 753 So. 2d at 1283-84. The purpose of Fla. Stat. Section §624.155 is to provide the insurer with an opportunity to resolve a first-party coverage dispute and otherwise avoid litigation. Id. The statute requires this notice to: [S]tate with specificity the following information . . . (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 such violation[;] (3) the name of any individual involved in the violation[;] (4) reference the specific policy language that is relevant to the violation, if any . . . [;] (5) a statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. Fla. Stat. § 624.155(3)(a). This statute has been interpreted to require that the Notice must be sufficiently specific to provide the insurer with an opportunity to cure the alleged violations. This would include i) identifying the specific policy provision(s) at issue, ii) citing the specific language of the statutory provision(s) the insurer allegedly violated, and iii) specifically identifying what actions the insurer must take to remedy the alleged violations. Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059 (S.D. Fla. August 13, 2010); Heritage Corp. of S. Fla. v. Nat’l Union Fire Ins. Co. of Pittsburg, PA, 580 F. Supp. 2nd 1294, 1299-1300 (S.D. Fla. 2008). In addition, providing vague reference to the policy is insufficient to put the insurer on notice of its alleged policy violation. See Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875, 879 (Fla. 4th DCA 2021). In contravention of these requirements, the subject Notice is vague and lacks fundamental information to allow State Farm to respond. Specifically, the civil remedy contains "cures" that are improper pursuant to Florida case law. Talat provides the scope of what can be "cured" is limited to the alleged non-payment of the contractual amounts due to an insured holding "the contractual amount due the insured is the amount owed pursuant to the express terms and conditions of the policy after all of the conditions precedent of the insurance policy in respect to payment are fulfilled..." Here, the Insured demands State Farm: 1) Tender full remaining payment to FIRM; 2) Pay any prejudgment interest 3) Make payment for any additional expense incurred by Insured in hiring an attorney 4) Implement appropriate standards and procedures for claims investigations and resolution in regarding to the outstanding amount of this claim. This is squarely what the Supreme Court of Florida rejected in Talat. 753 So.2d at 1284. According to Talat, the only amount properly sought within the remedy is the contractual amount due. Id. at 1283. “If the insurer may avoid a bad faith action only by paying in advance every penny of the damages that it faces if it loses at trial, the insurer would have no reason to pay.” Id. Second, the civil remedy is insufficient on its face and should be rejected since, contrary to the requirements of section 624.155, Florida Statutes, the civil remedy does not specifically describe the facts or circumstances giving rise to each specific violation alleged against State Farm, nor a specific manner to cure each allegation. The civil remedy makes generalized, unsupported, and incorrect statements without specifically identifying the facts that give rise to each allegation pursuant to the cited statutory provisions. The notice filed in this matter also includes alleges 11 statutory codes and references no specific policy provision. However, there are no specific allegations as to the conduct giving rise to the allegation or the policy provision, nor does Insured provide any specific nexus between facts and law to show a violation of any provision. See Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059 (S.D. Fla. August 13, 2010) ("[t]hese uninformative recitations do not meet the requirements of § 624.155 because they do not specifically inform the insurer of the facts underlying the alleged violations or the corrective action that the insurer needed to take to remedy the alleged violations.”)). Notwithstanding the above-mentioned civil remedy notice deficiencies, the following are State Farm's responses to each of the alleged violations noted in the civil remedy notice: 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 towards its insured and with due regard for his or her interests. Response: Denied. There are no facts, nor specific allegations, demonstrating how State Farm failed to operate in good faith. State Farm conducted a complete, thorough, and timely investigation of the loss including inspection of the property, and determined a portion of the loss was not covered and the covered portion of the loss fell below the policy deductible, which was conveyed via the coverage determination letter. Therefore, no violations of §624.155(1)(b)(1) have occurred. 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. Response: Denied. This section is facially invalid as it is contradicted by the facts of the claim as coverage was only sought under one provision of the policy. Additionally, Insured provides no specific allegation as to how this provision was violated. There is no facts supporting the allegation that State Farm utilized one policy coverage to influence the other. Lastly, a coverage decision was issued within 60 days of the report of loss. Fla. Stat. 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. Response: Denied. There are no specific allegations regarding State Farm’s lack of proper standards regarding claims investigation. On the contrary, State Farm has adopted all proper and best practices and standard operating procedures for claims handling with regard to §Fla. Stat. 626.9541(1)(i)(3)(a). State Farm conducted a complete, thorough, and timely investigation. Therefore, no violations of §Fla. Stat. 626.9541(1)(i)(3)(a) have occurred. Fla. Stat. 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims. Response: Denied. There are no specific allegations regarding State Farm’s lack of proper standards regarding claims investigation. On the contrary, State Farm has adopted all proper and best practices and standard operating procedures for claims handling with regard to §Fla. Stat. 626.9541(1)(i)(3)(a). State Farm conducted a complete, thorough, and timely investigation. Therefore, no violations of §Fla. Stat. 626.9541(1)(i)(3)(a) have occurred. Fla. Stat. 626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. Response: Denied. There is no specific allegation regarding policy misrepresentation. An allegation of misrepresentation requires specificity and the only allegation speculates that State Farm generally uses “deceptive practices” with no specific allegation to this claim. Such allegations are conclusory and presumptive as there is no support for such conclusion. Fla. Stat. 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims. Response: Denied. There is no specific allegation regarding State Farm’s failure to act promptly. There is no specific time line or basis to explain or assert how State Farm failed to act promptly. The allegations are generalized conclusions that State Farm wrongfully denied portions of the claim and is withholding payment. These are deficient allegations. The facts reflect the contrary as the claim was reported on August 1, 2024 and an claim decision was issued on or about September 19, 2024. Fla. Stat. 626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information. Response: Denied. The is a conclusory and generalized allegation with no factual support specific to this claim. Stating that a party did not conduct a reasonable investigation is insufficient without a factual basis as to how the investigation was unreasonable. Insured asserts generalized practice, but provides no basis to support this allegation. Fla. Stat. 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. Response: Denied. This allegation is facially deficient as it provides no specific information on how State Farm failed to explain the coverage decision. On the contrary, the conclusory allegations are that State Farm was wrong on the claim decision, but there is no basis specific to a failure to communicate coverages, denials or the need for further investigation. Fla. Stat. 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. Response: Denied. This allegation has no specificity and is unsupported by the facts. After State Farm conducted an inspection and completed its investigation, a decision letter was issued setting forth the policy provisions relied upon for finding the covered portion of the claim was for a value less than the deductible. Fla. Stat. 626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim. Response: Denied. This allegation has no specificity and is unsupported by the facts. After State Farm conducted an inspection and completed its investigation, a decision letter was issued setting forth the policy provisions relied upon for finding a portion of the loss was not covered and the covered portion of the loss fell below the policy deductible. Fla. Stat. 626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. Response: Denied. There is no factual support or specific allegations regarding this violation. On the contrary, Insured claims the decision was wrong and provides no basis for which to allege that information was not provided to the Insured and why information was required from the Insured. State Farm adamantly denies each and every allegation set forth in the civil remedy of insurer violation. The Insured also fails to state any factual basis for bad faith. A review of the civil remedy narrative fails to set forth any specific acts of misconduct or otherwise advise State Farm of specific facts underlying the alleged insurer violations. The facts reveal that State Farm promptly and properly investigated the Insured’s claim. Additionally, the civil remedy is insufficient on its face and should be rejected since, contrary to the requirements of Section 624.155 of Florida Statutes, the civil remedy does not specifically describe the facts or circumstances giving rise to each specific violation alleged against State Farm. Further, the civil remedy misrepresents the facts and mischaracterizes the actions of State Farm regarding the claims asserted by the Insured. The civil remedy makes generalized, unsupported, conclusory and incorrect statements without specifically identifying the facts that give rise to each of the allegations pursuant to the cited statutory provisions. Notwithstanding the deficiencies, State Farm denies that it acted in any manner that would have violated the statutes cited, or any other statutory provisions, and it asserts this is another reason why the civil remedy should be rejected. As can be seen from the facts of this claim, the allegations in the civil remedy are baseless and wholly without merit. Thus, the civil remedy is purposely drafted in a manner which does not allow State Farm proper notice of the allegations or any meaningful opportunity to respond and/or evaluate the claims being asserted. Based on the foregoing, the civil remedy is insufficient on its face and should be rejected. Talat Enterprises Inc. vs. Aetna Cas. & Sur. Co., 753 So. 2d 1278 (Fla. 2000); Lane v. Westfield Ins. Company, 862 So. 2d 744 (Fla. 5th DCA 2003). In closing, State Farm’s actions in handling the Insured’s claim were prompt, thorough, conducted in accordance with the Policy and Florida law and most importantly, in good faith. Furthermore, State Farm complied with all obligations under the Policy and the Florida Statutes. Therefore, State Farm denies each and every allegation contained in the Notice. State Farm first requests the civil remedy be rejected due to its failure to comply with section 624.155, Florida Statutes and Florida case law. Regardless of the rejection, as demonstrated above, State Farm has, at all times, acted in good faith, with due diligence, and in accordance with the terms of its insurance policy and Florida Statutes with respect to the requests made by the Insured, and her representatives. State Farm respectfully disagrees with all of the assertions made and expressly denies all allegations contained in the civil remedy. We trust this response adequately addresses the allegations of violation alleged in the civil remedy. In addition, you will find a copy of the response submitted to the Florida Department of Financial Services on its website. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned.
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