Civil Remedy Notice of Insurer Violations
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Filing Number:     787146
Filing Accepted:  10/16/2024
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Complainant
Last/Business Name *  
DAVIDSON   First Name   KIMBERLY
Street Address * 3000 PENNSYLVANIA ST
City, State Zip * MELBOURNE, FL 32904
Email Address * DAVIDSONK18@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   DAVIDSON   First Name   KIMBERLY
Policy # * GC90019137 Claim #* 2324259836
Attorney
Attorney is Applicable
Last Name* KRAPF First Name * GRANT Initial W
Street Address* 2790 SUNSET POINT RD
City, State Zip* CLEARWATER , FL 33759
Email Address * GRANT@KRAPFLEGAL.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   GEOVERA SPECIALTY INSURANCE COMPANY
NAIC Company Code 10182
 
Name of individual responsible for violation (if any):* MARSHA SANDERS, ADAM WINSTEAD, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, GEOVERA ADVANTAGE INSURANCE SERVICES, INC., WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unfair Trade Practice
Other : Not treating the Insured with good faith claims conduc
Other : Looking for ways to deny full recovery to the Insured
Other : Looking for ways to delay full recovery to the Insured
Other : Failing to properly investigate the Insured's loss
Other : Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made,
Other : Not adjusting claims and evaluating loss properly
Other : Shifting the burden of insuring the loss to the Insured
Other : Intentionally misstating the terms, conditions, and benefits of the insurance policy to the insured
Other : Failing to implement proper standards for the adjustment and investigation of claims
Other : Making material misrepresentations
* 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)(1) Attempting to settle claims on the basis of an application, when serving as a binder or intended to become a part of the policy, or any other material document which was altered without notice to, or knowledge or consent of, the insured.
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)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

GeoVera Advantage Insurance Services, Inc. (the "Insurer") has committed the following in handling the Insured's claim: 1) failing to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; and 7) failing to employ policies and procedures to conduct adequate investigations. On or about April 26, 2023, while the subject policy was in full force and effect, the insured property suffered a loss caused by wind and hail. The Insured timely submitted a claim on April 10, 2024, to the Insurer for damages caused by hail and wind and the ensuing damage therefrom. Given the scope and nature of the damage, the Insured retained a public adjuster. After assessing the damage and the true scope of repairs, the public adjuster prepared an estimate identifying $48,357.47 in covered damage to the dwelling. The foregoing estimate, photographs, and a letter of representation from the public adjuster were sent to the Insurer who thereafter assigned claim number 2324259836 to the loss and sent a field adjuster to inspect the property on April 17, 2024. Subsequently, in a letter dated May 7, 2024, the Insurer notified the Insured that it was demanding appraisal. An appraisal estimate was then prepared, dated May 27, 2024, that detailed $29,789.85 in covered damage to the roof, $1,091.39 in covered damage to exterior surfaces, $259.71 in covered damage to the screened enclosure, and $5,376.87 for Law & Ordinance allocated for roof damage. The total amount of $36,517.82 was then awarded to the Insured in an appraisal agreement dated May 27, 2024. The Insurer then sent a letter, dated June 3, 2024, to the Insured in which it outlined their payment of the appraisal award. However, the Insurer wrongfully declined to provide payment for the $5,376.87 allocated for Law & Ordinance as outlined in the appraisal award. By failing to provide full and final payment to the Insured despite being obligated to do so by its own policy, the Insurer is unnecessarily delaying resolution of the subject claim, placing its own financial interests over the health and safety of its Insured. The Insurer is not acting in accordance with the policy and all statutory and regulatory requirements and is instead declining to negotiate a fair settlement by engaging in discourteous tactics despite the obligation to pay the entire amount awarded by the appraisal process being entirely clear. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. However, when the Insurer conducted its inspection of the insured property, the Insurer's adjuster failed to conduct a thorough and adequate investigation, or the adjuster intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss. The conduct outlined above is done within the Insurer's routine course of the business. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer's claim file and standards and procedures for the adjustment and investigation of claims. In short, the Insurer is not acting with due regard for the Insured's interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully withheld $5,376.87 from the Insured as outlined in the appraisal award. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer's actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer's actions amount to but are not limited to the following: 1. Claim delay 2. Not treating the Insured with good faith claims conduct 3. Looking for way to reduce recovery to the Insured 4. Looking for ways to deny recovery to the Insured 5. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 6. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's' interests 7. Placing the financial interest of the Insurer over that of the health and safety of the Insured 8. Making material misrepresentations Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1). Admit full coverage for the Insured's loss. (2). Tender full benefits owed to the Insured under the insurance contract. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. Via Certified Mail: GeoVera Advantage Insurance Services, Inc. PO Box 2408 Fairfield, CA 94533 msanders@geovera.com
Comments
User Id Date Added Comment
service@larlegalgroup.com 11-15-2024 November 15, 2024 Via Electronic Filing Department of Financial Services Civil Remedy Notice Department 200 East Gaines Street Tallahassee, Florida 32399 RE: Complainant: Kimberly Davidson Claim No.: 2324259836 Policy No.: GC90019137 Date of Loss: 04/26/2023 DFS Filing No.: 787146 DFS Acceptance: 10/16/2024 To Whom It May Concern: This correspondence shall serve as the response of GeoVera Specialty Insurance Company (“GeoVera”) to the Civil Remedy Notice of Insurer Violations (“Notice”) that the Department of Financial Services (“Department”) accepted on October 16, 2024, and that Kimberly Davidson’s (“Complainant”) attorney, Grant W. Krapf, submitted to the Department. GeoVera denies all the allegations asserted in the Notice and denies any improper conduct or claims response in the handling of these claims. GeoVera does not consider there to have been any manner of violation and questions the validity of the CRN as it is a duplicate filing of the prior frivolous CRN with filing number 77546, on July 30, 2024, by co-insured Paul Davidson. Each co-insured filing individually does not add validity to the CRN. The Complainant re-alleges that GeoVera violated several provisions of Florida’s Civil Remedy statute (Section 624.155, Florida Statutes) and the Unfair Claims Practices Act (Section 626.9541, Florida Statutes) as was done in the previous, frivolous CRN. GeoVera denies violations of any statutory provision in the handling of, or response to, the Complainant’s claim. To allow for a full understanding of all actions in the claim, GeoVera sets forth herein a summary of relevant facts for the claim cited in the Notice. Factual History: On April 10, 2024, the public adjuster from Omega Public Adjusting for the Complainant reported a claim to GeoVera which allegedly occurred on April 26, 2023, due to hail. On this same day the public adjuster sent their letter of representation to GeoVera. On April 12, 2024, GeoVera issued correspondence to the Complainant regarding its reservations of rights, due to the late notice and request for documents. On May 2, 2024, GeoVera issued correspondence to the Complainant explaining that GeoVera tried to inspect the property and Complainant declined to allow the adjuster to inspect the interior of the property. On May 7, 2024, GeoVera issued correspondence to the Complainant outlining coverage, and confirming payment in the amount of $9,057.95. GeoVera acknowledged disagreement with the public adjuster’s estimate in the amount of $65,889.83 and demanded appraisal to resolve the dispute. On May 14, 2024, GeoVera issued correspondence to the Complainant, which was its Reservation of Rights, notifying the Complainant that the claim was reported late, and requesting a sworn proof of loss pursuant to the Policy, invoices, receipts, and repairs estimates and other documentation in relation to the alleged damages. On May 15, 2024, GeoVera received the Complainant’s sworn proof of loss in the amount of $38,277.47. Attached was an estimate in the amount of $48,357.47. On June 3, 2024, GeoVera issued correspondence to the Complainant detailing the appraisal award in the amount of $36,517.82. Out of this amount Law and Ordinance is $5,376,87, which is related to the roof. The Roof System Payment Schedule Endorsement precludes coverage for any items on the roof in relation to ordinance and law. Further, this endorsement depreciates the roof based upon age and type. The roof in this case is 7 years old, therefore, depreciation was applied, and the Policy covers 83% of the replacement cost of the roof minus ordinance and law. The applicable Policy language is as follows: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ROOF SYSTEMS PAYMENT SCHEDULE FORM HO 00 03 ONLY This Roof Systems Payment Schedule modifies the policy with respect to how we settle losses to “roof system(s)” damaged by the perils of windstorm or hail, or damage caused by rain, snow, or sleet, whether or not wind-driven. To the extent that any provision of this endorsement conflicts with any coverage or additional coverage provisions within the policy or other endorsements attached to the policy, the terms of this endorsement shall apply. SECTION I – PROPERTY COVERAGES E. Additional Coverages For purposes of this Roof Systems Payment Schedule only, the following is added to 11. Ordinance or Law, Paragraph c.: 11. Ordinance or Law c. We do not cover: (3) Any costs to comply with ordi¬nance or law related to “roofing system(s)” when damage is caused by the perils of windstorm or hail, or rain, snow, or sleet, whether or not wind driven. US 06 46 (04-22) Page 1 of 3 The total amount of the appraisal award for the roof of the property after application of the Roof Systems Payment Schedule was $24,725.57. The appraiser also awarded Law & Ordinance in the amount of $5,376.87 for the roof. The Windstorm/Hail deductible is $10,080.00. After the prior payment of $9,057.95 was applied, a payment in the amount of $6,938.72. Payment was issued to Paul Davidson, Kimberly Davidson, Rocket Mortgage LLC ISAO ATIMA and Omega Public Adjusting. Reasons for Notice: Complainant alleged twelve (12) reason for the Notice: Claim Delay; Unfair Trade Practice; Not treating the Insured with good faith claims conduct; Looking for ways to deny full recovery to the Insured; Failing to properly investigate the Insured’s loss; Failing to provide the Insured with the full benefits award under the contract of insurance; not training, supervising, or managing adjusters, properly so that prompt and full payments are made; Not adjusting claims and evaluating loss properly; Shifting the burden of insuring the loss to the Insured; Intentionally misstating the terms, conditions, and benefits of the insurance policy to the insured; Failing to implement proper standards for the adjustment and investigation of claims; Making material misrepresentations. GeoVera denies the allegations that the Complainant brought forth against it and specifically responds as follows: GeoVera denies each and every assertion of bad faith in the Notice. GeoVera promptly acknowledged the claim and sent a field adjuster to inspect and estimate the damage. Throughout the investigation and disagreement with the adjustment of the claim GeoVera continued prompt communication and went forward with the appraisal process. The appraisal award was issued pursuant to the terms, conditions, limitations, and exclusions of the Policy. GeoVera handled the subject claim in accordance with the insurance contract and all statutory and regulatory requirements. GeoVera considered all available information in furtherance of its investigation, and any delay in the investigation process was due to the actions of Complainant. GeoVera timely adjusted the claim and demanded appraisal, a process which has been delayed by Complainant. No Violation of Statute(s): These documented facts clearly reflect that GeoVera promptly responded to the Complainant’s claim, performed a professional inspection of claimed damages, and acted fairly and reasonably toward the Complainant. Its handling of the claim was responsive to the Complainant, and GeoVera remained professional while seeking full and complete information in accordance with the specific terms of the insurance policy. GeoVera contends that this Civil Remedy Notice is premature as Complainant has failed to comply with the post loss duties under the Policy and is delaying the claims process by failing to comply with the appraisal provision of the Policy. Section 624.155(1)(b)(1), Florida Statutes: GeoVera denies violation of Section 624.155(1)(b)(1), as it made a good faith effort to appropriately resolve the Complainant’s claim and has, at all times, acted in accordance with the terms, conditions, and coverages of the insurance policy. GeoVera timely conducted the inspection of the property. GeoVera reviewed all documents and information provided. GeoVera also timely demanded appraisal and promptly paid the appraisal award pursuant to the terms, conditions, limitations, and exclusion of the Policy to the Complainant. Any delay was caused by the Complainant and/or his representatives. Absolutely no facts or circumstances supporting this allegation have been set forth in the Notice. Section 624.155(1)(b)(3), Florida Statutes: GeoVera denies violation of Section 624.155(1)(b)(3), as it made a good faith effort to appropriately resolve the Complainant’s claim and has, at all times, acted in accordance with the terms, conditions, and coverages of the insurance policy. GeoVera inspected the Complainants’ property, reviewed all documents and information provided, and conducted its investigation in compliance with the policy. Since then and prior to the filing of this Notice, the Complainant refused to allow GeoVera access to the interior of the property. Accordingly, this allegation is not factually supported and is denied. Section 624.9541(1)(i)(1), Florida Statutes: GeoVera denies violation of Section 626.9541(1)(i)(1), as it complied with the Policy, endorsements and provisions for which the Complainant and GeoVera have privity of contract. The Roof Systems Payment Schedule is on the Policy declarations, and was a part of the Policy purchased by the Complainant, and, therefore, the appraisal award, and any settlement of the claim is subject to the endorsement. Further, any Policy violation was by Complainant as they failed to allow GeoVera to inspect the interior of the property. Section 624.9541(1)(i)(2), Florida Statutes: GeoVera denies violation of Section 626.9541(1)(i)(2), as there was no misrepresentation made to the Complainant nor any of his representatives. GeoVera acknowledged Complainant’s disagreement with its adjustment of the loss, and promptly demanded appraisal to resolve their claim. This resolution through the neutral appraiser was still subject to the terms, conditions, limitations, exclusions of the Policy. No allegations of any misrepresentation were made to GeoVera during the investigation of the claim, and all allegations are without merit. Section 626.9541(1)(i)(3)(a), Florida Statutes: GeoVera denies violation of Section 626.9541(1)(i)(3)(a), as it has adopted and implemented standards for the proper investigation of claims. The facts cited above show that GeoVera promptly responded to the Complainant’s claim and assigned an adjuster to inspect the property. Accordingly, this allegation is not factually supported and is denied. Section 626.9541(1)(i)(3)(c), Florida Statutes: GeoVera denies violation of Section 626.9541(1)(i)(3)(c), as it has promptly responded to the Complainant’s claim and immediately assigned representatives to inspect the property. The investigation was done in accordance with the terms and conditions of the Policy. Accordingly, this allegation is not factually supported and is denied. Section 626.9541(1)(i)(3)(i), Florida Statutes: GeoVera denies violation of Section 626.9541(1)(i)(3)(i), as it is wholly inapplicable, and thus further demonstrates the invalidity of the Notice. This subsection is specifically regarding personal injury coverage, which is in no way at issue in this matter. Conclusion: GeoVera has fully responded to all the Complainant’s conclusory and repeat allegations contained in the Notice. GeoVera has handled the Complainant’s claim with diligence, and has, at all times, acted fairly in the adjustment of the claim. Further, GeoVera has treated the Complainant with honesty and due regard to their interests, and GeoVera has done so in compliance with the policy of insurance and Florida law. Should the Department have any questions or further inquiry with respect to this matter, please contact the undersigned. Sincerely, Lucie A. Robinson, 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