Civil Remedy Notice of Insurer Violations
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Filing Number:     788471
Filing Accepted:  10/24/2024
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Complainant
Last/Business Name *  
AND INES MAYORGA DE   First Name   JOSE GUILLERMO GARCIA
Street Address * 14118 QUEENSIDE STREET
City, State Zip * ORLANDO, FL 32824
Email Address * INTAKE2@THEKRFIRM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   AND INES MAYORGA DE   First Name   JOSE GUILLERMO GARCIA
Policy # * IFH6035250-03 Claim #* CFL200131639
Attorney
Attorney is Applicable
Last Name* KADIR First Name * ALI Initial A.
Street Address* 986 DOUGLAS AVE, STE. 102
City, State Zip* ALTAMONTE SPRINGS , FL 32714
Email Address * INTAKE2@THEKRFIRM.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   CYPRESS PROPERTY & CASUALTY INSURANCE COMPANY
NAIC Company Code 10953
 
Name of individual responsible for violation (if any):* RYLAND DEMARCO, ALLIED RESTORATION & CONSTRUCTION, AND ALL CYPRESS CLAIMS ADJUSTERS, EMPLOYEES, REPRESENTATIVES, AGENTS, VENDORS, AND/OR ENGINEERS WHO HANDLED THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Misrepresentation
* 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)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
626.9541(1)(i)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

“We insure against risk of direct physical loss to property described in Coverages A and B.” Cypress possesses a complete copy of the subject insurance policy. The Insureds are not in possession of a complete copy of the subject policy and is requesting a copy from Cypress. Thus, this CRN cannot cite subject policy language verbatim due to such. Notwithstanding, the subject policy is an all-risks insurance policy and the applicable policy language is the provision regarding coverage of all risks for the dwelling (Language such as “We insure against direct physical loss to property…”, “We insure against risk of direct loss to property…”, among other similar policy language etc. is typically used.) and provisions regarding exclusions or limitations to this all-risks provision.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Jose Guillermo Garcia and Ines Mayorga De (“the Insureds”) are homeowner insureds with an all-risks policy issued by Cypress Property & Casualty Insurance Company (“Cypress”). The insured property or home is located at 14118 Queenside Street, Orlando, Florida 32824. In April of 2024, a kitchen pipe leak caused extensive damage to the Insureds’ home. The Insureds timely reported an insurance claim for this damage to Cypress and fully cooperated with all requests for inspections. They provided all requested documentation, if any, and complied with all post loss policy conditions. After reporting the claim, Cypress retained an unqualified and biased field adjuster who has a financial relationship with Cypress. This field adjuster inspected the Insureds’ home in an apparent effort to minimize Cypress’s losses instead of adjusting the claim in good faith in due regard for the Insureds’ interests. Cypress also hired a biased construction consultant, Allied Restoration & Construction (“Allied”), who has a financial relationship with Cypress. Like the field adjuster, this consultant’s goal was to provide incorrect and erroneous findings; again in an apparent effort to minimize Cypress’s losses to the detriment of the Insureds. Indeed, Allied incredulously found that none of the damage was related to a kitchen pipe leak and instead puzzlingly blamed the Insureds’ remediation company as the cause of the all the damage. However, Cypress has yet to provide a copy of their consultant’s report to the Insureds or their public adjuster to date. Despite Cypress finding coverage for their claim, it significantly undervalued the Insureds’ claim at only $1,435.93. Because this amount is less than the subject policy’s deductible, Cypress did not issue any payment to the Insureds. Due to such, the Insureds have not been able to permanently repair their home. Indeed, mitigation invoices for water damage restoration, mold remediation, and plumbing as well as an estimate for repair of all damages were prepared on their behalf totaling $43,071.93 were submitted to Cypress; well above the amount from Cypress. Based on these facts, it is clear Cypress unreasonably denied full coverage for the Insureds’ claim in bad faith through its extremely low and unreasonable undervaluation of their claim. Had Cypress conducted a reasonable investigation based upon the available information, it would have been evident that affording greater coverage and issuing a substantially higher payment is warranted. Instead, it failed to adopt and implement standards for proper claim investigation as well as misrepresented pertinent policy provisions/facts rather than act fairly and/or honestly with the Insureds in due regard for their interests. Cypress also delayed the claim and failed to timely respond to communications. This has become a common business practice of Cypress. Florida Statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit based on determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. Cypress has breached this duty by refusing to properly and timely adjust the loss. As a result, the Insureds will have no choice but to retain the undersigned counsel to file a lawsuit against Cypress. Cypress has more than enough information and is still refusing to accept coverage for this claim. This continued and repeated reckless claim delay and denial of coverage will result in a significant punitive damage award if a bad faith lawsuit is filed. Cypress can avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy for this claim and by paying the Insureds based on their $43,071.93 estimate and invoices.
Comments
User Id Date Added Comment
kmixon@gspalaw.com 11-08-2024 To Whom It May Concern: Cypress Property & Casualty Insurance Company (“Cypress”) is in receipt of the Civil Remedy Notice of Insurer Violation (“Notice”) submitted on behalf of the Complainants, Jose Guillermo Garcia and Ines Mayorga De, that was accepted by the Department of Financial Services on October 24, 2024 and assigned Filing Number 788471. The Notice alleges violations of Florida Statute Section 624.155 and 626.9541. Cypress specifically denies each and every allegation contained in the Notice. Additionally, Cypress denies that it violated these or any statutes, Florida law or policy provisions regarding the claim adjudication of this matter. With that said, Cypress asserts that the Notice fails to comply with the specific Notice and information requirements as set forth in Civil Remedy Notice of Insurer Violation document provisions, Florida Statute §624.155 and Florida law. The Notice is deficient as a matter of law as it fails to comply with Fla. Stat. §624.155. See 316, Inc. v. Maryland Cas. Ins. Co., 526 F. Supp. 2d 1187 (N.D. Fla. 2008); Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059, (S. D. Fla. 2010); Heritage Corp. of South Fla. v. Nat’l Union Fire Ins. Co. of Pittsburgh, P.A., 580 F. Supp. 2d 1294 (S.D. Fla. 2008); Talat Enterprises, Inc. v. Aetna Cas. & Surety Co., 753 So. 2d 1278 (Fla. 2000). Pursuant to Fla. Stat. §624.155(3)(b), the Notice “shall state with specificity” the following information: 1. The statutory provision, including the specific language, 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...; 5. a statement that the Notice is given in order to perfect the right to pursue the civil remedy authorized by this section. Moreover, the Department created form DFS-10-363, which lays out 15 requirements that the Complainant(s) must respond to with specificity. The Florida Supreme Court holds that Fla. Stat. § 624.155 “must be strictly construed.” Talat Enterprises, Inc. v. Aetna Cas. and Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Strict construction is appropriate as “this statute is in derogation of the common law.” Id. When interpreting a statute in derogation of the common law, “[a] court will presume that such a statute was not intended to alter the common law other than as clearly and plainly specified in the statute.” Time Ins. Co., Inc. v. Burger, 712 So. 2d 389, 393 (Fla. 1998). Such an interpretation would mean that statutory bad faith cases cannot proceed unless the Complainant(s) has specifically complied with all statutory requirements. Pin-Pon Corp. v. Landmark American Ins. Co., 2020 WL 6588379 (S.D. 2020); Julien v. United Property & Casualty Ins. Co., 2021 WL 824438. The Notice fails to meet the requirements of Fla. Stat. § 624.155 on several grounds. First, with respect to the requirement to set forth with specificity the “facts and circumstances giving rise to the violation,” the Notice fails to allege any specific conduct on the part of Cypress that would violate any policy provision or statute. The Notice asserts general allegations consisting largely upon conclusory and inaccurate statements rather than providing specific facts to support its conclusory allegations regarding any alleged misconduct or statutory violations. The Notice does not set forth any facts regarding Cypress’s purported failure to investigate the claim and does not set forth any facts to support any allegations in the Notice. It is evident that the statement of facts falls short of the specificity required by Fla. Stat. §624.155. As a result, the Complainant failed to comply with the requirements provided in Section 624.155(3)(b)(2), Fla. Stat. Further, the Notice generally alleges that Cypress violated Fla. Stat. 626.9541(1)(i)(3)(b) by “Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.” However, the Notice does not set forth any facts regarding any misrepresentations made by Cypress and does not identify the person or persons who made such misrepresentations with sufficient specificity. Specific identification of a person or persons with the most knowledge within Cypress is of particular importance because the Complainant alleges Cypress has “misrepresented pertinent facts or insurance policy provisions relating to coverages at issue.” The Notice fails to include sufficient specificity as to whom made any misrepresentations, what was misrepresented, and when any of these misrepresentations were made. As a result, the Complainant failed to comply with the requirements provided in Section 624.155(3)(b)(2), Fla. Stat. Second, the Notice fails to satisfy Fla. Stat. § 624.155(3)(b)(4) in that it fails to reference specific policy language relevant to the alleged violation with any degree of specificity. In particular, the Notice cites to language Complainant contends is potentially contained in the policy, as Complainant surther states they “cannot cite subject policy language verbatim.” The Notice asserts the potentially relevant language “among other similar language” is “typically used.” As such, the Notice is insufficient as a matter of law to satisfy the specificity requirement of Fla. Stat. § 624.155(3)(b)(4). Third, the Notice fails to satisfy the requirement to identify the person or persons representing the insurer most responsible for or knowledgeable of the facts giving rise to the allegations. In order to comply with the requirements of Fla. Stat. § 624.155, the Complainant must name the individual(s) involved with specificity as it relates to the purported violation(s) to allow Cypress to properly investigate the allegations. The Notice lists all “claims adjusters, employees, representatives, agents, vendors, and/or engineers who handled the claim.” The Notice lacks the requisite specificity as required by Fla. Stat. § 624.155. Fourth, the Notice does not provide a proper means whereby Cypress can “cure” the alleged defects. The purpose of a Civil Remedy Notice is to provide the insurer an opportunity to “cure” the alleged wrongdoing. Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278 (Fla. 2000). However, Section 624.155, Florida Statute, does not impose on an insurer the obligation to pay whatever an insured demands. Talat, 753 So. 2d at 1282. To the contrary, the Florida Supreme Court holds that the scope of what can be “cured” in responding to a Civil Remedy Notice, is limited to contractual amounts due to the insured. See Talat, 753 So. 2d at 1281. The Notice is deficient as the Notice does not provide Cypress an opportunity to “cure” the alleged violations without making payment of extracontractual damages. Cypress is only obligated to pay contractual amounts owed to cure a civil remedy. See id. at 1278. Finally, the Complainant failed to respond to each of the fields set forth on the DFS Form with the requisite specificity, including but not limited to failing to include the Insurer’s address and the Complainant’s e-mail address. Therefore, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. See Pin Pon, 2020 WL 6588379; Julien v. United Property & Casualty Ins. Co., 2021 WL 824438. While an insurance company is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested. Florida law continually affirms the principle that an insurer has the right to investigate claims presented for payment. An insurance company is expressly afforded an opportunity to evaluate its rights and liabilities. After reviewing the Civil Remedy Notice, Cypress conducted a thorough review of its handling of the Complainants’ claim. Cypress denies that it violated any statutes, administrative code provisions, or ethical rules or obligations in connection with its investigation and handling of the Complainants’ claim. Cypress unequivocally denies each and every allegation asserted in the Civil Remedy Notice. Cypress asserts it has complied with all policy provisions and applicable Florida law regarding the adjudication of this claim to date. We trust that the foregoing is sufficient to advise you of Cypress’s position with regard to this matter and fully responds to the alleged violations in the Notice filed by the Complainant. Very truly yours, GROELLE & SALMON, P.A. /s/ Tyler R. Groelle Tyler R. Groelle, Esq. For the Firm cc: Via email only Ali A. Kadir, Esq. intake2@thekrfirm.com
Acknowledgement
* The submitter hereby states that this notice is given in order to perfect the rights of the person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.

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




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