Civil Remedy Notice of Insurer Violations
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Filing Number:     787340
Filing Accepted:  10/17/2024
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Complainant
Last/Business Name *  
WAEL DUBBANEH   First Name  
Street Address * 3591 TAMIAMI TRAIL
City, State Zip * PORT CHARLOTTE, FL 33952
Email Address * WDUBBANEH@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   WAEL DUBBANEH   First Name  
Policy # * PRP008006/2400 Claim #* AMDU2409001
Attorney
Attorney is Applicable
Last Name* MESSINGER First Name * MAX Initial
Street Address* 925 FEDERAL HWY
City, State Zip* BOCA RATON , FL 33432
Email Address * MMESSINGER@KPATTORNEY.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   UNDERWRITERS AT LLOYD'S, LONDON
NAIC Company Code
 
Name of individual responsible for violation (if any):* CLAIMS DEPARTMENT
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
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)(f) Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

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

The carrier was put on notice of the fire which caused damage to the insureds’ property damage. Subsequently, the insured submitted a loss package in the amount of $244,152.25 needed to restore the property back to its pre-loss condition to the carrier. The insured has attempted to follow-up with the carrier multiple times regarding the status of the claim and has been ignored by the carrier. The insured has complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insured. More than fifty-five days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of the damage sustained by the insured’s property and has not taken any meaningful ensuing action. It is clear that the carrier is not treating the insured with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insured; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insured’s interests; refusing to pay the full amount owed to the insured despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insured, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $244,152.25, less any prior payments and less any applicable policy deductible; and 2.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier. Please do not hesitate to contact the undersigned or Rebecca Barrett at (561)-892-9746 if you have any questions or concerns. Sincerely, Max Messinger Attorney at Law
Comments
User Id Date Added Comment
klyde.bedford@csklegal.com 12-03-2024 Dear Mr. Messinger: This correspondence is in response to the Civil Remedy Notice of Insurer Violations (hereinafter referred to as the “Notice”) filed by your office on behalf of Chicken & Subs Delight, Inc. (hereinafter referred to as “Claimants”). The Department of Financial Services assigned an accepted date of October 17, 2024, for the Notice. As you are aware, the law firm Cole, Scott & Kissane, P.A. has been retained to represent Certain Underwriters at Lloyd’s, London (hereinafter referred to as “Insurer” or “Underwriters”) in this matter. This matter concerns a claim regarding alleged water damage pursuant to a homeowners’ insurance policy provided by Policy No.: PRP008006/2400. Underwriters welcomes this opportunity to respond to the Notice and denies each and every allegation contained therein. Underwriters does not consider there to have been any manner of violation and questions the validity of the Notice as it fails to meet the requirements set forth in Florida Statute Section 624.155 and Florida law and thus fails to perfect the Claimants’ 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 Underwriters. As indicated below, the subject property was dutifully inspected and proper coverage for the claim was afforded based on the clear meaning of the subject policy. I. Specificity Requirement The Claimants’ Civil Remedy Notice violates multiple requirements set forth in the Florida courts’ jurisprudence for civil remedy notices. In addition, it fails to meet even the most basic requirements of the Statute. Accordingly, Underwriters respectfully requests the Department return the Civil Remedy Notice and insist the Claimants provide the specific facts required for civil remedy notices. See Section 624.155(3)(c), Fla. Stat. (2021). These requirements arise from the following provisions of Section 624.155(3)(c): (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 in order 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 Notice 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 insured 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 plaintiffs’ civil remedy notice included allegations that the defendant conducted an inadequate investigation. The plaintiffs, 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. … Plaintiffs’ 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. Plaintiffs’ 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 Plaintiffs 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. II. The Elements of a Valid Civil Remedy Notice 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 insured 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. Requirements two and four regarding the alleged damages must also be specifically provided in the civil remedy notices. Importantly, the Talat court held that payment of undisputed damages within the cure period is sufficient to preclude a statutory bad faith action. In that circumstance, the insurer has “timely paid ‘the damages’ and has corrected ‘the circumstances giving rise to the violation’ within the meaning of [Section 624.155(2)(d), Florida Statutes].” Id. at 1281. The insurer is not required to pay any compensatory damages that flow from any alleged delay in settling the claim. Importantly, only the contractual benefits are owed during the 60-day cure period. To provide an insurer with the notice of the contractual and extra-contractual damages, Florida law clearly requires facts supporting the amount. Merely requesting payment within policy limits without any basis renders the civil remedy notice invalid. If the civil remedy notice does not satisfy each of the eight elements, it cannot be considered valid pursuant to the Florida case authority cited above. A further requirement of section 624.155, Florida Statutes, is that the complainant shall state with specificity the name of any individual involved in the violation. § 624.155(3)(b)3, Fla. Stat. The Claimants do not name a single individual; therefore, this Notice does not meet the requirements of the statute. For these reasons alone, this CRN should be stricken as the Notice clearly suffers from lack of specificity pursuant to section 624.155(3)(c), Florida Statutes (“Within 20 days of receipt of the notice, the department may return any notice that does not provide the specific information required by this section, and the department shall indicate the specific deficiencies contained in the notice.”). III. Facts The facts surrounding this claim are as follows. On September 3, 2024, a claim was reported by the Claimant regarding purported fire damage sustained to the insured property on or about August 31, 2024. On September 3, 2024, an initial inspection of the property was completed by Defendant’s assigned fire investigator. On September 5, 2024, an independent adjuster assigned by Underwriters also inspected the property. On September 13, 2024, the Claimant’s Public Adjuster sent over numerous invoices purportedly in support of the Claimant’s claim. In the days thereafter, Underwriters and the Public Adjuster communicated via email whereby Underwriters kept the Public Adjuster informed as to the status of the claim investigation. During those communications, Underwriters requested on numerous occasions for inspection reports substantiating various invoices that were previously sent by the Public Adjuster. On October 2, 2024, the Public Adjuster was informed that the full scope of coverage was yet to be determined, but that coverage could be afforded for $13,345.94 worth of food contents that were lost, and that payment of $3,345.94 could be made after applying the deductible. On October 5, 2024, Underwriters requested various invoices that had not been properly attached in the previous correspondences. On October 7, 2024, the documents were sent by the Public Adjuster, but again Underwriters requested inspection reports that would coincide the invoices to the fact that they were a part of the loss for this particular claim. On October 9, 2024, the Public Adjuster sent an executed sworn proof of loss. On October 17, 2024, the Public Adjuster sent an email confirming that a revised estimate was in the process of being completed so that Underwriters could respond to the sworn proof of loss. The Public Adjuster wrongfully asserted that there was unnecessary delay, despite being fully up to date as to nearly every step of the claim investigation which was filed just over a month before this date. Nonetheless, the Notice was filed by the Claimant on October 17, 2024. All the while, the Public Adjuster was, as indicated above, kept fully updated as to the process of the investigation, and was aware of the ongoing nature of the investigation, evidenced by the fact that an Engineering inspection was set to be completed on October 22, 2024, albeit same being canceled by the request of either the Public Adjuster or Claimant. On October 25, 2024, Underwriters sent a formal correspondence rejecting the sworn proof of loss, including the revised estimates, and enclosing supplemental payment totaling $46,184.68. The correspondence requested additional information from the Claimant, and also reiterated the ongoing nature of the investigation, and the fact that this supplemental claim was not a reflection of Underwriters’ total determination as to the scope of covered damages. IV. Inaccuracy of Statutory Allegations in Civil Remedy Notice 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 Claimants, Underwriters 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 Notice. From those facts, it becomes clear that Underwriters is dealing with the claim pursuant to the professional standards of care. Your notice alleges the following statutory violations by Underwriters and, because of the bare nature of the allegations and facts provided, we address each as follows: • 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 – This allegation is baseless. The claim investigation was ongoing at the time this Notice was filed. There had yet to be a full determination of covered damages, and the Claimant and/or Claimant’s representatives were fully aware of this. Thus, no circumstances revealed that Underwriters “should have” settled the claim as so alleged, considering any such determination had yet to be made. • 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 – This allegation is baseless. The claim investigation was ongoing at the time this Notice was filed. There had yet to be a full determination of covered damages, and the Claimant and/or Claimant’s representatives were fully aware of this. Thus, there was no clear “obligation” to settle the claim as so alleged, considering the ongoing nature of the investigation and the premature filing of the Civil Remedy Notice. • Failing to adopt and implement standards for the proper investigation of claims – This allegation is baseless. Underwriters’ investigation involved inspections by an independent adjuster and fire investigator, and was also set to include an inspection by an independent engineer, albeit said inspection was canceled by either the Public Adjuster or Claimant. No facts are contained within the Civil Remedy Notice that would substantiate the assertion that Underwriters failed to implement adequate standards during its investigation, and rather any such allegation is a frivolous attempt to associate a fair and thorough investigation with allegations of statutory bad faith. • Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue – This allegation is baseless. At all times, the Public Adjuster was kept fully updated as to the process of the investigation, and at no time did Underwriters engage in any form of misrepresentation. The frivolity of such an assertion is evidenced by the lack of any coherent facts that would support the statutory allegation. • Failing to acknowledge and act promptly upon communications with respect to claims – The facts directly contradict this allegation. At all times, as stated above, the Public Adjuster was kept up to date on the status of the claims investigation, and at all times was responded to in a prompt manner. • Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement – This allegation is baseless. As evidenced above, Underwriters issued a formal correspondence on October 25, 2024, including therein an explanation as to coverage afforded up to that point, and requesting additional information to supplement the ongoing investigation. This was sent to the insured approximately 45 days after the claim was reported, and well before the 60 day statutory deadline for Underwriters to make an initial coverage decision. Nonetheless, the correspondence, and those with the Public Adjuster prior, clearly show ongoing communications with the insured’s representatives that explain the status of the claim, decisions as to coverages, and the additional information needed by Underwriters to further process the claim. V. Conclusion Underwriters specifically denies any and all allegations contained within the Civil Remedy Notice of Insurer Violation including, but not limited to, those allegations contained within “Reason for Notice” including any claim for bad faith. There are no benefits due or owing at this time to either the Claimant or the insureds and, as such, no attorneys’ fees are due or owing. The facts referenced in the Civil Remedy Notice are inaccurate, incomplete and premature. Underwriters has not acted in bad faith. The CRN also contains no valid cure. Claimant has not produced any evidence to substantiate the aforementioned allegations. Furthermore, the bare nature of the Civil Remedy Notice does not allow for a more specific response to the alleged violations. Underwriters will provide a further response and consider the same if and when any additional information is provided relative to any alleged violation. Underwriters 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. Sincerely, /s/ Klyde Bedford Klyde Bedford
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