Civil Remedy Notice of Insurer Violations
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Filing Number:     786691
Filing Accepted:  10/14/2024
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Complainant
Last/Business Name *  
GUNDERSEN   First Name   ERIC
Street Address * 927 NE 17 TERRACE
City, State Zip * CAPE CORAL, FL 33909
Email Address * N/A
Complainant Type: * Insured
Insured
Last/Business Name*   GUNDERSEN   First Name   ERIC
Policy # * PFL380850-03 Claim #* CFL22584529
Attorney
Attorney is Applicable
Last Name* FRASER First Name * WARREN Initial
Street Address* 16375 NE 18TH AVE
City, State Zip* MIAMI , FL 33162
Email Address * ZWMFRASER@LRLC.LEGAL
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   PEOPLE'S TRUST INSURANCE COMPANY
NAIC Company Code 13125
 
Name of individual responsible for violation (if any):* ALAYSIA FISHER
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
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)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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.
624.401(1) No person shall act as an insurer, and no insurer or its agents, attorneys, subscribers, or representatives shall directly or indirectly transact insurance, in this state except as authorized by a subsisting certificate of authority issued to the insurer by the office, except as to such transactions as are expressly otherwise provided for in this code.
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)(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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

D. Loss Settlement; the entire provision including but not limited to; "Covered losses will be settled as follows" 1.-2. J. "Our option" the entire provision including but not limited to; provisions 1 through 9 K. "Loss payment", the entire provision
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Dear Florida Department of Financial Services, Pursuant to Florida Statutes §624.155, this Civil Remedy Notice (CRN) is being submitted by the Litigation and Recovery Law Center, as legal representatives for and on behalf of our client, Eric Gunderson, regarding the improper handling of his claim under his policy with Peoples Trust Insurance Company. This notice is addressed to the Florida Department of Financial Services as the receiver for Peoples Trust Insurance Company. Description of the Facts: 1. **Claim Overview:** Following Hurricane Ian, Mr. Gunderson submitted a claim under his insurance policy for damages sustained to his property. Peoples Trust Insurance Company acknowledged coverage and committed to making necessary repairs through a managed repair program. 2. **Communication of Coverage:** Shortly after the hurricane, the company sent a letter admitting coverage and indicating an intention to proceed with repairs, per the MRP policy program rather than issuing an indemnity payment. 3. **Violation of policy commitment** Instead of fulfilling its obligations, Peoples Trust Insurance Company sent two small checks accompanied by a cover letter stating that cashing these checks would constitute full and final payment for the claim. This action was misleading and failed to facilitate the proper indemnity process. 4. **Concealment of Rights:** The letter included language that would have denied Mr. Gunderson the right to negotiate, supplement, or dispute the payment if he were to cash the checks. This practice is deceptive and violates the provisions of the policy and the ethical responsibilities of insurance carriers. **Violations:** The actions of Peoples Trust Insurance Company constitute bad faith practices and a failure to comply with the policy provisions. Specifically: - Failure to indemnify the insured as stipulated in the insurance policy or to promptly perform the MRP as the carrier originally committed to doing. Simply put, the insured was placed, by the actions of his carrier , in a deceived and damaged state with no ability to fully recover. The carrier, by plotting to deceive the insured into "cashing" his undisputed checks, (checks he was clearly already due and owed under the subject policy, and in fact, significantly under valued his loss) would have led him to possibly waive any further policy rights. By doing so, the carrier improperly attempting to force "settle" the claim through the issuance of the undisputed checks without proper consideration or negotiation, engaged in deceptive practices that would have led the insured into waiving his rights unintentionally by simply assuming the checks were part of the undisputed payments considering the carrier was already violating the previous commitment to officiate the repairs (the carrier committed to officiating repairs on or about November 29, 2022 and failed to do so for four months on or about February 2, 2023 and six month before finally issuing the undisputed. In addition, there are multiple ongoing volitions of civil procedures and/or ethical requirements and/or improperly attempting to contact the insured or provide him with adjusting advise by an unlicensed adjuster (the project manager for RRT the carriers assigned contractor ) The excepted resolution is for the carrier to fully comply with all policy and statutory provisions and to pay any/and all payments due and owed under the above.
Comments
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bfrankel@gmail.com 12-09-2024 This correspondence is in response to Civil Remedy Notice of Insurer Violations #786691 (hereinafter referred to as the “CRN”) filed on behalf of Eric Gundersen (hereinafter “Claimant”). The Department of Financial Services assigned an accepted date of October 14, 2024, for the CRN. This matter concerns a claim for reported roof and interior damage pursuant to a homeowners insurance policy provided by People’s Trust Policy No.: PFL380850-03. People’s Trust Insurance Company (hereinafter “PTI”) welcomes this opportunity to respond to these very general allegations, and to comply with its statutory obligations, PTI responds by denying each and every allegation of misconduct asserted in the CRN, whether expressed and or implied, and by categorically denying each and every alleged statutory violation.?? PTI further maintains that the CRN, as filed, is defective on its face as it fails to meet the specificity requirements of Florida Statute 624.155. PTI does not consider there to have been any manner of violation and questions the validity of the CRN as it fails to meet the requirements set forth in Section 624.155, Florida Statutes and Florida law and thus fails to perfect the Claimant’s right to pursue civil remedies under Florida Statutes. Furthermore, the Notice does not accurately reflect the development of the claim as presented. The potential statutory violations and facts provided are nothing more than unsupported, baseless allegations. There are no facts or circumstances to support any kind of mishandling of this matter by PTI. As indicated below, the subject property was dutifully inspected, and the proper coverage determination was made for the claim based on the clear meaning of the subject policy. These requirements arise from the following provisions of Section 624.155: (3)(a) As a condition precedent to bringing an action under this section, the department and the authorized insurer must have been given 60 days' written notice of the violation. If the department returns a notice for lack of specificity, the 60-day time period shall not begin until a proper notice is filed. (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 (emphasis added): 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, he 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. 5. A statement that the notice is given to perfect the right to pursue the civil remedy authorized by this section. In interpreting this statute, courts have emphasized the importance of filing specific civil remedy notices. The civil remedy notice is “crucial to the procedural integrity of an action” under the Statute. Allstate Ins. Co. v. Clohessy, 32 F.Supp.2d 1328, 1333 (M.D. Fla. 1998). “It is, without a doubt, a condition that must be satisfied in order for one to perfect the right to sue under the statute.” Id. “In creating this statutory remedy for bad-faith actions, the Legislature provided this sixty-day window as a last opportunity for insurers to comply with their claim-handling obligations when a good-faith decision by the insurer would indicate that contractual benefits are owed.” Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So.2d 1284 (Fla. 2000). Thus, the CRN cannot be “vague and ‘shotgun’ in nature,” rather than “the type of specific notice required by the statute that would allow [the insurer] an opportunity to cure.” Heritage Corp. of South Florida v. National Union Fire Ins. Co. of Pittsburgh, PA, 580 F. Supp. 2d 1294, 1299 (S.D. Fla. 2008). Because it is in derogation of the common law, Section 624.155(1)(b), Florida Statutes must be strictly construed. Talat, 753 So.2d at 1283 (citing Baxter v. Royal Indem. Co., 285 So.2d 652 (Fla. 1st DCA 1973). To perfect the right to sue under the statute, the Insured must specifically notify the insurer of any and all alleged violations claimed. Talat Enterprises, Inc. v. Aetna Casualty & Surety Co., 952 F.Supp. 773, 776 (M.D. Fla. 1996) (“Talat I”). In Valenti, the District Court for the Middle District of Florida considered the practical consequences of an Insured’s non-specific civil remedy notice. Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006). The Plaintiff’s civil remedy notice included allegations that the defendant conducted an inadequate investigation. The Plaintiff, however, failed to identify with the requisite specificity the defendant’s actions that were inadequate. The Middle District held that the Plaintiff’s civil remedy notice was insufficient, and stated the following: [T]he civil remedy notice must be specific enough to provide insurers notice of the wrongdoing so the insurer can cure the same within sixty days. … Plaintiff’s counsel, during the hearing in this matter, argued a civil remedy notice that states “you denied my claim” should be sufficient to place the insurer on notice of what was needed to be cured. Plaintiff’s counsel further argued that it was up to the insurer, as the insurance expert, to decipher what actions needed to be cured. This argument, in this Court's estimation, is illogical and is counter to the purpose of the civil remedy notice. If a simple “you denied my claim” was sufficient to put insurers on notice, the sixty-day cure period would be little more than a guessing game with the insurer attempting to correctly guess what errors the Insured claimed it made in the claims handling process, or risk defending a bad faith action. This surely is not what the legislature had in mind when it created the civil remedy notice. Accordingly, this Court finds that Plaintiff’s allegation that Defendant failed to conduct an adequate investigation is insufficient to provide Defendant an opportunity to cure. Id. at *2. The guidance for an Insured could not be clearer. “The purpose of the civil remedy notice is to give the insurer one last chance to settle a claim with its Insured and avoid unnecessary bad faith litigation.” Lane v. Westfield Insurance Co., 862 So.2d 774, 779 (Fla. 5th DCA 2004). Its purpose is not “to give the Insured a right of action to proceed against the insurer even after the Insured’s claim has been paid or resolved.” Id. Ultimately, conclusory allegations without facts fail to perfect a statutory bad faith claim. Merely alleging the bare minimum allegations is insufficient pursuant to Florida courts’ interpretations of Section 624.155, Florida Statutes. There are at least eight requirements for a valid civil remedy notice. Pursuant to Section 624.155(3)(c)’s requirement that a civil remedy notice must set forth the “facts and circumstances giving rise to the violation,” a valid civil remedy notice must contain the following: 1. “explain how the [insurer] violated [the statutes],” Heritage Corp., 580 F.Supp. 2d at 1299; 2. “explain the amounts of damage at issue caused by the [insurer’s] alleged statutory violations,” rather than caused by the loss itself, Id.; 3. Provide the facts showing “knowledge and/or delay on the insurance company’s part,” 316, Inc. v. Maryland Cas. Co., 625 F. Supp. 2d 1187, 1192 (N.D. Fla. 2008). 4. provide the facts supporting the specific contractual damages allegedly owed rather than merely the policy limits, Id. at 1193; 5. if an inadequate investigation is alleged, the civil remedy notice must be specific enough to allow the insurer to conduct an additional investigation, Nowak v. Lexington Ins. Co., 464 F.Supp.2d 1248, 1252 (S.D. Fla. 2006). Additionally, subsections (3)(a)1., 3. and 4. require: 6. “the statutory provision, including the specific language of the statute, which the authorized insurer allegedly violated;” 7. “the name of any individual involved in the violation;” and 8. “Reference to specific policy language that is relevant to the violation.” As noted, the first five requirements mandate the Claimant to provide specific facts and circumstances of the alleged violations. This would necessarily include specific facts regarding the method of the investigation; the reasons the investigation was improper or otherwise inadequate; the reasons why this alleged inadequacy is due to the failure to adopt and implement standards for the proper investigation of claims, and the facts supporting these conclusions. To allege an inadequate investigation, the Notice must include specific facts regarding the method, rather than merely the results. Valenti, 2006 WL 1627276, at *1. Florida law does not allow an Insured, without providing any facts, to allege that the insurer’s only option to avoid bad faith is paying whatever the Insured demands. 316, Inc., 625 F.Supp.2d at 1194. Eric Gundersen’s CRN is deficient for several reasons. The CRN fails to include necessary facts that provide context to their statutory allegations aside from broad accusations and conclusions without any factual support. The CRN fails to refer to specific policy language that is relevant to the alleged violations aside from entire provisions. The aggregate of the CRN deficiencies causes the CRN to fall woefully short of providing notice to PTI of any alleged wrongdoing, and these deficiencies deny PTI the ability to cure the alleged wrongdoing within sixty (60) days. Notwithstanding, to comply with statutory obligations, PTI provides the following summary of facts in support of its categorical denial of every alleged statutory violation raised in this CRN. In short, PTI implemented compliant standards for investigating claims—including performing reasonable investigations, accurately representing facts and policy provisions, acknowledging and promptly acting upon communications from and on behalf of its policyholders, promptly advising when additional information is needed and why, and setting forth in writing detailed policy grounds supporting its coverage decisions. PTI implemented those standards as a general practice and fully adhered to them while adjusting this Claim. On September 29, 2022, PTI first received notice of the subject loss for damage reportedly caused by a windstorm on September 28, 2022. PTI quickly began investigating the loss under claim #CFL22584529 (“Claim”) and mailed the Insured information on what to expect during the adjusting process along with a Homeowner Claims Bill of Rights. PTI sent a field adjuster to inspect and document the nature and extent of reported damage that were preserved and made available for inspection on October 11, 20222. On November 29, 2022, PTI sent a written coverage determination letter setting forth the policy language and factual grounds upon which the decision was made. PTI covered the loss and exercised its option to have Rapid Response Team (“RRT”) repair all covered Dwelling or Other Structure damages rather than issue any loss payments to the Insured for them under the terms and conditions of the Policy and its optional Preferred Contractor Endorsement purchased by the Insured in exchange for lower annual premium rates. PTI enclosed a detailed estimate itemizing the scope of covered repairs RRT would perform with the coverage determination letter. PTI asked the Insured for a fully executed Sworn Proof of Loss (“SPOL”), which was attached the coverage letter, and detailed supporting estimate if the Insured disputed the scope of covered repairs RRT would perform as PTI estimated. PTI also attached a blank work authorization for execution if the Insured agreed with PTI’s scope. PTI never received either document requested from the Insured. After not receiving any documentation from the Insured that would allow the repair process to begin, on or about February 2, 2023, PTI extended its initial claim settlement offer as an alternative option to proceeding with managed repairs, for which the insured would have to pay RRT their deductible before covered repairs would commence. The claim settlement offer issued by PTI clearly stated that acceptance of the offer, which included endorsing and depositing the checks, would constitute a full and final settlement of the claim. The letter also advised that if the Insured rejected the offer, or failed to accept it within 30 days, the current status of their claim and PTI’s election to repair would remain in full effect, meaning RRT would still have the exclusive right to perform all covered repairs for your claim and no loss payments would be owed under Coverages A or B; and the Insured must still perform all obligations arising from the claim and PTI’s election to repair. The Insured, on August 30, 2024, by way of their attorney, submitted a signed sworn proof of loss, thus disputing the scope of covered repairs. On September 10, 2024, PTI demanded appraisal pursuant to the Preferred Contractor Endorsement in the Policy to resolve the disagreement over which covered repairs RRT must perform for the Claim. Of note, the Policy’s appraisal provision appears only in the Preferred Contractor Endorsement and, in sum, establishes only the scope of covered repairs RRT must perform for the Claim and initial amount PTI must pay RRT to do so. Those covered repairs are made by RRT in lieu of any loss payments PTI might otherwise owe the Insured under Coverages A or B of the Policy. The parties sent the Claim to appraisal and selected the neutral umpire. At this time, the parties are waiting for an appraisal award to be issued setting forth the scope of covered repairs for RRT to perform. Following the issuance of the appraisal award, the Insured will need to sign the Work Authorization, which authorizes licensed general contractor Rapid Response Team, LLC and/or its subcontractors, on behalf of People's Trust Insurance Company, to enter the property in order to make repairs to the property pursuant to the Policy’s E023 Preferred Contractor Endorsement. The CRN allegations are misplaced. The above timeline of events details how PTI conducted a proper investigation of the claim, timely completed repairs pursuant to the policy and appraisal award, and acted promptly upon all communications. The CRN contains no facts to support its allegations and said allegations are contrary to the facts discussed above. With the above referenced facts established, it is clear the alleged statutory violations are also unsupported. Without any supporting facts other than conclusory statements provided by the Claimant, PTI cannot adequately address the same. In our factual analysis provided in this Response, we provided facts that implicitly address many of the allegations in the CRN. From those facts, it becomes clear that PTI is dealing with the claim pursuant to the professional standards of care. The CRN alleges the following statutory violations by PTI and, because of the bare nature of the allegations and facts provided, we address each as follows: • 624.155(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 toward its Insured and with due regards for her or his interests – PTI denies this alleged statutory violation, and advises that Claimant has not provided any facts to sustain such an allegation. PTI accepted coverage, timely invoked its option to repair. RRT completed the repairs to the property pursuant to the appraisal award to restore the home to pre-loss condition. • 624.155(1)(b)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made; – PTI denies this alleged statutory violation, and advises that Claimant has not provided any facts to sustain such an allegation. PTI accepted coverage and timely invoked its option to repair. The claim settlement offer sent to the Insured on February 3, 2023, contained a statement setting forth the coverage under which payments are being made. • 624.401(1) No person shall act as an insurer, and no insurer or its agents, attorneys, subscribers, or representatives shall directly or indirectly transact insurance, in this state except as authorized by a subsisting certificate of authority issued to the insurer by the office, except as to such transactions as are expressly otherwise provided for in this code – Claimant has not provided any facts to sustain such an allegation and PTI denies any and all allegations contained within. • 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. Claimants have not provided any facts to sustain such an allegation. PTI accepted coverage and timely invoked its option to repair. After the Insured’s non-compliance with PTI’s election to repair, PTI extended its initial claim settlement offer as an alternative option to proceeding with managed repairs. • 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims – PTI denies this alleged statutory violation, and advises that Claimant has not provided any facts to sustain such an allegation. PTI advises that this allegation requires specific facts regarding the method of the investigation; the reasons the investigation was improper or otherwise inadequate; the reasons why this alleged inadequacy is due to the failure to adopt and implement standards for the proper investigation of claims, and the facts supporting these conclusions. To allege an inadequate investigation, the Notice must include specific facts regarding the method, rather than merely the results. Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006). • 626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. Claimant has not provided any facts to sustain such an allegation. PTI accepted coverage and timely invoked its option to repair. After the Insured’s non-compliance with PTI’s election to repair, PTI extended its initial claim settlement offer as an alternative option to proceeding with managed repairs. Following the presentation of a scope dispute via a sworn proof of loss, PTI demanded appraisal, which is where the claim is currently at. • 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims; Claimant has not provided any facts to sustain such an allegation. • 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; Claimant has not provided any facts to sustain such an allegation. PTI accepted coverage and timely invoked its option to repair. After the Insured’s non-compliance with PTI’s election to repair, PTI extended its initial claim settlement offer as an alternative option to proceeding with managed repairs. Following the presentation of a scope dispute via a sworn proof of loss, PTI demanded appraisal, which is where the claim is currently at. PTI specifically denies any and all allegations contained within the CRN including, but not limited to, those allegations contained within “Reason for Notice” including any claim for bad faith. PTI made its coverage determination after a thorough investigation of the loss. There are no additional benefits due or owing at this time. The Claimant has not produced any evidence to substantiate the aforementioned allegations. Furthermore, the bare nature of the CRN does not allow for a more specific response to the alleged violations. PTI will provide a further response and consider the same if and when any additional information is provided relative to any alleged violation. PTI continues to reserve all of its rights. We trust this fully and adequately responds to any inquiry regarding the instant claim. If you have any questions or require further clarification with regard to the above, please do not hesitate to contact us. Very truly yours, /S/ Andres Zornosa Andres Zornosa, Esq. People’s Trust Insurance Company
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