Civil Remedy Notice of Insurer Violations
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Filing Number:     788000
Filing Accepted:  10/22/2024
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Complainant
Last/Business Name *  
BAJALIA   First Name   MICHAEL
Street Address * 1246 PALISADES DRIVE
City, State Zip * JACKSONVILLE, FL 32221
Email Address * LL@WEKLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   BAJALIA   First Name   MICHAEL
Policy # * P000292656 Claim #* 253595
Attorney
Attorney is Applicable
Last Name* LIEB First Name * LORA Initial
Street Address* 800 E. BROWARD BLVD STE 510
City, State Zip* FORT LAUDERDALE , FLORIDA 33301
Email Address * LL@WEKLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   SECURITY FIRST INSURANCE COMPANY
NAIC Company Code 10117
 
Name of individual responsible for violation (if any):* OSCAR VAZQUEZ
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
* 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)(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.

A full copy of the policy has not been provided to Plaintiff to date and is in the possession of Security First. Based upon the information in hand, relevant language is as follows: Policy Type: Homeowners HO3 Policy Number:P000292656 Policy Effective Date: 06/27/2023 12:01 AM Policy Expiration Date: 06/27/2024 12:01 AM Coverage A (Dwelling) $361,000 $6,474.00 Coverage B (Other Structures) $7,220 Included Roof Loss Settlement: Replacement Cost Included
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Prior to January 9, 2024, Security First Insurance Company (hereinafter “Security First”) sold an insurance policy, identified by policy number P000292656, to Michael and Emily Bajalia for their home located at 1246 Palisades Dr., Jacksonville, FL 32221 (hereinafter “Home”). Security First sold Mr. and Mrs. Bajalia an H03 policy with broad coverages, including but not limited to coverage for wind damage. On or about January 9, 2024, while the subject policy was in full force and effect a wind/rain storm caused substantial damage to the Home, which resulted in claim no. 253595 (hereinafter “Loss”). After receiving prompt notice of the loss, Security First assigned Elizabeth Evans Custom Homes to inspect the home and photograph the property. As a result of the adjuster’s review, Security First issued its claim decision for the loss claiming that the inspection found “old damage to the shingles from installation” despite issuing the policy less than seven months before the loss occurred. Additionally, Security First claimed that the damage observed was limited to the removal of a satellite dish with unrepaired fasteners despite the roof having lifted and damaged shingles on all slopes. Per the denial letter, it appears that Security First failed to ever consider the weather events around the time of the loss and focused solely on a farcical claim of damage existing from the installation of the roof despite never noticing this supposed damage prior to this loss. At the same time, Mr. and Mrs. Bajalia, through his public adjuster, Fifth Element Adjusting, Inc. (Fifth Element) investigated and adjusted the loss, determining a value of the Loss under Coverages A & B at $44,243.92. Fifth Element presented its findings to Security First yet no payment has been forthcoming to date. Security First adjustment of the loss was not a fair or honest adjustment of the loss. Security First’s adjustment of the loss was intended to provide the illusion of a fair adjustment, to avoid full payment to Mr. and Mrs. Bajalia. Security First knows or should know that its adjustment of the Loss is not a fair or honest assessment of the Loss, yet Security First has refused to attempt to settle the Loss with Mr. and Mrs. Bajalia or their representatives. Security First has made the practice of under valuing a claim in order to leverage more favorable claim settlements and to avoid having to fairly and honestly adjust and pay for losses. Further, Security First does not have appropriate standards in place to be able to investigate claims such as the Loss at Mr. and Mrs. Bajalia’s Home. Security First ’s failure to have appropriate standards, led to the assignment of an inadequate adjusting team, which ultimately led to Security First ’s unfair and dishonest adjustment of the Loss. In total, and as exhibited above, Security First has implemented a strategy and approach to the Loss that is unfair, and Security First is unfairly attempting to deny the Loss. In order to remedy the above referenced violations, Security First must promptly fairly and honestly assess or reassess the Loss so that it may engage in good faith settlement negotiations with Mr. and Mrs. Bajalia and their representatives.
Comments
User Id Date Added Comment
Amanda.lancaster@securityfirstflorida.com 12-20-2024 Via Electronic Filing: Florida Department of Financial Services Bureau of Consumer Assistance c/o: Civil Remedy Section Larson Building 200 East Gaines Street Tallahassee, Florida 32399-0322 Via Email: LORA LIEB 800 E. BROWARD BLVD STE 510 FORT LAUDERDALE, FLORIDA 33301 LL@WEKLAW.COM Re: CIVIL REMEDY NOTICE OF INSURER VIOLATION Filing No.: 788000 Insured: MICHAEL BAJALIA Insurer: Security First Insurance Company Claim No.: 253595 Policy No.: P000292656 Date of Loss: 01/09/2024 Dear Sir or Madam: This correspondence is in response to the Civil Remedy Notice of Insurer Violations (hereinafter referred to as the “CRN”) was filed by LORA LIEB on behalf of her client, MICHAEL BAJALIA (hereinafter referred to as “Insured”). Please be advised that the undersigned represents the interests of Security First Insurance Company (hereinafter referred to as “Security First”) with respect to the above-referenced matter. The Florida Department of Financial Services (hereinafter referred to as “Department”) assigned this CRN an acceptance date of 10/22/2024 and DFS File No.: 788000. This matter concerns a property damage claim made by the Insured pursuant to a homeowners’ insurance policy provided by Security First Policy No. P000292656 and assigned Claim No. 253595. As the basis for filing the CRN against Security First, MICHAEL BAJALIA asserts in the “Reasons for Notice” section violations such as Claim Denial, along with the following statutory violations: 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)(d) Denying claims without conducting reasonable investigations based upon available information. Security First welcomes this opportunity to respond to the CRN and denies each allegation contained therein. The allegations made in the CRN are premature, as the insured has failed to perfect the claim for bad faith and the CRN does not meet the specificity requirement of Section 624.155, Florida Statutes. This CRN does not sufficiently support the allegations stated above. As is standard procedure, upon the first notice of the claim, the subject property was dutifully inspected by an SFIC representative, which was documented through photographs. I. Perfecting a Claim for Bad Faith SFIC specifically denies all allegations set forth in the Notice. SFIC contends that the Notice should be rejected and returned by the Department of Financial Services as it is premature. Pursuant to statute, there is no potential violation until a breach of contract is established. § 624.1551, Florida Statutes. Accordingly, any Notice filed prior to a finding that SFIC has breached the terms of the policy, is not ripe and is premature and thus fails to perfect MICHAEL BAJALIA’s rights to pursue civil remedies under Florida Statutes. II. Specificity Requirement The Insured’s CRN 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. Pursuant to the terms of the statute, (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 violations. Notice to the authorized insurer must be provided by the department to the e-mail address designated by the insurer under s. 624.422. a. 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): b. (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 violations. Notice to the authorized insurer must be provided by the department to the e-mail address designated by the insurer under s. 624.422. i. The statutory provision, including the specific language of the statute, which the authorized insurer allegedly violated. ii. The facts and circumstances giving rise to the violation. iii. The name of any individual involved in the violation. iv. 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, she 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. v. 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”) See Fox v. Starr Indem. & Liab. Co., No. 8:16-CV-3254-T-23MAP, 2017 WL 1541294, at *2 (M.D. Fla. Apr. 28, 2017) (sufficiency means specificity). In Junior Julien v. United Property and Casualty Insurance Company, 311 So.3d 875, 879 (Fla. 4th DCA 2021), the Honorable Court stated: The Middle District of Florida was confronted with a civil remedy notice that was similarly broad in scope and concluded that listing nearly all policy provisions on the notice did not satisfy the statute. Fox v. Starr Indem. & Liab. Co., No. 8:16-CV-3254-T-23MAP, 2017 WL 1541294, at *2 (M.D. Fla. Apr. 28, 2017). The court explained that “[i]f the statute contained no specificity requirement, [then] the [insureds’] casual ‘reference’ to the entire insurance policy undoubtedly would suffice.” Id. But, the court continued, “the Legislature included ‘specific’ or a variant not once but twice in the statute.” Id. As a result, the insureds’ listing of whole sections of the insurance policy “appear[ed] to lack specificity.” Id. 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 plaintiff’s civil remedy notice included allegations that the defendant conducted an inadequate investigation. The plaintiff, 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 more clear. “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. III. Conclusion At all times, Security First has acted in good faith in its handling of the claim and it has acted fairly, honestly, and with due regard for the Insured’s interest and in determining obligations to Insured. Specifically, Security First has complied with its obligations under the applicable Florida Statutes and the applicable Security First Insurance policy. Security First specifically denies any claim for bad faith and argues that the insured’s claim for bad faith is premature. Security First continues to reserve all its rights under the policy, at law and in equity. Regardless, Insured’s conclusory allegations fail to place Security First on notice of any purported violations. Furthermore, the Civil Remedy Notice fails to identify how to cure the allegations set forth. The allegations are without basis. It is clear Security First properly handled and adequately investigated the claim. We hope that this response has answered any concerns regarding this matter. If the Department has any questions concerning this matter, please do not hesitate to contact me. Sincerely, Amanda Lancaster Company Litigation Specialist, Security First Insurance Company Florida Bar No. 67557 1001 Broadway Avenue Ormond Beach, Florida 32714 Amanda.lancaster@securityfirstflorida.com Telephone Number: (386) 245-2413
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