Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 787329

Filing Accepted: 10/17/2024

Print Filing

Complainant

Last/Business Name *

JOSEY

First Name

GREGORY AND BRIGGITTE

Street Address *

1238 SE 12TH AVENUE

City, State Zip *

DEERFIELD BEACH, FL 33441

Email Address *

GELSINGER@MINEOLAW.COM

Complainant Type: *

Insured

Last/Business Name*		JOSEY		First Name		GREGORY AND BRIGGITTE
Policy # *		HCPC-HW2-447193-9		Claim #*		941380

Attorney

Attorney is Applicable

Last Name*	GARRETT First Name * ELSINGER Initial
Street Address*		5600 DAVIE ROAD
City, State Zip*		DAVIE , FL 33314
Email Address *		GELSINGER@MINEOLAW.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		HOMEOWNERS CHOICE PROPERTY & CASUALTY INSURANCE COMPANY, INC.
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 12944

Name of individual responsible for violation (if any):* ALL ADJUSTERS, SUPERVISORS, MANAGERS, ATTORNEYS, AND INDIVIDUALS ASSOCIATED WITH AND/OR RETAINED BY HOMEOWNER'S CHOICE PROPERTY & CASUALTY INSURANCE COMPANY CONCERNING THE CLAIM AT ISSUE INCLUDING BUT NOT LIMITED TO ALONSO SMITH AND LAUREN WEBER, ESQ
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)(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.

• In addition to the breach of the above statutory duties, see Coverage A and Loss Payment Provisions

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Homeowners Choice Property & Casualty Insurance Company (“the Insurance Company”) issued a homeowners’ insurance policy to its insureds Gregory Josey and Briggitte Josey (the “Insureds”), for the insured property located at 1238 SE 12th Avenue, Deerfield Beach, FL 33441. The subject Policy afforded various types of coverages including coverage for caused by windstorm. On or about April 12, 2023, while the subject Policy was in full force and effect, the Insured’s home was damaged as a result of a windstorm with ensuing interior water damage. The Insured promptly notified the Insurance Company of the loss. Thereafter, the Insurance Company acknowledged the loss and assigned claim number 941380 to the loss. The Insured complied with all policy conditions and cooperated with the Insurance Company’s investigation efforts. The Insurance Company performed an inspection of the property during its investigation of the claim but failed to retain experts necessary to identify all the repairs necessary to restore the property to its pre-loss condition as required by the subject insurance policy. Additionally, despite the insured’s cooperation, the insurance company, in bad faith, failed to issue a reasonable payment for the actual cash value of the damages. The insurance company has been provided with an estimate for the amount of damages necessary to restore the insured’s property to its pre-loss condition however despite this knowledge, the insurance company continues to refuse requests for payment and instead is attempting to low ball the plaintiff into accepting an amount of money that can’t possible allow them to repair the subject property. Additionally, counsel for the insurer, Lauren Weber, Esq. and the direction of the insurer, in bad faith has delayed discovery in the insureds related litigation and in bad faith, has refused to produce claim related documents in Homeowner’s Choices possession. Accordingly, the Insurance Company has misrepresented facts and policy language related to the coverages provided under the policy, and has accordingly collected a premium for insurance that has not been provided in full. The obligation to pay the full value of the Insureds’ claim has been made clear based on the facts and evidence available, yet the Insurance Company has failed to pay the full value of the Insureds’ claim. This is caused in part by the Insurance Company’s failure to adopt and implement standards for the proper investigation of claims. The Insureds provided the Insurance Company with documentation evaluating the loss, and rather than issuing the proper payment or attempting to reach an agreement with its Insureds, the Insurance Company is delaying and denying the claim. Upon information and belief, the Insurance Company performs the subject actions as a business practice, including delaying the claim and/or denying the claim in an attempt to dissuade its insureds from pursuing the claim to the detriment of its insureds to increase financial profits. In order to remedy the above defects, the Insurance Company must do the following: 1. Immediately admit coverage and pay the Insureds the full value of the claim. 2. Pay statutory interest on the amount of unpaid damages from the date of loss. 3. Act fairly and honestly toward its Insureds with due regard for her interests in attempting to resolve the claim. 4. Cease and desist all present and future bad faith actions with regard to this claim. 5. Implement standards for the property investigation of claims.

Comments

User Id		Date Added		Comment
Legal@hcpci.com		12-13-2024		This is Homeowners Choice Property & Insurance Company’s (“HCPCI”) response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed by Garrett Elsinger, Esq. on behalf of Gregory and Briggitte Josey (“Insured”). HCPCI reviewed this CRN and conducted a thorough review of the subject claim (“claim”) and confirmed it handled the claim properly. Under the relevant facts and circumstances, the applicable insurance contract did not provide coverage for the claim. Ultimately, HCPCI handled the claim in accordance with the policy and all statutory and regulatory requirements. HCPCI denies each allegation of bad faith and improper conduct in the CRN. At all times, HCPCI acted in good faith, fairly and honestly toward the Insured and with due regard for the Insured’s interests. Otherwise, the CRN is deficient. Generally, pursuant to Florida Statutes, Section 624.155, CRNs must identify and set forth statutory provisions insurers allegedly violated in handling insureds’ insurance claims along with specific, relevant insurance contract language and facts and circumstances. The foregoing provides insurers with notice of alleged statutory violations AND the opportunity to cure such alleged violations. Instead of complying with Florida Statutes, Section 624.155, the Insured’s attorney in the CRN contained an inaccurate recitation of the facts, failed to reference specific, relevant insurance policy language; cited irrelevant statutes; and relied on inaccurate and conclusory statements. The Insured’s laundry list of inapplicable statutes is insufficient. Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). Furthermore, the Insured’s attorney filed a lawsuit based on the claim prior to the filing of this CRN. Regardless of the fact there were no violations in this case, any action by HCPCI to cure violations alleged in the CRN could have been used against HCPCI in the lawsuit. The foregoing shows abuse by the Insured and the Insured’s attorney of the CRN and legal processes. Also and generally, the CRN constitutes an abuse of the CRN process, contravenes the purpose of CRNs, which is to promote resolution of issues in insurance claims. The CRN must be rejected, and it cannot serve as the basis of any action against HCPCI. Upon request by the Florida Department of Financial Services, HCPCI will provide to the DFS detailed correspondence HCPCI provided regarding the claim.

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. Before submitting a Notice using this system, please verify that all text has been entered correctly and completely. Once the Notice has been submitted, the text cannot be changed or deleted.

DFS-10-363
Rev. 10/14/2008