Civil Remedy Notice of Insurer Violations
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Filing Number:     786910
Filing Accepted:  10/15/2024
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Complainant
Last/Business Name *  
ALMANZA   First Name   MELINDA
Street Address * 2219 LAKE HOLLOWAY BOULEVARD
City, State Zip * LAKELAND, FL 33801
Email Address * MAJ@WEKLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   ALMANZA   First Name   MELINDA
Policy # * 0760701722 Claim #* 7007373753­1
Attorney
Attorney is Applicable
Last Name* JORDAN First Name * MATTHEW Initial A
Street Address* 708 E COLONIAL DR, 103
City, State Zip* ORLANDO , FLORIDA 32803
Email Address * MAJ@WEKLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   TRUCK INSURANCE EXCHANGE
NAIC Company Code 21709
 
Name of individual responsible for violation (if any):* N/A
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unsatisfactory Settlement Offer
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The policy as a whole applies, including, but not limited to Section 1 – Perils Insured Against; Section 1 – Exclusions; Section 1 – Conditions and the endorsements thereto.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Truck Insurance Exchange (Insurer) acted in bad faith in its dealings with Melinda Almanza and Ivan Almanza (Insureds) regarding a direct physical loss (Loss) at 2219 Lake Holloway Boulevard, Lakeland, FL 33801 Property) violating Fla. Stat. § 624.155. Fla. Stat. § 624.155 provides a cause of action for bad faith in first-party claims. Fridman v. Safeco Ins. Co., 185 So. 3d 1214, 1220 (Fla. 2016). These first-party claims are treated the same as third-party claims. Id. at 1221. The question of whether an insurer acted in bad faith is determined by the “totality of the circumstances” standard. Berges v. Infinity Ins. Co., 896 So. 2d 665, 680 (Fla. 2004). This inquiry focuses on the actions of the insurer. Id. at 677. The insurer has a duty to use the degree of care and diligence as a person of ordinary care. Bos. Old Colony Ins. Co. v. Gutierrez, 386 So. 2d 783, 785 (Fla. 1980). The insurer must investigate the facts, give fair consideration to all settlement offers, and settle when a reasonable prudent person would. Id. Additionally, an insurer must not act solely in their own interest in settlement. State Farm Mut. Auto Ins. Co. v. LaForet, 658 So.2d 55, 58 (Fla. 1995). Furthermore, the insurer has the burden to show that there was no realistic possibility of settlement. Powell v. Prudential Prop. & Cas. Ins. Co., 584 So. 2d 12, 14 (Fla. 3d DCA 1991). Insurer acted in bad faith under Fla. Stat. § 624.155(1)(b)(1) in their dealings with Insured by failing to attempt to fairly settle Insured’s claims when it could and should have done so had it acted fairly and honestly towards insured. Here, Insurer acted in bad faith for failing to reasonably settle insured’s claim. Insurer underpaid Insured’s claim for obvious damage caused by a covered peril. Insurers investigation is clearly deficient. Pursuant to Fla. Stat. § 626.9541(1)(i)(3)(a), an insurer must adopt and implement standards for the proper investigation of claims. Additionally, pursuant to Fla. Stat. § 626.9541(1)(i)(3)(d), an insurer acts in bad faith if it denies or underpays a claim without conducting a reasonable investigation based upon available information. Here, the facts of this loss investigation indicate that Insurer does not have adequate standards for the proper investigation of claims and Insurer did not conduct a reasonable investigation before underpaying Insured’s claim. Insurer sent Adjuster to investigate the claim. Adjuster conducted a cursory investigation failing to take into account clear evidence of damage caused by the Loss. (Hurricane Ian) As exhibited above, Insurer has acted in bad faith in its dealings with Insured by failing to adopt and implement standards for the proper investigation of claims in violation of Fla. Stat. § 626.9541(1)(i)(3)(a) and Fla. Stat. § 626.9541(1)(i)(3)(d). This bad faith failure to investigate is part of a pattern and practice implemented by Insurer against Insured to delay and leverage settlement. Ultimately, Insurer’s claim investigation procedure, as referenced above, serves no purpose other than to increase Insurer’s profits. In order to remedy the above referenced violation Insurer must promptly fairly and honestly assess or reassess the Loss so that it may engage in good faith settlement negotiations with Insured and Insured’s representatives.
Comments
User Id Date Added Comment
sadavis@bankerlopez.com 10-29-2024 Madison W. Breder, Esq. Direct Dial: 813-769-7978 Email: mbreder@bankerlopez.com October 29, 2024 Via E-Mail and Certified Mail Matthew A Jordan, Esq. maj@weklaw.com 708 E Colonial Dr, 103 Orlando, Florida 32803 RE: Melinda Almanza Our Client: Truck Insurance Exchange Policy: 0760701722 Claim No.: 7007373753-1 Dear Attorney Jordan: This correspondence is Truck Insurance Exchange’s (“TIE”), response to the Civil Remedy Notice of Insurer Violation (“Notice”) filed on behalf of Complainant, Melinda Almanza, regarding CRN No. 786910 filed on October 15, 2024. Complainant alleges that TIE violated various subsections within Sections 624.155 and 626.9541, Florida Statutes, pertaining to Claim No. 7007373753-1 under an insurance policy TIE issued to Complainant. On the merits, TIE avers it handled Complainants’ claim correctly, fairly, in good faith and with due regard for their interests under Complainant’s policy. On March 28, 2024, TIE received notice of the subject claim, damage to the Complainant’s roof and interior water damage as a result of Hurricane Ian. Despite Complainant’s year and a half delay in reporting this loss, TIE conducted a prompt and thorough investigation into this claim. TIE’s claim representative, Tim Stock, inspected the insured property on April 8, 2024. This inspection found one wind damaged shingle and some mechanical damage throughout the roof due to the prior installation of the solar panels. The inspection also found very minor water staining to the ceiling of the home but importantly this water staining was not the result of the storm created opening. As a result, TIE prepared an estimate to repair only covered damage under the policy, the single wind damaged shingle. Because wear and tear and mechanical damage is an excluded cause of loss under the policy, TIE’s estimate of covered damage did not include the mechanical damage from the installation of the solar panels. Likewise, since TIE’s policy excludes coverage for interior water damage that is not the result of a storm created opening, TIE’s estimate of covered damage did not include the water staining to the ceiling of the home. Because the cost to repair the only covered damage, the one wind damaged shingle, amounted to $593.28 and fell below the hurricane deductible, no payment was issued for the loss. The primary fact that Complainants allege to support their allegations that TIE violated Florida law and handled Complainants’ claim in bad faith is that TIE’s adjustment of the claim did not result in payment of Complainants’ exorbitant demand. Moreover, Complainants failed to provide any evidence that the insured property sustained a covered loss beyond that accounted for in TIE’s estimate; Complainants merely submitted an inflated estimate to repair parts of the property, which clearly did not suffer a covered loss. TIE’s policy only covers accidental direct physical loss or damage to the property that is not otherwise excluded, which is further limited by the conditions, terms, deductible, and coverage limits of the policy. In accordance with these terms, TIE properly adjusted this claim. Accordingly, contrary to Complainants’ apparent contention, TIE’s coverage determination was made in good faith. Next, the Notice fails to comply with the specific notice and information requirements as set forth in Section 624.155 and 626.9541, Florida Statutes. A complainant wishing to avail itself of the statute’s benefits must strictly comply with its requirements. Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000); Florida Steel Corp. v. Adaptable Devs., Inc., 503 So. 2d 1232, 1234 (Fla. 1986). Preliminarily, the Notice fails to list both named insureds; it lists only Melinda Almanza but does not include Ivan Almanza. Further, the Complainant’s email address is not included in the Notice; instead, only Complainant’s counsel email address is listed. Therefore, the Notice is defective in its entirety. Next, the Notice states that in order to “remedy” the defects outlined in the Notice, “[TIE] must promptly fairly and honestly assess or reassess the Loss so that it may engage in good faith settlement negotiations with Insured and Insured’s representatives.” The Florida Supreme Court has stated that “cure” demands beyond the contractual amount due are expressly disallowed. Talat Enterprises, Inc v. Aetna Cas. & Sur. Co., 735 So. 2d 1282 (Fla. 2000). Accordingly, the Notice is invalid and defective in its entirety because the Complainants have conditioned TIE’s ability to “cure” by demanding TIE do more than pay the contractual amount allegedly due. Also, the Notice fails to adequately allege what conduct gave rise to a violation of the listed statutory language. Specific information regarding the facts and circumstances giving rise to the violation is required by statute. Courts interpreting this requirement have explained that the claimant must recite facts related to the insurer’s actions. Heritage Corp. of S. Fla. v. Nat'l Union Fire Ins. Co. of Pittsburgh, PA, 580 F. Supp. 2d 1294, 1299 (S.D. Fla. 2008). These facts should match up with the statutory provisions claimed to have been violated and should specifically explain how the insurer violated those statutes. Rousso v. Liberty Surplus Ins. Corp., No. 10-CV-20554, 2010 WL 7367059, at *4 (S.D. Fla. Aug. 13, 2010). “The civil remedy notice must reflect a good-faith effort to inform the insurer of how it has fallen short of its obligations under the policy and what it can do to fix its shortcomings.” Id. at *5. Here, the Notice fails to adequately match up which alleged action or inaction violated which statute and fails to explain how the alleged conduct contravened the statute. For instance, the Notice provides a boiler plat narrative and lists several subsections of Florida Statute Sections 624.155 and 626.9541, which Complainants contend that TIE violation. But, the Notice fails to match up and identify which specific conduct, if any, violated which statutes. Throughout the claim process, TIE has been aware of its obligations to its insured and has fully met those obligations. TIE has proceeded in good faith and has not violated the above-referenced statutes. While this response is meant to be comprehensive, TIE’s response is based upon the information provided in the Notice and the information known to date. This response should not be construed as a waiver of any rights or defenses, as all such rights and defenses are specifically reserved. Sincerely, BANKER LOPEZ GASSLER, P.A. Madison Breder Madison Breder, Esq.
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