Civil Remedy Notice of Insurer Violations
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Filing Number:     788385
Filing Accepted:  10/23/2024
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Complainant
Last/Business Name *  
CASAMENTO   First Name   TIMOTHY
Street Address * 610 BRINDISI COURT
City, State Zip * PUNTA GORDA, FL 33950
Email Address * TPCPE@MSN.COM
Complainant Type: * Insured
Insured
Last/Business Name*   CASAMENTO   First Name   TIMOTHY
Policy # * FPH5345552-01 Claim #* FPI230870
Attorney
Attorney is Applicable
Last Name* VELMOSKY First Name * AARON Initial M
Street Address* 800 EAST BROWARD BLVD, STE. 510
City, State Zip* FT. LAUDERDALE , FLORIDA 33301
Email Address * AV@WEKLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   FLORIDA PENINSULA INSURANCE COMPANY
NAIC Company Code 10132
 
Name of individual responsible for violation (if any):* MIKE TREATSER, BRADLEY MARSHALL, BENT BUCKENDAHL, DEBBIE BAXTER, JAMES CURD, LARASHA CARATHERS
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)(d) Denying claims without conducting reasonable investigations based upon available information.
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.

SECTION I – PERILS INSURED AGAINST COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES 1. We insure for sudden and accidental direct loss to property described in Coverages A and B only if that loss is a physical loss to covered property. Section I - Conditions 3. Loss Settlement. Covered property losses are settled as follows: a. Property of the following types: (1) Personal property; (2) Awnings, carpeting, household appliances, outdoor antennas and outdoor equipment, whether or not attached to buildings; and (3) Structures that are not buildings; at actual cash value at the time of loss but not more than the amount required to repair or replace. b. Buildings under Coverage A or B at replacement cost without deduction for depreciation, : (1) Subject to: (a) The limit of liability under this policy that applies to the building; (b) The replacement cost of that part of the building damaged for like construction and use on the same premises; or (c) The necessary amount actually spent to repair or replace the damaged building. (d) “Emergency Mitigation Services” will be adjusted in accordance with Additional Coverages 2. “Emergency Mitigation Services” of this policy. (e) All repairs other than “Emergency Mitigation Services” performed by repairpersons(s), contractors, or “assignees” shall not exceed the reasonable and necessary labor, materials, costs or measures to repair the property, unless otherwise specifically covered under the terms and conditions of the policy (e.g., ordinance or law coverage). (f) Any contract entered into by you to perform non-emergency repairs for any loss attributed to a covered peril shall not interfere with the Our Option provision under this policy. (2) If, at the time of loss, the amount of insurance in this policy on the damaged building is less than 80% of the full replacement cost of the building immediately before the loss, we will pay the greater of the following amounts, but not more than the limit of liability under this policy that applies to the building: (a) The actual cash value of that part of the building damaged; or (b) That proportion of the cost to repair or replace, after application of deductible and without deduction for depreciation, that part of the building damaged, which the total amount of insurance in this policy on the damaged building bears to 80% of the replacement cost of the building. (3) To determine the amount of insurance required to equal 80% of the full replacement cost of the building immediately before the loss, do not include the value of: (a) Excavations, foundations, piers or any supports which are below the undersurface of the lowest basement floor; (b) Those supports in (a) above which are below the surface of the ground inside the foundation walls, if there is no basement; and (c) Underground flues, pipes, wiring and drains. (4) We will initially pay at least the actual cash value of the insured loss less any applicable deductible. We shall pay any remaining amounts necessary to perform such repairs as work is performed and expenses are incurred or we will pay a licensed contractor after the insured signs a contract and as repairs are made to the covered property. If a total loss of the covered dwelling occurs, we shall pay the replacement cost coverage without reservation of any depreciation in value, subject to policy limits. (5) If the dwelling where loss or damage occurs has been “vacant” for more than thirty (30) consecutive days before the loss or damage, we will: Not pay for any loss or damage caused by any of the following perils, even if they are Perils Insured Against: (a) Vandalism; (b) Sprinkler leakage, when caused by or arising out of the freezing of a fire protective sprinkler system, unless you have protected the system against freezing; (c) Dwelling glass breakage; (d) Water damage; (e) Theft; or (f) Attempted theft. Dwellings under construction are not considered “vacant.” In the event the construction extends greater than 60 days you must notify us. Section I - Conditions 10. Loss Payment. We will adjust all losses with you. Claims payments issued for damage under Coverage A – Dwelling or Coverage B – Other Structures will be made payable to all persons, parties, and entities with an insurable interest in the property covered (including but not limited to, named insureds and mortgagees listed on the Declarations page of this Policy), and your “assignee(s)”. In the event that any repair services were performed under the Our Option provision, we will pay the retained contractor directly for those services or part or portion of any services the retained contractor performs or provides. For all other claims payments, we will pay you unless some other person is named in the policy or is legally entitled to receive payment. Loss will be payable upon the earlier of the following: a. Twenty (20) days after we receive your proof of loss and reach written agreement with you; or b. Sixty (60) days after we receive your proof of loss; and (1) There is an entry of a final judgment; or (2) There is a filing of a mediation settlement with us. c. Within 90 days after we receive the notice of a property insurance claim from you, we shall pay or deny such claim or portion of such claim, unless there are circumstances beyond our control, which reasonably prevent such payment. Our failure to comply with this paragraph shall not form the sole basis for an action against us for breach of contract under this policy or for benefits under this policy. “Emergency Mitigation Services” will be payable in accordance with SECTION I – PROPERTY COVERAGES, ADDITIONAL COVERAGES, 2. “Emergency Mitigation Services”.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Timothy Casamento (the "Insured") purchased an insurance policy ("Policy") from Florida Peninsula Insurance Company ("Florida Peninsula"), with effective coverage on the date of the loss, on or about September 28, 2022, and policy number FPH5345552-01 to insure his home located at 610 Brindisi Court, Punta Gorda, FL 33950 (the "Property"). Of note, the Property is located upon a canal; and therefore, there is open water bordering its rear elevation. On or about September 28, 2022, the aforementioned Property’s exterior was damaged as a result of Hurricane Ian’s dangerous winds (the “Loss”). As a result of this event, the Property sustained immediate direct damage throughout its roofing system, including slipped and broken tiles, and to its elevations, including damage to the soffits, gutters and pool cage. As a result of Hurricane Ian’s strong winds, the screen enclosure folded back and crashed into the roofing system. Additionally, the strong negative pressure generated by Ian’s winds sucked portions of the insulation out of the attic through a hole in the soffit and strewn same throughout the Property, including upon the dwelling’s exterior elevations. As time passed, the Insured noticed ensuing water damage to the living room and second floor landing ceilings. This damage was not immediately apparent when the Loss was reported to Florida Peninsula. The Insured promptly reported his claim to Florida Peninsula after discovering the exterior damage. Florida Peninsula acknowledged receipt of the claim by generating claim number FPI230870 on or about October 2, 2022. Florida Peninsula unreasonably delayed its initial investigation by requesting multiple inspections and the production of documentation in support what was clearly a covered loss. For example, Florida Peninsula initially sent a field adjuster, Sony Richard, to inspect the Property on October 15, 2022. Mr. Richard, inspected the Property, took photographs in the presence of the Insured, interviewed the Insured about the Loss and advised the Insured that he observed wind damage to the roofing system, which he did not think that Florida Peninsula would agree to cover. This representation would ring true, as to date, Defendant has not opened coverage for any portion of the sustained roofing system damage. However, what is puzzling is Florida Peninsula’s disclaimer as to the scope of Mr. Richard’s involved in the claim investigation. In deposition, Defendant’s corporate representative testified that there was a note in the file concerning an inspection that was scheduled for October 15, 2022. However, she conveniently testified that she did not know if what involvement Mr. Richard had with the file, that she did not have any photographs from that date and did not know if the inspection went forward. Assuming that Florida Peninsula’s corporate representative’s testimony was accurate, it appears that Florida Peninsula did not make a strong effort to learn of Mr. Richard’s findings. It is not as if Mr. Richard is no longer an adjuster as he still holds an adjuster’s license and has a current appointment that does not expire until May 31, 2026. Florida Peninsula conducted a second field adjuster inspection on November 8, 2022. When asked what damage had been observed, Defendant’s corporate representative deferred to what the Insured had pointed out. No clear factual support was identified. Of note, the field adjuster did not inspect the roofing system. Accordingly, over a month later, on December 12, 2022, Florida Peninsula conducted a third field adjuster inspection. Based upon that inspection, Defendant’s corporate representative testified that there was no covered damage to the roofing system. Yet, she refused to offer any factual support for this conclusion. Instead, she deferred to the field adjuster, whose photographs depicted impact damage to the roofing tiles located two rows above where the folded back screen enclosure came to rest. Despite this clear evidence of wind-related damage, Florida Peninsula denied coverage for the claimed roofing damage and issued payment for the undisputed amount of loss in the sum for exterior damage in the sum of $9,828.83 Coverage A; $2,197.36 Coverage B and $10K for screen enclosure. This determination was set forth in correspondence, dated December 27, 2022, on letterhead naming Florida Peninsula Insurance Company and Edison Insurance Company. The supporting estimate bore a header identifying a company named Peak Claims Group, which was based out of Alabama. Prior to the issuance of the coverage determination, the Insured produced documentation in support of the claim, including requested photographs depicting the sustained screen enclosure and fan damage, an invoice for power washing, an estimate for Bahama shutters, an estimate for a roof replacement from Total Home Exteriors, and invoices for additional amounts paid to repair exterior damage. Florida Peninsula’s initial payment was predicated upon invoices submitted for repairs to the Bahama shutters, exterior painting, insulation, flag pole and boat dock. Thereafter, the Insured opened a supplemental claim. In response, Florida Peninsula conducted a fourth field adjuster’s inspection and then issued a supplemental payment in the sum of $7,506.02, which allowed for some, but not all of the claimed interior damage, as described in correspondence dated February 20, 2023, on letterhead naming Florida Peninsula Insurance Company and Edison Insurance Company. The estimate supporting this payment sum also removed line items for work to the rear elevation that Florida Peninsula had previously opened coverage. The supporting estimate appeared with a header of a company named AllCat that was based out of Texas. In response to the supplemental claim determination, the Insured sought further payment for the damages, inter alia, to the interior drywall, roofing system, dock pole and pool masonry. Within a few days, rejected coverage for the interior drywall contending that same resulted from settlement. On or about April 28, 2023, Florida Peninsula rejected coverage for all supplementally claim damage in reliance upon its prior stance. This position was set forth in correspondence, dated April 28, 2023, with a letterhead naming Florida Peninsula Insurance Company and Edison Insurance Company. Defendant’s corporate representative’s testimony suggest that this was an inappropriate conclusion as she confirmed that Plaintiff submitted evidence that he incurred $354.49 to repair a dock pole and $622 to perform masonry work performed on February 22, 2023, and for some reason tried to argue that those payments were previously address in the prior claims communications. The Insured cannot understand how or why that would be as he did not pursue the incurred amounts until the second supplemental claim determination was rendered. Defendant’s corporate representative then initially testified that nothing further happened with regard to the claim until a Notice of Intent to Initiate Litigation was served by the Insured. Upon further questioning, Defendant’s corporate representative confirmed receipt of an email communication whereby the Insured’s public adjuster provided a copy of the Insured’s engineering report concluding that wind damage had been sustained to the roofing system and advising that the roofing system would be replaced in the near future. However, Defendant’s corporate representative testified that the report itself was not in the file. After hearing nothing further from Florida Peninsula, the Insured’s public adjuster reached out again on June 2, 2023 advising that the roofing system would be replaced on June 9, 2023. Defendant’s corporate representative testified that Florida Peninsula, whom previously requested four inspections ultimately conducted by a field adjuster, did not seek a fifth inspection by someone that would be qualified to conclude whether the Insured’s engineer misidentified the cause or origin of the sustained roofing system damage. On June 15, 2023, the Insured served a notice of intent to initiate litigation upon Florida Peninsula. Florida Peninsula responded to the notice through correspondence, dated June 28, 2023 bearing a letterhead of Florida Peninsula Insurance Company and Edison Insurance Company, with a pre-suit settlement offer, which the Insured rejected. Suit was filed thereafter. Through this suit, the Insured has submitted documentation evidence that he spent at least $123,916.93 transacting repairs to his property. To date, Florida Peninsula has issued payment for the value of $34,880.21 for those repairs. Nevertheless, Florida Peninsula has not released the $5,996.22 of depreciation that has been withheld. On or about August 30, 2024, the Insured, in error, filed a Civil Remedy Notice of Insurer Violation, Filing No. 780919 (the “First Notice”) against Edison Insurance Company (“Edison”). The First Notice correctly identified the Policy, Property and Loss. Yet, same improperly identified Edison, in place of Florida Peninsula. On or about October 23, 2024, Florida Peninsula responded to the First Notice. Therein, Florida Peninsula correctly advised that the First Notice was filed against the incorrect party. Importantly, had Florida Peninsula pointed this out to the Insured, the First Notice would have been withdrawn. Upon discovery of the response to the First Notice, the Insured updated filing number 780919 and withdrew the First Notice. Accordingly, the Insured offers this Notice to cure those defects. Of note, based upon its response to the First Notice, the Insured anticipates an objection to this Notice. For example, Florida Peninsula previously alleged that the identification of the following policy provisions was not specific: SEction I - Conditions, Loss Settlement; Section I - Conditions, Loss Payment; Section I - Perils Insured Against -- 1. We insure for sudden and accidental direct loss to property described in Coverages A and B only if that loss is a physical loss to covered property. In support Florida Peninsula identified Julien v. United Property and Casualty Insurance Co., 311 So. 3d 875 (Fla. 4th DCA 2021). Julien provided that a “blanket” identification of the “entire policy” did not meet the specificity requirement. The First Notice identified three provisions of the subject policy of insurance with particularity, which should have allowed Florida Peninsula the ability to respond. Accordingly, to avoid any confusion moving forward, the Insured identifies the following provisions: SECTION I – PERILS INSURED AGAINST COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES 1. We insure for sudden and accidental direct loss to property described in Coverages A and B only if that loss is a physical loss to covered property. Section I - Conditions 3. Loss Settlement. Covered property losses are settled as follows: a. Property of the following types: (1) Personal property; (2) Awnings, carpeting, household appliances, outdoor antennas and outdoor equipment, whether or not attached to buildings; and (3) Structures that are not buildings; at actual cash value at the time of loss but not more than the amount required to repair or replace. b. Buildings under Coverage A or B at replacement cost without deduction for depreciation, : (1) Subject to: (a) The limit of liability under this policy that applies to the building; (b) The replacement cost of that part of the building damaged for like construction and use on the same premises; or (c) The necessary amount actually spent to repair or replace the damaged building. (d) “Emergency Mitigation Services” will be adjusted in accordance with Additional Coverages 2. “Emergency Mitigation Services” of this policy. (e) All repairs other than “Emergency Mitigation Services” performed by repairpersons(s), contractors, or “assignees” shall not exceed the reasonable and necessary labor, materials, costs or measures to repair the property, unless otherwise specifically covered under the terms and conditions of the policy (e.g., ordinance or law coverage). (f) Any contract entered into by you to perform non-emergency repairs for any loss attributed to a covered peril shall not interfere with the Our Option provision under this policy. (2) If, at the time of loss, the amount of insurance in this policy on the damaged building is less than 80% of the full replacement cost of the building immediately before the loss, we will pay the greater of the following amounts, but not more than the limit of liability under this policy that applies to the building: (a) The actual cash value of that part of the building damaged; or (b) That proportion of the cost to repair or replace, after application of deductible and without deduction for depreciation, that part of the building damaged, which the total amount of insurance in this policy on the damaged building bears to 80% of the replacement cost of the building. (3) To determine the amount of insurance required to equal 80% of the full replacement cost of the building immediately before the loss, do not include the value of: (a) Excavations, foundations, piers or any supports which are below the undersurface of the lowest basement floor; (b) Those supports in (a) above which are below the surface of the ground inside the foundation walls, if there is no basement; and (c) Underground flues, pipes, wiring and drains. (4) We will initially pay at least the actual cash value of the insured loss less any applicable deductible. We shall pay any remaining amounts necessary to perform such repairs as work is performed and expenses are incurred or we will pay a licensed contractor after the insured signs a contract and as repairs are made to the covered property. If a total loss of the covered dwelling occurs, we shall pay the replacement cost coverage without reservation of any depreciation in value, subject to policy limits. (5) If the dwelling where loss or damage occurs has been “vacant” for more than thirty (30) consecutive days before the loss or damage, we will: Not pay for any loss or damage caused by any of the following perils, even if they are Perils Insured Against: (a) Vandalism; (b) Sprinkler leakage, when caused by or arising out of the freezing of a fire protective sprinkler system, unless you have protected the system against freezing; (c) Dwelling glass breakage; (d) Water damage; (e) Theft; or (f) Attempted theft. Dwellings under construction are not considered “vacant.” In the event the construction extends greater than 60 days you must notify us. Section I - Conditions 10. Loss Payment. We will adjust all losses with you. Claims payments issued for damage under Coverage A – Dwelling or Coverage B – Other Structures will be made payable to all persons, parties, and entities with an insurable interest in the property covered (including but not limited to, named insureds and mortgagees listed on the Declarations page of this Policy), and your “assignee(s)”. In the event that any repair services were performed under the Our Option provision, we will pay the retained contractor directly for those services or part or portion of any services the retained contractor performs or provides. For all other claims payments, we will pay you unless some other person is named in the policy or is legally entitled to receive payment. Loss will be payable upon the earlier of the following: a. Twenty (20) days after we receive your proof of loss and reach written agreement with you; or b. Sixty (60) days after we receive your proof of loss; and (1) There is an entry of a final judgment; or (2) There is a filing of a mediation settlement with us. c. Within 90 days after we receive the notice of a property insurance claim from you, we shall pay or deny such claim or portion of such claim, unless there are circumstances beyond our control, which reasonably prevent such payment. Our failure to comply with this paragraph shall not form the sole basis for an action against us for breach of contract under this policy or for benefits under this policy. “Emergency Mitigation Services” will be payable in accordance with SECTION I – PROPERTY COVERAGES, ADDITIONAL COVERAGES, 2. “Emergency Mitigation Services”. Of note, Florida Peninsula also blatantly mispresented facts concerning its investigation, including the omission of any mention of Sony Richard, its first field adjuster, whom it sent out to the Property. This individual told the Insured that he observed wind damage to the roofing system and Florida Peninsula has acted as if he did not exist. To the extent that Florida Peninsula corporate representative testified accurately, Florida Peninsula at a minimum failed to oversee the participants of its claim investigation and make a reasonable effort to obtain its work product. Notwithstanding, the Insured believes that Florida Peninsula knew that Mr. Richard observed wind damage, so it disregarded his opinion in violation in violation of its obligation to investigate the claim in good faith and to have a fair dealing with the Insured. Additionally, through its response to the First Notice, Florida Peninsula discussed a letter from Total Home Exteriors signed by Michael Rimkus, which represented that wind damage had been sustained to the roofing system. To further investigate, Defendant sent another field adjuster to the Property to investigate. According to Defendant’s corporate representative that individual was sent to the Property to “confirm and missing or additional damage that was being claimed by the insured.” The roofing system damage had been claimed since day one and had been inspected by the three adjusters. Moreover, in its response to the First Notice, Florida Peninsula “[used] the previous field adjuster as a baseline”. To date, the Insured has been unable to depose this field adjuster; and therefore, he has not learned why the field adjuster did not agree that that the damage pointed was wind damage. Florida Peninsula’s response to the First Notice further did not explain why it did not send out anyone to the Property to inspect same after it was presented with an engineering report confirming the presence of wind damage. At that point, multiple professionals, both roofers and an engineer, advised that wind damage was present. To counter those allegations, Florida Peninsula was unreasonably relying upon field adjusters, who lack the qualifications to offer an opinion as to the cause or origin of damage. Lasty, despite conceding that a “plethora of documentation was received” Florida Peninsula neglected to offer any explanation as to why the requested recoverable depreciation was not refunded to the Insured. By stating the above detailed facts, it is clear that Florida Peninsula has violated the following Florida statutes: • 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 their interest; • 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) 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; or • 626.9541(1)(i)(3)(b) Failing to adopt and implement standards for the proper investigation of claims; • 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims, by failing to respond to the Insured’ public adjuster, and Insured’ counsel with respect to supplemental requests for payments; • 626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information. • 626.9541(1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the Insured and/or their public adjuster of the basis in the insurance policy, in relation to the facts or applicable law, for the offer of a compromise settlement; To date, Florida Peninsula has failed to accept and fully perform its obligations under the operable insurance contract. The Property remains in an unsafe condition because they have not been paid the necessary, covered insurance proceeds sufficient to return the Property to its pre-loss condition. As a direct result of Florida Peninsula’s initial insufficient investigation and handling of the claim, deficient extension of coverage and subsequent breaches of not only the policy of insurance, but also Florida Statutes, the Insured had no choice other than to seek the help of licensed professionals to assist him, including, but not limited to a public adjuster and legal counsel. Considering the aforementioned conduct, it is irrefutable that Florida Peninsula knowingly and intentionally, and in bad faith delays the claims process in order to further disadvantage the Insured. The financial detriment caused to the Insured is a direct result of Florida Peninsula’s dismissive, reckless treatment of the claims process. The Insured submitted all available requested documents in his custody and control in a timely fashion, repeatedly made the Property available for inspection and submitted additional documentation in support of the insurance proceeds sought under his insurance contract, including an engineering report. Nevertheless, Florida Peninsula failed to properly assess this information and reach the logical conclusion that it needed to retain an engineer to inspect the damaged property before the roofing system was replaced. Florida Peninsula also neglected to follow up with its initial field adjuster and obtain his work product. The Insured suspects that had it done so his claim would have quickly been resolved due to the initial adjuster’s detection of wind damage. Consequently, Florida Peninsula’s overall conduct from start to find amounts to its gross mismanagement and handling of the claim. To deny the Insured the remaining benefits clearly due and owing under the Policy, for which he has time and time again been making premium payments for and after he has satisfied all his obligations is morally and ethically reprehensible, and reeks of Unfair Claims Practice and Bad Faith. Upon information and belief, the above identified actions taken by Florida Peninsula, among others, were made so often as to constitute a general business practice, evidencing a motive to enhance Florida Peninsula’s profits, and designed to cause a detrimental effect to its policyholders. Such motive seems readily apparent to the participants of Florida Peninsula’s claim investigation concerning the initial field adjuster’s comment to the Insured concerning his belief that Florida Peninsula would not pay for the roofing system damage. This notice is given to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should Florida Peninsula fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, Florida Peninsula must: (1) Immediately tender all proceeds due and owing to the Insured that are fairly owed to the Insured under the insurance policy that would reasonably compensate the Insured in order to put the loss property back to its pre-loss condition in the sum of at least $169,429.17; (2) Concede that the Policy affords coverage for the replacement of the roofing system; (3) Concede that the sustained damage in the second floor landing and living room is afforded coverage; (4) Agree to reimburse the Insured's reasonable attorneys’ fees and costs for having to become involved to resolve the claim; (5) Agree to reimburse the Insured for interest on the amount of benefits that was found to be due and owing to the Insured, relating back to the date of loss.
Comments
User Id Date Added Comment
jbosch@qpwblaw.com 12-16-2024 QUINTAIROS, PRIETO, WOOD & BOYER ATTORNEYS AT LAW 9300 S. Dadeland Boulevard 4th Floor MIAMI, FLORIDA 33156 TELEPHONE: (305) 670-1101 - FACSIMILE: (305) 670-1161 December 16, 2024 VIA DFS WEBSITE Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Complainant: TIMOTHY CASAMENTO Claim No: FPI230870 (“subject claim”) Policy No: FPH5345552-01 (“policy”) Loss Location: 610 Brindisi Court, Punta Gorda, Florida 33950 (“property”) CRN Filing No: 788385 CRN Acceptance Date: 10/23/2024 RE: CIVIL REMEDY NOTICE - DFS FILING NUMBER 788385 Dear Sir or Madam: The undersigned counsel represents Florida Peninsula Insurance Company (“Florida Peninsula”) in regard to the alleged dispute as to the subject claim number listed above involving an alleged windstorm with a date of loss of on or about September 28, 2022, made under the Policy of insurance Florida Peninsula issued to the Insureds, Timothy Casamento and Kleo King. This correspondence constitutes Florida Peninsula Insurance Company’s response to the Civil Remedy Notice of Insurer Violations (“Notice” or “CRN”) filed on behalf of Timothy Casamento (referenced herein as “Insured” or “Complainant”) regarding the claim listed above. Based on the below response, the Civil Remedy Notice should be rejected and returned by the Department of Financial Services as it is substantively defective and objectionable for the reasons stated herein, and, without waiving objections, as it completely misstates the facts surrounding this claim. ALLEGED STATUTORY VIOLATIONS Subject to, but notwithstanding, the fact that Complainant has completely failed to make any allegations of statutory violations committed against the insuring party – Florida Peninsula Insurance Company – Florida Peninsula responds as follows: 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. Florida Peninsula specifically denies any inferred allegations that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. Outside of any baseless statements made within the CRN and incorrect presumptions and assumptions. The CRN does not include any specific verifiable facts to support this allegation. Florida Peninsula conducted a thorough investigation of the claimed damages, in good faith, and issued multiple payments accordingly. Simply because the value of covered damages determined by Florida Peninsula was not equivalent to the unjust demands Complainant, does not mean that Florida Peninsula has violated the above statue. Rather, Florida Peninsula has properly applied the verifiable facts of its investigation to terms, conditions, limitations, and exclusions of the subject policy and Florida law. As such, Florida Peninsula has complied with its duties and obligations under the subject policy and Florda law and has acted fairly and honestly towards the Complainant and with due regard for 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. Florida Peninsula specifically denies any inferred allegations that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. Outside of any baseless statements made within the CRN and incorrect presumptions and assumptions. The CRN does not include any specific verifiable facts to support this allegation. Florida Peninsula conducted a thorough investigation of the claimed damages, in good faith, and issued multiple payments accordingly. Simply because the value of covered damages determined by Florida Peninsula was not equivalent to the unjust demands Complainant, does not mean that Florida Peninsula has violated the above statue. Rather, Florida Peninsula has properly applied the verifiable facts of its investigation to terms, conditions, limitations, and exclusions of the subject policy and Florida law. As such, Florida Peninsula has complied with its duties and obligations under the subject policy and Florda law and has acted fairly and honestly towards the Complainant and with due regard for his interests. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. Florida Peninsula specifically denies any inferred allegations that it has violated the above referenced statute. The CRN does not include any facts to support this allegation. Florida Peninsula did not fail to adopt and implement standards for the proper investigation of the claim. 626.9541(1)(i)(3)(b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. Florida Peninsula specifically denies any inferred allegations that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. The CRN does not include any facts to support this allegation. Florida Peninsula did not materially misrepresent anything to the insured, limiting coverage is not a material misrepresentation. 626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims. Florida Peninsula specifically denies any inferred allegations that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. The CRN does not include any facts to support this allegation. Florida Peninsula did not fail to acknowledge or act promptly upon communications with respect to the subject claim. 626.9541(1)(i)(3)(d): Denying claims without conducting reasonable investigations based upon available information. Florida Peninsula specifically denies any inferred allegations that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. Outside of any baseless statements made within the CRN and incorrect presumptions and assumptions. The CRN does not include any specific verifiable facts to support this allegation. Florida Peninsula conducted a thorough investigation of the claimed damages, in good faith, and issued multiple payments accordingly. Simply because the value of covered damages determined by Florida Peninsula was not equivalent to the unjust demands Complainant, does not mean that Florida Peninsula has failed to conduct a reasonable investigation of the Complainants claim. Rather, Florida Peninsula has properly applied the verifiable facts of its investigation to terms, conditions, limitations, and exclusions of the subject policy and Florida law. 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. Florida Peninsula specifically denies any inferred allegations that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. Contrary to the Complainant’s baseless allegations, the actual facts of this matter indicate that Florida Peninsula specifically explained its coverage determinations in this claim on December 27, 2022, February 20, 2023, and April 28, 2023. Despite the baseless allegations against Florida Peninsula Insurance Company included in Complainant’s CRN, Florida Peninsula sent these coverage correspondences to the Insured during the claims process and have since been provided to Complainant and his counsel in the civil litigation of this matter. As such, Florida Peninsula has not failed to promptly provide reasonable explanation in writing of the basis in the insurance policy for denial of a claim or for the offer of a compromise settlement. Furthermore, Complainant makes bald allegations regarding testimony provided by Florida Peninsula’s Corporate Representative in the civil proceeding related to the subject claim. Not only do these allegations assume Complainant’s self-serving analysis of testimony provided as fact, but they also fail to properly explain the testimony of the Florida Peninsula’s Corporate Representative in the context in which it was given. The testimony transcript, which has been stenographically recorded, is the full, complete, an accurate account of the testimony provided and as a writing, speaks for itself. In addition to the allegations specifically denied above, Florida Peninsula generally denies all allegations presented in this CRN, as Florida Peninsula has not violated any statute, Code or Rule. SPECIFICITY REQUIREMENTS Florida Statute requires that a CRN state the facts and circumstances giving rise to the alleged violations with specificity sufficient to allow an insurer to “cure” the alleged violations within the sixty-day statutory period. See Fla. Stat. § 624. 155(3)(b)(2). See also Lane v. Westfield Ins. Co., 862 So. 2d 774, 777 (Fla. 5th DCA 2003), Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). However, here, the CRN is deficient and defective in that it fails to state with sufficient specificity the necessary facts in support of the Complainant’s contentions, including but not limited to, those that would be necessary for Florida Peninsula to “cure” the alleged violations. Further, the subject CRN provides what appears to be several boilerplate and conclusory statements, which fail to describe any accurate facts constituting violations of the statutes cited therein. Thus, because the allegations in the CRN are incomplete and incorrect, they fail to provide actual notice of the specific allegations and the actions that Florida Peninsula could undertake to cure any alleged violations. 316, Inc. v. Maryland Cas. Co., 625 F. Supp. 2d 1187, 1193 (N. D. Fla. 2008). Blanket references to policy provisions and statutes without specification deems the Civil Remedy Notice deficient. Julien v. United Property and Casualty Insurance Co., 311 So. 3d 875 (Fla. 4th DCA 2021). For the reasons set forth herein, Florida Peninsula hereby objects to the subject CRN and states it does not intend to waive, ratify or otherwise accept the deficiencies in the CRN, and reserves the right to contest the legal adequacy of the CRN hereinafter as appropriate. As to the content of the CRN here, it is important to note that said CRN is a nullity and should be rejected because the CRN fails to comply with the specific requirements mandated by Florida Statutes §624.155. Specifically, Fla. Stat. § 624.155(3)(b)(2) requires the Complainant to set forth with specificity, sufficient factual allegations to state a prima facie case of an insurer violation, so as to put the insurer on notice and be afforded the opportunity to cure the deficiency. However, the Complainant failed to do so in the subject CRN and instead only included conclusory statements, which lack even minimal specificity and/or lack the underlying factual basis to support them. The Complainant’s failure to describe any actual facts or circumstances, outside of self-supporting assumptions and unverifiable statements, to support the alleged statutory violations in the CRN precludes Florida Peninsula from evaluating what error, if any, allegedly occurred during the claim process. Furthermore, contrary to the requirement to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time,” the purpose of which is “to enable the insurer to investigate and resolve [the] claim,” the CRN itself only provides unsupported and incorrect allegations with no basis in fact or circumstances. Consequently, the CRN lacks the requisite minimal specificity and Florida Peninsula is unable to determine what specifically the Complainant is claiming was done by or on behalf of Edison that constitutes the bad faith alleged. Rather, Complainant simply argues that he is in disagreement with Florida Peninsula’s valuation of the claim and provides no verifiable evidence of any bad-faith claims handling on the part of the insurer. Due to the absence of specific and accurate information regarding the alleged acts or omissions by Florida Peninsula which allegedly give rise to any violation of the Civil Remedy Statute, Florida Peninsula is limited in its ability to set forth specific facts to address and/or refute these unsubstantiated assertions. Notwithstanding, Peninsula explicitly denies violations of any applicable Florida Statute in the adjustment of the subject claim and realleges and re-asserts its specific denials to the alleged violations in the subject CRN as set forth above. Florida Peninsula maintains that it has acted and continues at all times to act in good faith during the investigation and adjustment of the Insured’s claim. Further, Florida Peninsula wishes to dispel even the inference of any statutory violation and reiterates below the various reasons which clearly show the proper handling of the subject claim by Florida Peninsula. Additionally, the CRN fails to state with specificity the actual policy language relevant to an alleged. Blanket references to policy provisions and statutes without specification deems the Civil Remedy Notice deficient. Julien v. United Property and Casualty Insurance Co., 311 So.3d 875 (Fla. 4th DCA 2021). The Complainants failed to state any specific policy language. The CRN refers to general headings and the Complainants’ interpretation of the policy and facts. Thus, the CRN does not satisfy the requirements. Moreover, as stated in Demase v. State Farm Florida Insurance Company, 351 So. 3d 136 (Fla. Dist. Ct. App. 2022), and as a condition precedent to bringing a first-party bad faith case, an insured must provide timely notice of the alleged violation to the authorized insurer and to the DFS. The Insureds have failed to provide such timely notice to Florida Peninsula. BACKGROUND FACTS Florida Peninsula received first notice of this loss on October 2, 2022 with a reported date of loss of September 28, 2022. The loss was reported by Insured, Kleo King, as damage done to the home as a result of Hurricane Ian. The claim was thereafter assigned to independent adjusters, Bradley Marshall and Mike Treaster, of Peak Claims Group for further handling and investigation. Mr. Treaster inspected the property on November 8, 2022, while FA Bradley Marshall inspected the roof on December 12, 2022. Following the inspections an estimate of damages restoring the property to its pre-loss condition was prepared. Florida Peninsula ultimately determined that partial coverage would be afforded for the claim and on December 27, 2022 issued written correspondence to the Insureds indicating and explain the nature of its coverage decision. FPI sent written correspondence to the Insureds communicating their decision on the same date and provided net indemnification in the amounts of $9,828.83 for Coverage A, $2,197.36 for Coverage B, and exhausting the limit of liability for Screened Enclosures in the amount of $10,000. Furthermore, the coverage letter advised the Insureds that Florida Peninsula did not observe any wind damage to the tile roof. The letter also advised that they observed a worn tile roof system in the form of slid tiles, horizontal cracks from foot traffic and corner expansion cracks – damages specifically excluded from coverage under the Policy. Subsequently, FPI received a plethora of documentation from Plaintiffs and their representatives specifically claiming that the roof of the property is damaged from the storm and that the initial indemnification was undervalued. We will discuss the documentation in further detail infra. One of the primary documents that Plaintiffs provided was a letter from Total Home Exteriors of Florida, Inc. dated October 15, 2022. The letter advised that Michael Rimkus inspected the roof on October 15, 2022 and found that there were multiple locations of broken, damaged and loss tiles found on the surface and that hurricane force winds and flying debris caused said damage. Total Home claimed that the original fastening mechanisms of the roof became detached or “pulled out” from the roof deck due to the winds from Hurricane Ian. Furthermore, Mr. Rimkus advised that the tiles on the roof are Hanson Venetian currier barrier tiles that are discontinued. The roof was opined to be unrepairable and will need to be replaced in order to guarantee the performance of the roof covering. As a result of the documentation provided to Florida Peninsula, a supplemental claim was opened to further its investigation. Florida Peninsula retained independent adjuster, Brent Buckendahl, of Allcat Claims Service, to re-inspect the subject property. Mr. Buckendahl inspected the property on January 30, 2023 in the presence of Plaintiffs’ roofer, Wayne Griffing of Total Home. The roofer claimed that the uplift of certain tiles was indicative of wind damage. Contrarily, these same areas of the roof exhibited old weathered damage from wear and tear, and were not specifically storm related. Following his inspection, Mr. Buckendahl prepared an estimate of damages restoring the property to its pre-loss condition, using the previous field adjuster estimate as a baseline. Mr. Buckendahl noted that there was invoice documentation for the soffit repairs from Quality Aluminum Soffit and Fascia totaling $3,180, which was specifically included as a line item in his estimate. Allowances were made for replacement of a ceiling fan on the first floor, allowances for lighting replacement of an invoice from Mister Sparky for repairs to the boat deck, and allowances for Parsons Construction Group invoice totaling $11,754.50 for attic insulation. Mr. Buckendahl’s estimate totaled $23,331.07 RCV for the Dwelling, $2,675.05 RCV for Other Structures and $36,644,24 RCV for the Screened Enclosure. Following Mr. Buckendahl’s inspection and reviewing additional information to that date, on February 20, 2023, Florida Peninsula issued a supplemental coverage determination and supplemental indemnification totaling $7,506.02 for Coverage A. Clear and concise explanations of the supplemental coverage determination were included in the February 20, 2023 Supplemental Coverage Letter along with specific policy excerpts. Unsatisfied with Florida Peninsula’s Coverage Determinations and indemnity payments in this letter, Claimant, along with co-insured Kleo King, filed a breach of contract action in Charlotte County, Florida, which is currently active and pending. As the above CRN is merely a disagreement with the evaluation of damages under the policy, all Plaintiff’s concerns properly raised and addresses in the civil litigation associated with this claim as disagreement as to policy coverages and the valuation of damages does not amount to bad faith claims adjustment. As you can see, Florida Peninsula conducted a good faith comprehensive and prompt investigation of this claim. Florida Peninsula consistently and promptly communicated with the Insureds and its representatives and conducted an inspection of the property. Florida Peninsula afforded coverage, and issued payment, based on the inspection and investigation of the claim. When Florida Peninsula received supplemental information about the claim, it conducted further investigation and issued another payment to the Insureds. Florida Peninsula respectfully denies any wrongdoing in the adjustment and handling of the Subject Claim, including the supplemental claim, and further denies any and all allegations that it violated any statutes. Instead, Florida Peninsula acted quickly and responsibly and in accordance with the terms and provisions of the applicable Policy of insurance as well as with F.S. §624.155 and §626.9541 and its sub-parts. INACCURACY OF ALLEGATIONS IN THE SUBJECT CRN The case specific facts related to Florida Peninsula’s handling of the subject claim provided above implicitly address many of the vague allegations contained within the Complainant’s CRN and further establish that Florida Peninsula undertook a thorough investigation in accordance with applicable statutory requirements and professional standards of care. It is important to note that the Complainant has not provided any factual support for any of the his allegations outside of self-serving conclusory statements. Instead, the facts support that Florida Peninsula promptly contacted its Insureds, inspected the claim shortly after it was reported, and issued a coverage determination based on a thorough investigation. When additional information was provided, Florida Peninsula conducted additional investigations. The circumstances support that Florida Peninsula conducted a good faith, thorough, prompt investigation with the information provided. The Complainant is alleging bad faith in a scenario where Florida Peninsula conducted a comprehensive, prompt investigation in good faith. Simply because the parties disagree as to coverages and value of damages under the policy, does not mean that Florida Peninsula has engaged in bad-faith claims handling. The Civil Remedy Notice does not show how Florida Peninsula has failed to comply with the statutory provisions alleged to have been violated. Evidently, this Civil Remedy Notice was filed in bad faith, as it is being used as an improper mechanism designed solely for the purpose of intimidating Florida Peninsula into potentially overpaying the Complainant. For the aforementioned reasons, Florida Peninsula categorically denies that it has acted with bad faith in connection with this claim. CONCLUSION The purpose of a CRN is to provide the insurer an opportunity to “cure” the alleged wrongdoing. Talat Enterprises, Inc. v. Aetna Casualty and Surety Co. , 753 So. 2d 1278 (Fla. 2000). However, the CRN here does not serve this purpose because it does not provide any means as to how Florida Peninsula can “cure” the alleged defects. This failure to provide a proper opportunity to cure renders the CRN improper. Longpoint Condominium Associations v. Allstate Insurance Co. , 2005 WL 131580 (N. D. Fla. June 2, 2005). Moreover, the method for curing the violations alleged in a civil remedy notice are not determined by the insured. In Talat Enterprises, Inc. v. Aetna Casualty and Surety Co. , 753 So. 2d 1278 (Fla. 2000), the Florida Supreme Court accepted and quoted the reasoning of the court below in its opinion which stated in relevant part, as follows: Section 624. 155 does not impose on an insurer the obligation to pay whatever the insured demands. . . . Section 624. 155(2)(d) would have no effect or purpose under such an interpretation. The law does not support such an expansive and illogical reading of Fla. Stat. Ann. §624. 155(2)(d). . . . To cure an alleged violation and to avoid a civil action, an insurer must pay the claim . . . before the sixty days expire. Talat, 753 So2d at 1282 citing Talat Enterprises Inc. v. Aetna Cas. & Sur. Co., 952 F. Supp. 773, 777-778 (M. D. Fla. 1996). Here, Florida Peninsula has properly investigated, adjusted, and indemnified the Complainant for covered damages pursuant to the express terms, conditions, limitations, and exclusions of the subject policy and Florida Law based on the physical condition of the property at the time of Florida Peninsula’s investigations. Florida Peninsula denies all of the allegations contained in the subject CRN, which is defective and improper, as Florida Peninsula has not violated any of the subject statutes. Florida Peninsula further states that the accusations made against it in the subject CRN are patently false. In closing, Florida Peninsula first believes that the Civil Remedy Notice should be rejected and returned by the Department of Financial Services due to Complainant’s failure to properly name an insuring party. Furthermore, and to the extent Florida Peninsula is to assume that Complainant intended to allege the statutory violations included supra against Florida Peninsula, the Complainant’s failure to comply with Florida Statute §624.155 and Florida Case law render this CRN improper, objectionable, and obsolete. Due to the lack of any factual and circumstantial basis to support the allegations therein, Florida Peninsula respectfully requests, through this response, that the DFS return and reject the CRN for lack of specificity pursuant to Florida Statutes. Regardless of the rejection, Florida Peninsula denies all allegations contained in the Civil Remedy Notice and submits there are no violations. While Florida Peninsula’s response herein is meant to address the allegations in the Complainant’s Notice, it is based upon the limited information provided in the Civil Remedy Notice and the information presented to date. If the Complainant feels that Florida Peninsula is not in possession of all the facts, please inform the undersigned immediately. Please note that Florida Peninsula’s response is not necessarily exhaustive and does not preclude Florida Peninsula or anyone on Florida Peninsula’s behalf from asserting any other valid reason for seeking rejection and return of the Civil Remedy Notice. Also, this letter or any act or failure to act on the part of Florida Peninsula or any agent or representative of Florida Peninsula should not be construed as a waiver of any rights or defenses available to it by contract or at law, as all such rights and defenses are hereby specifically reserved. On behalf of Florida Peninsula, we trust that this response addresses the allegations in the Civil Remedy Notice of Insurer Violation. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Very Truly Yours, Jose E. Bosch, Esq. Thomas E. Durborow, Esq. QUINTAIROS, PRIETO, WOOD & BOYER, P.A.
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