Civil Remedy Notice of Insurer Violations
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Filing Number:     787210
Filing Accepted:  10/16/2024
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Complainant
Last/Business Name *  
WILEY   First Name   ZACHARY
Street Address * 2847 SOUTHWEST 5TH STREET
City, State Zip * FORT LAUDERDALE, FL 33312
Email Address * CLAY@THEKRFIRM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   WILEY   First Name   ZACHARY
Policy # * OIHT000642 Claim #* 3324000175
Attorney
Attorney is Applicable
Last Name* KUHN First Name * CLAYTON Initial
Street Address* 2110 WEST PLATT STREET
City, State Zip* TAMPA , FLORIDA 33606
Email Address * CLAY@THEKRFIRM.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   ORANGE INSURANCE EXCHANGE
NAIC Company Code 17522
 
Name of individual responsible for violation (if any):* ANY AND ALL PERSONS ASSOCIATED WITH THE CLAIMS HANDLING FROM ORANGE INSURANCE EXCHANGE
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
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.
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)(d) Denying claims without conducting reasonable investigations based upon available information.
* 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 LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE LOSS PAYMENT AND COVERAGE PROVISIONS OF POLICY NUMBER OIHT000642, INCLUDING THE DECLARATIONS PAGE AND ALL ENDORSEMENTS TO THE POLICY, WITH RESPECT TO COVERAGES A, B, C, AND D. ADDITIONALLY, ANY SECTIONS RELIED UPON BY THE INSURER IN ITS DENIAL TO FULLY PAY THE CLAIM, INCLUDING THE DUTIES IN THE EVENT OF LOSS PROVISIONS AND THE POLICY'S EXCLUSION OF COVERAGE PROVISIONS.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Zachary Wiley (hereinafter “Insured”) is a homeowner insured with an all-risks policy issued by Orange Insurance Exchange (hereinafter “Carrier”). On or about June 12, 2024, Insured’s home located at 2847 Southwest 5th Street, Fort Lauderdale, Florida 33312 sustained significant damage as a result of a water event. Specifically, Insured’s property sustained water damage due to a plumbing failure in the bathroom. The discharge of water caused damage to the Insured’s property, including but not limited to, multiple bedrooms, bathroom, living room, hallway, dining room, and kitchen. The Loss is covered under Insured’s policy issued by Carrier. The Insured mitigated damages by contacting Restoration 1 of Boca Raton who performed mitigation services on the subject property. All of the relevant documents were provided to Carrier. Insured promptly reported the claim and fully cooperated with all requests for inspections. Carrier assigned Claim No. 3324000175 to the loss. The Insured has fully cooperated with Carrier’s investigation of the claim, including providing all requested documentation and complying with all post-loss policy conditions. Specifically, the Insured, with assistance from their public adjuster, submitted an estimate for $87,058.77, which was a fair and reasonable assessment for the repair/replacement of damages. Restoration 1 of Boca Raton has an outstanding balance in the amount of $3,855.42 for their mitigation services. Carrier failed to retain qualified experts necessary to identify the repairs necessary to restore the property to its pre-loss condition. Despite Insured providing Carrier with a detailed estimate, Carrier failed to pay Insured the amount necessary to repair/replace the damaged property, less the applicable deductible. Instead, Carrier gave Insured a lowball estimate that failed to encompass all covered damages. The carrier only offered to pay $7,985.57, a gross underpayment for all the damage associated with this claim. Under the circumstances surrounding this claim, had Carrier acted fairly and honestly toward the Insured and with due regard for the Insured’s interests, Carrier could and should have attempted in good faith to settle this claim. Carrier did not and, instead, dishonestly, and unfairly placed its own interests well ahead of those of the Insured. In doing so, Carrier violated Section 624.155(1)(b)(1), Florida Statutes. Carrier’s use of unqualified and biased adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to adopt and implement standards for the proper investigation of claims in violation of Section 626.9541(1)(i)(3)(a), Florida Statutes. Carrier’s use of unqualified and biased adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to conduct a reasonable investigation based upon available information. In denying full coverage for this claim without conducting reasonable investigations based upon available information, Carrier has violated Section 626.9541(1)(i)(3)(d), Florida Statutes. By representing to Insured that the Policy does not afford full coverage for this loss, Carrier is misrepresenting pertinent facts and/or insurance policy provisions relating to coverages at issue, in violation of Section 626.9541(1)(i)(3)(b), Florida Statutes. When applying the facts present here to Florida law, it is clear that Carrier is acting in bad faith. Florida Statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit based on determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. Carrier has breached this duty by refusing to properly and timely adjust the loss. Moreover, Section 69B-220.201 of the Florida Administrative Code defines Carrier’s adjusters conduct here as an unfair claims settlement practice. Specifically, Section 69B-220.201(3) provides that “[a]n adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured” and that “[a]n adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.” As detailed above, Carrier’s investigation and adjustment of this claim was done in a manner prejudicial to Insured, was incomplete, and lacked truthful and unbiased reports of the facts. Carrier has more than enough information and is still refusing to accept coverage for the Insured’s claim. This continued and repeated reckless claim delay and denial of coverage will result in a significant punitive damage award if a bad faith lawsuit is filed. Carrier can cure the defects outlined in this Civil Remedy Notice and avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy for this claim and by paying Insured’s estimate of damages $87,058.77, and Restoration 1 of Boca Raton in the amount of $3,855.42, less applicable deductible and prior payments, which is the reasonable amount of the covered loss pursuant to the policy. A copy of this form has been submitted to the Florida Department of Financial Services who has transmitted the same to the following parties providing them notice of the filing of this Civil Remedy Notice: Orange Insurance Exchange
Comments
User Id Date Added Comment
mmd@lydeckerdiaz.com 12-06-2024 December 6, 2024 SENT VIA EMAIL TO: Mr. Clayton Kuhn, Esq. KUHN RASLAVICH, P.A. 2110 West Platt Street Tampa, FL 33606 clay@thekrfirm.com Re: Insured(s): Zachary Wiley Claim #: 3324000175 Policy #: OIHT000642 Date of Loss: June 12, 2024 Insured Property: 2847 SW 5th St, Ft Lauderdale, FL 33312 DFS File Number: 787210 Dear Mr. Kuhn: Response to Civil Remedy Notice The law firm of Lydecker, LLP has been retained by Orange Insurance Exchange (“Orange”) to file a response on its behalf to the Civil Remedy Notice filed in the above referenced matter. The Civil Remedy Notice of Insurer Violations (Form DFS-10-363 revised 10/2008) (“Civil Remedy Notice”) filed on October 16, 2024, alleges that Orange violated Florida Statute §624.155 and Florida’s Unfair Claims Settlement Practices Act set forth in Florida Statute §626.9541. Orange specifically denies each and every allegation contained in the Civil Remedy Notice filed in relation to this claim. Orange requests that the Civil Remedy Notice be rejected as it fails to comply with the requirements set forth in Civil Remedy Notice of Insurer Violation documents provisions pursuant to Florida Statute §624.155 and Florida case law. In determining whether an insurer acted fairly and honestly toward its insured with regard to the settlement of the claim, Florida’s Legislature enacted the Unfair Claims Settlement Practices Act which sets forth several obligations on behalf of a carrier. In 1982, the Florida Legislature enacted section 624.155, which created a statutory civil remedy that allows policyholders to assert first-party bad faith claims and recover extra-contractual damages. Due to the fact that this statute is in derogation of common law, the requirements of a Civil Remedy Notice must be strictly construed. The Civil Remedy Notice filed by Zachary Wiley (“Complainant” or “Insured”) fails to meet the requirements set forth in section 624.155. The statute mandates that a complainant includes in a Civil Remedy Notice all information requested in the form provided by the Department of Financial Services. Here, the Complainant has not provided all the information requested in the Civil Remedy Notice as it has failed to include Complainant’s email address; the specific policy language relevant to the violation; and misses the person or persons representing the insurer who are most responsible for/knowledgeable of the facts giving rise to the allegations thus; thus rendering it invalid. The Complainant raises two reasons for the Civil Remedy Notice: unsatisfactory settlement offer and unfair trade practice. While the Complainant vaguely recites broad self-serving conclusions throughout the Civil Remedy Notice, it fails to provide any specificity as to how the statutory provisions were violated, contrary to the requirements of Florida Statutes. The words “specific” and “specificity” are mentioned four times in section 624.155(3)(b), delineating the clear intent of the Florida legislator to require any potential claimant to explicitly state the detailed reasons why they are bringing these claims. The Complainant appears to identify the following provisions as provisions of the Florida Statutes that Orange allegedly violated: Florida Statute §624.155(1)(b)(1). This provision provides in relevant part: (1) Any person may bring a civil action against an insurer when such person is damaged: (b) By the commission of any of the following acts by the insurer: 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 insureds and with due regard for her or his interest; Florida Statute §626.9541(1)(i)(3)(a). This provision provides in relevant part: (1) UNFAIR METHODS OF COMPETITION AND UNFAIR OR DECEPTIVE ACTS.—The following are defined as unfair methods of competition and unfair or deceptive acts or practices: (i) Unfair claim settlement practices.— 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; Florida Statute §626.9541(1)(i)(3)(b). This provision provides in relevant part: (1) UNFAIR METHODS OF COMPETITION AND UNFAIR OR DECEPTIVE ACTS.—The following are defined as unfair methods of competition and unfair or deceptive acts or practices: (i) Unfair claim settlement practices.— 3. Committing or performing with such frequency as to indicate a general business practice any of the following: b. Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.; Florida Statute §626.9541(1)(i)(3)(d). This provision provides in relevant part: (1) UNFAIR METHODS OF COMPETITION AND UNFAIR OR DECEPTIVE ACTS.—The following are defined as unfair methods of competition and unfair or deceptive acts or practices: (i) Unfair claim settlement practices.— 3. Committing or performing with such frequency as to indicate a general business practice any of the following: d. Denying claims without conducting reasonable investigations based upon available information; While the Complainant identifies several statutory schemes, the Civil Remedy Notice fails to provide specific facts that arise to a violation of the same or even a violation of the terms of the policy as required by 624.155(3)(b)(2). The allegations contained therein, are assertions that are merely self-serving conclusory statements and not founded or supported by any facts or law. The Civil Remedy Notice is inadequate as it fails to specifically identify, what, if anything, Orange has failed to do, or the acts which constitute a violation of §624.155(1)(b)(1) or a violation of §626.9541(1) or its subparts. “The purpose of the civil remedy notice is to give the insurer one last chance to settle a claim with its Complainant and avoid unnecessary bad faith litigation – 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.” If Orange is not fully notified of the act of which the Complainant complains, how can it be said that Orange was provided with the opportunity to cure any alleged defect or one last chance to settle the claim? This same question applies to each and every statutory provision alleged to have been violated. While the Insured raises an “unsatisfactory settlement offer” as a reason for the notice, it raises no allegations concerning Orange making a settlement offer or why that offer was unsatisfactory. Orange conducted an independent investigation of the claim and issued its undisputed payment but the Insured does not provide any information concerning an additional offer. As such, Orange has not been provided with the necessary information to respond. Similarly, the Insured raises no allegation supporting the conclusion that Orange engaged in an “unfair trade practice.” Moreover, the Insured alleges violations of the Florida Administrative Code. However, an alleged violation of the Code cannot give rise to a bad faith claim under Fla. Stat. 624,155. In addition, the Complainant fails to state with specificity how the statutory provisions have been violated. The Complainant also fails to explain how any specific policy provision cited in the Civil Remedy Notice are relevant to the violations. However, the Complainant fails to provide specific provisions or facts to support a breach of these provisions. Accordingly, the Insured has failed to satisfy the requirement that the claimant identify the specific statutes, the specific policy provisions, and the facts and circumstances giving rise to the violation; as required by Section 624.155(3)(b). Given the foregoing, it is clear to see that any allegations contained in the Complainant’s Civil Remedy Notice regarding the failure to act fairly and honestly towards the Complainant are unfounded, as the Complainant has not and cannot identify any instances in which Orange failed to investigate the claim of loss or handle the claim of loss in accordance with the terms and conditions of the policy and relevant law. Nor can the Complainant point to one instance when Orange did not act diligently in its handling of the claim. The Civil Remedy Notice does not include one fact specific to this claim that evidences how Orange has failed to comply with the policy or the statutory provisions alleged to have been violated. Notwithstanding the procedural deficiencies contained within the Civil Remedy Notice, Orange maintains that it has acted fairly and honestly toward the Complainant in connection with its claim of loss. Orange has handled the claim diligently and as required under Florida law. Initially, and throughout the adjustment of the claim, Orange has communicated with the Complainant on numerous occasions regarding the damages claimed and the steps Orange would take to address them, providing updates and detailed explanation regarding all of its requests. During the inspection the Insured indicated that he had concerns about the damage sustained to the property that may have been caused by water. Orange’s inspection revealed damage to the kitchen, living room, bathroom, and hallway. With the assistance of Jeremy D. Beagle of SDII Engineering, it was confirmed that there was a soft blockage under the kitchen drain line, which allowed water damage to occur in the adjoining hallway and living room. However, there were no cracks found in the cast iron drain lines themselves. Following the investigation, Orange issued the undisputed payment for the covered damages after applying the deductible and the matching limit under the Policy. Finally, regarding the allegations on how to cure the alleged violations, Florida law does not impose on insurers the obligation to pay or do whatever an insured or claimant demands in a Civil Remedy Notice. Section 624.155(3)(d) is clear that “[n]o action shall lie if, within 60 days after filing notice, the damages are paid or the circumstances giving rise to the violation are corrected.” The Florida Supreme Court has held that the “damages” mentioned in section 624.155(3)(d) do not include extra-contractual damages and are limited to “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.” Moreover, “the circumstances giving rise to the violation” must be ones that can in fact be remedied; a Civil Remedy Notice cannot make it impossible for the insurer to “cure” the alleged violation. In the event this correspondence does not satisfy the requirements of Florida Statutes, §624.155(3)(d), or does not adequately respond to the Civil Remedy Notice of Insurer Violation referenced above, please contact our office immediately so we may correct same. All rights are hereby preserved. Regards, /s/ Alex S. Parraga Alejandro Sanchez Parraga, Esq. Florida Bar Number: 1011105 Michelle Diverio, Esq. Florida Bar Number: 60392 1 Talat Enters., Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000); Mathurin v. State Farm Mut. Auto. Ins. Co., 285 F. Supp. 3d 1311, 1320 (M.D. Fla. 2018). 2 Pin-Pon Corp. v. Landmark Am. Ins. Co., No. 20-CV-14013, 2020 WL 3038576, at *3 (S.D. Fla. June 5, 2020). 3 Heritage Corp. of South Florida v National Union Fire Ins. Co. of Pittsburgh, PA. 580 F. Supp. 2d 1294 (S.D. Fla. 2008). 4 Julien v. United Prop. & Cas. Ins. Co., No. 4D19-2763, 2020 WL 5652364, at *3 (Fla. 4th DCA Sept. 23, 2020). 5 Lane v. Westfield Insur. Co., 862 So. 2d 774, 779 (Fla. 5th DCA 2003). 6 Talat, 753 So. 2d at 1283. 7 Fox Haven of Foxfire Condo. IV Ass'n, Inc. v. Nationwide Mut. Fire Ins. Co., No. 2:13-cv-399-FtM-29CM, 2015 WL 667935, at *5 (M.D. Fla. Feb. 17, 2015).
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