Civil Remedy Notice of Insurer Violations
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Filing Number:     786609
Filing Accepted:  10/13/2024
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Complainant
Last/Business Name *  
SUSAN HARRINGTON   First Name   WENDY DELANEY AND
Street Address * 6925 NOWIKI AVE
City, State Zip * HUDSON, FL 34667
Email Address * N/A
Complainant Type: * Insured
Insured
Last/Business Name*   SUSAN HARRINGTON   First Name   WENDY DELANEY AND
Policy # * 80G561335 Claim #* 59-53P8-57B
Attorney
Attorney is Applicable
Last Name* ELIMELECH First Name * REBECCA Initial R
Street Address* 1500 N.E. 162ND ST.
City, State Zip* MIAMI , FLORIDA 33162
Email Address * RELIMELECH@ILGPA.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):* N/A
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
* 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)(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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Unable to specify language in the policy that is relevant to the violation, as State Farm Florida Insurance Company has refused to provide a certified copy of the policy, in violation of 627.421(1) (A paper copy of the policy shall be provided to the insured or to the person entitled to delivery at his or her request.)
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Wendy Delaney and Susan Harrington (hereinafter the “Insureds”), paid for a policy of insurance with State Farm Florida Insurance Company (hereinafter, “Insurer”) bearing policy number 80G561335 (the “Policy”). The Policy provides coverage for damage to the Insureds’ property located at 6925 Nowiki Ave, Hudson, FL 34667 (the “Property”), including the significant damage that occurred as a result of a sudden and accidental water leak from a broken pipe on or about July 11, 2023 (the “loss”). Specifically, the Insureds’ Property sustained substantial damage to the kitchen cabinets, countertops and floors in the kitchen, dining room and living area, in addition to the garage ceiling and walls due to a water leak in the kitchen. The Insureds promptly reported their claim to the Insurer. On August 29, 2023, the Insurer issued a letter to the Insureds denying the claim based on the continuous and repeated moisture exposure policy exclusion. In this letter, the Insurer advises that based on their inspection on August 16, 2023, they determined that the damage was caused by a plumbing leak over an unknown period of time and that the damages were not indicative of accidental direct physical loss but are indicative of damage from continuous and repeated moisture exposure resulting in discoloration, deterioration, and mold. The Insureds subsequently contacted Israel Veitman P.A., who conducted a thorough inspection of the property and compiled an estimate of damages. Israel Veitman P.A., on behalf of the Insureds, forwarded said estimate which fully detailed the Insureds’ damages and total $73,983.13. However, the Insurer refuses to resolve the Insureds’ claim and pay for all damages to the Property. On January 24, 2024, in response to the Notice of Intent to Litigate, the Insurer sent a letter informing the Insureds that they are standing by their denial of the claim. The Insurer’s conduct is in bad faith and violates Florida’s statutes concerning the adjustment of insurance claims. First, Florida Statute § 624.155(1)(B)(1) requires good faith in the settlement of claims. The Insurer is in violation of this Statute for failing to provide coverage for the Insureds’ loss. The Insurer has acted in bad faith by wrongfully denying the claim, despite there being evidence of a covered loss. What is more, the Insurer violated Florida Statute § 624.155(1)(b)(3) by failing to promptly settle the claim, when the obligation to settle the claim became reasonably clear. Again, the Insurer failed to make a good faith offer to settle this claim and failed to account for the full scope of the damages. They failed to respond to the estimate provided by Israel Veitman P.A., on the Insureds’ behalf, in a timely manner. They are obligated to provide coverage for all damages to the Insureds’ Property, and not attempt to resolve this claim with lowball offers. Additionally, the Insurer’s conduct violates Florida Statute § 626.9541, which prohibits unfair settlement practices. More specifically, the Insurer has violated Florida Statute § 626.9541(1)(i)(3)(a) by failing to adopt and implement standards for the proper investigation of claims. Further, the Insurer has violated Florida Statute § 626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly with the Insureds and its counsel. The Insurer failed to comply with the Insureds’ request for a certified copy of their policy in violation of Florida Statute § 627.421(1), providing that “[a] paper copy of the policy shall be provided to the insured or to the person entitled to delivery at his or her request.” Moreover, as mentioned above, the Insurer failed to account for the full scope of the damages and has additionally failed to respond to the estimate provided by Israel Veitman P.A., on behalf of the Insureds, in a timely manner, delaying the resolution of this claim. Had the Insurer done so, it would have immediately settled this claim on a fair and reasonable basis and provided full coverage to its Insureds. Therefore, to cure the defects outlined in this Civil Remedy Notice, the Insurer must: (1) create and implement adequate guidelines for the proper investigation and evaluation of claims and for the training and supervision of employees, which will avoid future statutory violations and avoid this from occurring in the future; (2) immediately tender all insurance proceeds due and owing its Insureds under the Policy in the amount of $73,983.13 (less the deductible and any prior payments), plus all statutory interest; (3) act fairly and honestly towards its Insureds and with due regard for their interests in attempting to settle their Insureds’ claim; (4) hold the claim open in the event that its errors and delay does or may cause the Insureds to suffer either further loss and/or damage; and, (5) stipulate to the Insureds’ entitlement to attorney’s fees and court costs pursuant to Florida Statutes §§ 627.428 and 626.9373. Acknowledgment This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statutes section 624.155, should State Farm Florida Insurance Company fail to cure the violations set forth in this Civil Remedy Notice within the given cure period.
Comments
User Id Date Added Comment
jnovaes@butler.legal 11-25-2024 Re: Complainants: Wendy Delaney and Susan Harrington Insured: Wendy Delaney Claim Number: 59-53P8-57B Policy Number: 80-G5-6133-5 DFS Number: 786609 Dear Sir/Madam: This letter responds on behalf of State Farm Florida Insurance Company (“State Farm”) to the Civil Remedy Notice of Insurer Violation (the “Notice”) filed by attorney Rebecca Elimelech on behalf of Wendy Delaney and Susan Harrington. State Farm welcomes the opportunity to respond to this Notice and specifically denies each and every allegation contained in the Notice. That said, State Farm believes the Notice fails to comply with the specific notice and information requirements as set forth in the Civil Remedy Notice of Insurer Violation document provisions, Florida Statute § 624.155, and Florida case law. State Farm has acted fairly and with due diligence throughout the handling of the insured’s claim. To the extent this reply does not fully address and respond to the allegations set forth by the Notice, such deficiency is the direct result of the lack of specificity and the overall vague nature of the allegations contained therein. First, Florida Statute § 624.155(3)(b) requires that the Notice be on a form provided by the department. The form requires that the Complainant list an email address. Here, the Notice fails to list an Email Address for the Complainant. Second, § 624.155(3)(b)(3) requires: (b) The notice shall be on a form provided by the department and shall state with specificity the following information, and such other information as the department may require: … 3. The name of any individual involved in the violation. In the space provided on the form, the Notice names no one. Instead, it says “N/A.” To be valid, it must “state with specificity. . . [t]he name of any individual involved in the violation.” Therefore, the Notice fails to comply with §624.155(3)(b)(3). Third, § 624.155(3)(b)(4) requires: (b) The notice shall be on a form provided by the department and shall state with specificity the following information, and such other information as the department may require: … 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. The insured is not a third-party claimant. And, State Farm previously provided a copy of the policy to Ms. Delaney. Hence, to be valid, the Notice must “[r]eference [the] specific policy language that is relevant to the violation.” It does not. Thus, it fails to comply with § 624.155(3)(b)(4). Fourth, §624.155(3)(b)(2) requires: (b) The notice shall be on a form provided by the department and shall state with specificity the following information, and such other information as the department may require: … 2. The facts and circumstances giving rise to the violation. The Notice fails to supply the facts and circumstances giving rise to the alleged violations. It does not explain how the scant, supposed “facts,” and, scant, supposed “circumstances,” correspond to the alleged statutory violations. To be valid, the Notice must “state with specificity . . . [t]he facts and circumstances giving rise to the violation.” Thus, it fails to comply with §624.155(3)(b)(2), Florida Statutes. See also, Talat Enter., Inc. v. Aetna Cas. and Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000); Julien v. United Prop. and Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). The deficiencies in the Notice deprive State Farm of a legitimate opportunity to “cure” the purported violations. Fifth, the Notice is invalid because it makes improper demands to cure, which is at odds with the Florida Supreme Court’s ruling in Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Lastly, Complainant does not have standing to file this Notice. For these reasons, State Farm believes the Notice does not comply with § 624.155. State Farm hereby asserts all, and does not waive any, defects in the Notice by filing this response. Despite that the Notice is invalid, State Farm denies the allegations in the civil remedy notice and denies that it has done anything improper. State Farm has, at all times, acted in good faith toward Ms. Delaney. State Farm denies that is violated §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.954(1)(i)(3)(c), 626.9541(1)(i)(3)(d), 626.9541(1)(i)(3)(f), or 627.421(1). State Farm hereby denies each and every allegation in the Notice, either explicitly or implicitly, and denies any wrongdoing in the handling of the subject claim. This matter arises out of a claim for loss and alleged damage that occurred at the insured property on July 11, 2023. The claim was reported to State Farm on July 28, 2023. Following the notice of loss State Farm performed an investigation into the alleged damage purportedly caused by the loss. State Farm inspected the property. Thereafter, State Farm timely issued a coverage determination letter to Ms. Delaney based upon the results of State Farm’s investigation of the claim. Unfortunately, there is no coverage for Ms. Delaney’s claim under the terms of the subject insurance policy. Florida Statute § 624.155(1)(b)(1) State Farm denies any violation of § 624.155(1)(b)(1), which provides: 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 her or his interests. State Farm acted fairly and honestly toward Ms. Delaney at all times. At no time has State Farm acted dishonestly or unfairly toward Ms. Delaney. All of State Farm’s actions have been performed in good faith and for the purpose of moving Ms. Delaney’s claim toward a just and proper determination of coverage under the subject insurance policy. Absolutely no facts or circumstances supporting this allegation have been provided by Ms. Delaney in the Notice. To the contrary, as outlined above, State Farm promptly initiated an investigation into the damages allegedly caused by the loss and advised Ms. Delaney of State Farm’s coverage determination. As a result, there is no evidence that State Farm violated § 624.155(1)(b)(1) that it did not act in good faith to settle Ms. Delaney’s claim or that it did not act fairly and honestly towards the Complainant with due regard for Ms. Delaney’s interests. Florida Statute § 624.155(1)(b)(3) State Farm denies any violation of Fla. Stat. §624.155(1)(b)(3), which provides: 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 conducted a thorough investigation of Ms. Delaney’s claim and promptly made a claim determination. As a result, State Farm has properly adjusted Ms. Delaney’s claim. However, State Farm continues to remain open to consideration of any records, documents, or information to be submitted on behalf of Ms. Delaney contrary to State Farm’s claim determination. To date, Ms. Delaney or her representatives has not submitted any records, documents, or information for State Farm’s consideration, which would affect State Farm’s determination of coverages for this claim. As a result, there is no evidence to substantiate Ms. Delaney’s claim that State Farm has failed to promptly settle her claim, 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. Florida Statute § 626.9541(1)(i)(3)(a) State Farm denies any violation of § 626.9541(1)(i)(3)(a), which provides: Failing to adopt and implement standards for the proper investigation of claims. This allegation is without basis, and the Notice again fails to allege any facts or circumstances whatsoever that would provide any support for this allegation. State Farm has adopted and implemented standards for the proper investigation of insurance claims and has complied with the same at all times during the investigation of Ms. Delaney’s claim. The standards and methods utilized by State Farm in examining its claims have met and exceeded its obligations and industry standards. State Farm has conducted the handling of this claim according to such standards and Ms. Delaney has failed to allege any factual support or evidence to substantiate her allegation that State Farm has failed to adopt and implement standards for the proper investigation of insurance claims. Florida Statute § 626.9541(1)(i)(3)(c) State Farm denies any violation of § 626.9541(1)(i)(3)(c), which provides: Failing to acknowledge and act promptly upon communications with respect to claims. State Farm has at no time acted in violation of the above-referenced statute. Further, there are absolutely no facts or evidence contained in the Notice to substantiate the Complainant’s allegation that State Farm has acted in violation of this section. To the contrary, State Farm has acknowledged and acted promptly upon all communications. There is no evidence to substantiate the Complainant’s claim that State Farm has failed to acknowledge and act promptly upon communications with respect to claims. To the extent the civil remedy notice alleges that State Farm did not respond to certain communications, please allow this letter to respond to any communications the Complainant believes were not adequately responded to by State Farm. Additionally, State Farm denies any violation of § 627.421(1), which states, in pertinent part: “Subject to the insurer’s requirement as to payment of premium, every policy shall be mailed, delivered, or electronically transmitted to the insured or to the person entitled thereto not later than 60 days after the effectuation of coverage.” State Farm has at no time acted in violation of the above-referenced statute. Further, there are absolutely no facts or evidence contained in the Notice to substantiate the Complainant’s allegation that State Farm acted in violation of this section. Rather, State Farm provided Ms. Delaney with a copy of the subject insurance policy in accordance with the terms of the policy and the statute in effect at the time the policy incepted. Florida Statute § 626.9541(1)(i)(3)(d) State Farm denies any violation of § 626.9541(1)(i)(3)(d), which provides: Denying claims without conducting reasonable investigations based upon available information. State Farm has not acted in violation of the above-referenced statute at any time. Further, there are absolutely no facts or evidence contained in the Notice to substantiate Ms. Delaney’s allegation that State Farm has acted in violation of this section. To the contrary, the standards and methods utilized by State Farm in investigating the claims of its policyholders have met and exceeded the requirements of all applicable Florida laws. State Farm has conducted a reasonable investigation of Ms. Delaney’s claim for loss and damages. In this regard, State Farm has properly investigated Ms. Delaney’s claim for loss and damages, and advised her of the status of this investigation. The coverage determination issued by State Farm for Ms. Delaney’s claim was based upon State Farm’s investigation of the loss. Further, State Farm advised Ms. Delaney that any additional documentation to be provided to State Farm her would be considered. Based upon the above, there is no evidence to substantiate Ms. Delaney’s claim that State Farm denied any of the claim without conducting a reasonable investigation based upon available information. Florida Statute § 626.9541(1)(i)(3)(f) State Farm denies any violation of § 626.9541(1)(i)(3)(f), which provides: 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 has not acted in violation of the above-referenced statute at any time. Further, there are absolutely no facts or evidence contained in the Notice to substantiate the allegation that State Farm has acted in violation of this section. To the contrary, State Farm has properly investigated Ms. Delaney’s claim for loss and damages, and advised her of the status of this investigation. The coverage determination issued by State Farm for Ms. Delaney’s claim was based upon State Farm’s investigation of the loss. Further, State Farm advised Ms. Delaney that any additional documentation to be provided to State Farm her would be considered. Based upon the above, there is no evidence to substantiate the Complainant’s claim that State Farm failed to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy for the denial of the claim. Claim Denial State Farm properly investigated Ms. Delaney’s claim for loss and damages. This allegation is without basis, and the Notice again fails to allege any facts or circumstances whatsoever that would provide any support for this allegation. State Farm has adopted and implemented standards for the proper investigation of insurance claims and has complied with the same at all times during the investigation of Ms. Delaney’s claim. The standards and methods utilized by State Farm in examining its claims have met and exceeded its obligations and industry standards. State Farm has conducted the handling of this claim according to such standards and the Notice fails to allege any factual support or evidence to substantiate this allegation. Claim Delay State Farm denies that it has caused a “claim delay.” This allegation is without basis, and the Notice again fails to allege any facts or circumstances whatsoever that would provide any support for this allegation. State Farm has adopted and implemented standards for the proper investigation of insurance claims and has complied with the same at all times during the investigation of Ms. Delaney’s claim. The standards and methods utilized by State Farm in examining its claims have met and exceeded its obligations and industry standards. State Farm has conducted the handling of this claim according to such standards and the Complainant has failed to allege any factual support or evidence to substantiate her allegation that State Farm has caused a “claim delay.” Unsatisfactory Settlement Offer State Farm has acted fairly and honestly towards Ms. Delaney at all times. At no time has State Farm acted dishonestly or unfairly towards Ms. Delaney. All of State Farm’s actions have been performed in good faith and for the purpose of moving her claim toward a just and proper determination of coverage under the subject policy of insurance. To that end, State Farm was unable to extend coverage for the subject claim under the terms of the insurance policy and did not make a settlement offer. Absolutely no facts or circumstances supporting this allegation have been provided in the Notice. To the contrary, as outlined above, State Farm promptly initiated an investigation into the damages allegedly caused by the loss and advised Ms. Delaney of State Farm’s coverage determination. As a result, there is no evidence that State Farm made an unsatisfactory settlement offer. Unfair Trade Practice State Farm denies that it has an “unfair trade practice.” This allegation is without basis, and the Notice again fails to allege any facts or circumstances whatsoever that would provide any support for this allegation. State Farm has adopted and implemented standards for the proper investigation of insurance claims and has complied with the same at all times during the investigation of Ms. Delaney’s claim. The standards and methods utilized by State Farm in examining its claims have met and exceeded its obligations and industry standards. State Farm has conducted the handling of this claim according to such standards and the Notice has failed to allege any factual support or evidence to substantiate the allegation that State Farm has an “unfair trade practice.” State Farm has acted fairly and with due diligence throughout the handling of Ms. Delaney’s claim. State Farm has properly determined that there was no coverage under Ms. Delaney’s policy for the loss, which was done in good faith and strictly in accordance with the terms, conditions, exceptions, exclusions, endorsements and limitations of Ms. Delaney’s policy and Florida law. To the extent that this reply does not fully address and respond to the allegations set forth by the Notice, such deficiency is the direct result of the lack of specificity and the overall vague nature of the allegations contained therein. Nevertheless, State Farm disputes all facts alleged in the Notice, denies all allegations in the Notice, and relies upon the facts cited above and throughout its response to the Notice and in opposition to the same. Additionally, State Farm asserts that all actions it has taken in response to Ms. Delaney’s claim have been done entirely in good faith and for the purpose of fair, just and timely disposition of the same. This letter or any act or failure to act on the part of State Farm or any agent or representative of State Farm should not be construed as a waiver of any rights or defenses, including but not limited to proper Notice and service, available to State Farm by contract or at law as all such rights and defenses are specifically reserved. Please contact us if you have any questions.
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