Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 788785

Filing Accepted: 10/25/2024

Print Filing

Complainant

Last/Business Name *

RESNICOW

First Name

JACOB

Street Address *

106 2ND RIVO ALTO TERR

City, State Zip *

MIAMI BEACH, FL 33139

Email Address *

JRESNICOW@GMAIL.COM

Complainant Type: *

Insured

Last/Business Name*		RESNICOW		First Name		JACOB
Policy # *		JVS102442		Claim #*		160618

Attorney

Attorney is Applicable

Last Name*	KUBIAK First Name * KELLY Initial L
Street Address*		4904 WEST CYPRESS STREET
City, State Zip*		TAMPA , FL 33607
Email Address *		KUBIAKPLEADINGS@KUBIAKLAWGROUP.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		GREAT LAKES INSURANCE SE
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code

Name of individual responsible for violation (if any):* GREAT LAKES INSURANCE SE (INSURER); DIONIS PEREZ; CAROL CANNON; JEREMY CARLSON AND ROBERT WILSON ALONG WITH ALL ADJUSTERS, SUPERVISORS, MANAGEMENT, AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY GREAT LAKES INSURANCE COMPANY IN THE CLAIM.
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Non-renewal
	Claim Delay
	Unfair Trade Practice
	Unsatisfactory Settlement Offer
	Other : Failure to Properly Investigate Claim and with Due Regard to Insureds’ Interest
	Other : Failure to Acknowledge and Act Promptly to Communications Regarding Claim
	Other : Failure to Pay the Claim in Full

* Statutory provision(s) which the insurer allegedly violated.

626.9541(1)(i)(3)(j)

Altering or amending an insurance adjuster’s report without: (I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and (II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or (III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

RELEVANT POLICY LANGUAGE Specific policy language that is believed to be relevant to the violations includes, but is not limited to, the following: Loss Payment provision

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

Great Lakes Insurance SE, (“Great Lakes”) has committed the following in handling the Insured’s claim: 1) failure to pay claim in full; 2) failure to promptly investigate claim; 3) failure to properly investigate claim; 4) failure to adjust loss; 5) failure to act in due diligence and good faith to resolve claim; 6) placing financial interest of insurer before that of policyholders and claimants; 7) failure to properly train, evaluate and manage adjusters; 8) looking for ways to deny coverage, pay less, delay payment and otherwise “low ball” or “stone wall” claim; 9) The reasons for this may be attributed to improper training, supervision, and/or motivation of adjusters and claims supervisors to promptly and fairly investigate, adjust and pay full benefits available to all beneficiaries. The insurer may have failed to adopt proper standards of investigation and adjustment of losses or is otherwise not implementing those standards because full payment and prompt payment for the loss is not occurring. 10)Conducting an inadequate investigation of Jacob Resnicow Property. This complaint is made on behalf of Jacob Resnicow (“Mr. Resnicow”). In consideration of the premium paid to it by Mr. Resnicow, Great Lakes issued a Homeowner’s Insurance Policy, Policy No.: JVS102442 (the “Policy”). On June 4, 2022, while the Policy was in full force and effect Mr. Resnicow’s property, located at 106 2nd Rivo Alto Terrace, Miami Beach, FL 33139 (“the Property”) suffered damages because of Tropical Storm Alex. Tropical Storm Alex caused damage to the Property to areas including, but not limited to, the roof, windows and ceiling. Tropical storm damage is a covered peril under the policy. After notifying Great Lakes of the loss, Great Lakes’s Claims Department opened a claim and assigned Claim No.: 160618. The following timeline of events details the nature of Great Lakes’s improper adjustment and delay of Mr. Resnicow’s claim. On June 4, 2022, a tropical storm caused damages to the Property. Mr. Resnicow reported the claim to his agent. Mr. Resnicow’s agent advised Mr. Resnicow not to report the claim until he was certain the damages exceeded the $10,000 deductible. On June 4, 2022, Mr. Resnicow retained Zerzura Restoration to mitigate the damages and dry out the Property. On June 14, 2022, Mr. Resnicow retained American Leak Detection. On or about June 27, 2022, Mr. Resnicow retained Mt Construction Group to begin repairs to the Property. From June 27, 2022, to July 22, 2023, no visible leaks were noticed. On July 23, 2023, Mr. Resnicow noticed leaking and hired American Leak Detection again. Mr. Resnicow made additional repairs based on the American Leak Detection report. In November of 2023, a handyman noticed the sloping of the ceiling above the kitchen. On or about November 13, 2023, Mr. Resnicow again called his agent and reported the Tropical Storm Alex loss. Mr. Resnicow knew at this time, his claim was not going to be handled properly. On November 15, 2023, Mr. Resnicow hired a public adjuster to assist him. On November 16, 2023, Great Lakes adjuster, Dionis Perez, and the public adjuster inspected the Property. After the inspection, Mr. Perez recommended Mr. Resnicow install temporary safety support columns and remove all the weight on the deck above the kitchen ceiling. The public adjuster informed Mr. Perez that Mr. Resnicow installed safety support columns and removed the heavy items from the deck. On November 24, 2023, the public adjuster inquired about the status of the structural engineer. The public adjuster was informed by Carol Cannon, Mr. Perez’s supervisor, she was still awaiting approval for a structural engineer. On November 28, Mr. Perez email the public adjuster a reservation of rights letter with November 13, 2023, as the date of loss for a water loss. On November 28, 2023, the engineer was approved by Great Lakes. On November 30, 2023, the public adjuster responded to the November 28, 2023, letter outlining the timeline of events, and clarified that the date of loss is June 4, 2022, from Tropical Storm Alex loss. On December 6, 2023, the engineer, ProNet, issued its report and findings to Great Lakes. On December 20, 2023, the public adjuster requested a copy of the engineer report. Mr. Perez informed the public adjuster he needed approval to produce the same. On January 2, 2024, Mr. Perez sent a letter introducing himself as the adjuster assigned to claim with a date of loss of July 23, 2023. On January 3, 2024, the public adjuster asked for clarification of the January 2, 2024, letter as to the date of loss and requested another inspection. On January 4, 2024, Mr. Perez stated it was a standard letter. He stated Great Lakes decided to split the claim into 3 losses. On January 17, 2024, the public adjuster sent a letter to Mr. Perez regarding the erroneous claims being opened as asked that all of them be closed, except the June 4, 2022, loss. On January 31, 2024, the public adjuster requested an update and was informed the claim was still under review. Finally, on February 9, 2024, the supervisor, Carol Cannon, agreed to close the claim dated July 23, 2023. On March 6, 2024, the public adjuster provided his estimate and supporting documents to Ms. Cannon. Great Lakes’s adjusters failed to conduct a thorough investigation. Great Lakes must investigate claims in an unbiased manner. It is apparent that Great Lakes breached its obligation and because of that Great Lakes significantly underestimated the scope of the damage to the above-referenced property, which is its duty under the contract of insurance issued by it. Great Lakes "low balled" the Insured to place its financial interests above the Insured’s interest in restoring the property to its pre-loss condition. Great Lakes and its adjustor have conspired to misrepresent the true scope of damages to the Insured’s property and the actual replacement cost of the damages. Mr. Resnicow responded to all of Great Lakes’ requests for information and documents, including attending an examination under oath. On July 23, 2024, Great Lakes sent a non-renewal that stated: Reason for Non-Renewal: Claims History This means record of past claims made against an insurance policy. On September 15, 2024, the policy was non-renewed. On October 11, 2024, Great Lakes via through its counsel, David Levin, Esq., sent Resnicow’s counsel a letter attempting to re-write the reason the policy was renewed. Mr. Levin letter stated that the reason for the non-renewal was: As you are aware, the Notice noted “Reason for Non-Renewal: Claims history.” Pursuant to Fla. Stat. § 626.9201(1), and to provide further explanation for non-renewal of the Policy, please be advised that GLISE decided to not renew coverage for the Property because it became known to GLISE that subsequent to the original policy underwriting, the Insured made material modifications to the Property, including the installation of the deck over the Property’s kitchen, which were done without permits, not in compliance with local code, without notice to GLISE, and which directly increased the bargained for risk that GLISE had previously assumed, and directly caused and/or contributed to losses to the Property. There is a difference between claims history and changing the risk. The non-renewal stated, “claims history.” It never stated because the risk was changed. Great Lakes is now trying to re-write the basis of its non-renewal. Great Lakes has misrepresented the basis of the non-renewal. Great Lakes’ refusal to renew the Insured’s policy while a claim is pending places a severe burden on him. It is difficult, if not impossible, to find another carrier to issue a new insurance policy while a loss claim is pending, and, if a new carrier can be found, the premium will surely increase substantially. Great Lakes wishes to allege mere coincidence between the Insured’s claim for benefits, and its nonrenewal of his policy. This is no coincidence— Great Lakes was happy to collect the Insured’s premium month after month; yet, once he filed a claim for benefits, the policy nonrenewal soon followed. Great Lakes’ failure to provide adequate explanation or justification for its terminating the Policy leaves only one possible motive: to financially and emotionally pressure the Insured into dropping the claim or settling for less than the full value of the claim. These reasons are exactly why the Florida lawmakers prohibit this type of conduct. Mr. Resnicow’s counsel spoke with Great Lake’s counsel regarding Great Lakes improperly opening multiple claims for one loss. Great Lakes counsel said he would get in contact with Great Lakes underwriting department. Great Lakes’ underwriting department never resolved the problem. Instead, it is now misrepresenting the basis of the non-renewal. Despite the fact that Resnicow gave all the documents and information to Great Lakes, Great Lakes still has failed to state its position regarding this claim. To date, Great Lakes has failed and/or refused to provide Mr. Resnicow with all the insurance benefits due and owing, despite knowing that Mr. Resnicow has sustained covered damages to its Property. Despite Mr. Resnicow’s pleas, Great Lakes has not tendered the full amount needed to repair its Property under the Policy. Instead, Great Lakes is attempting to deny coverage with an end goal of “low-balling” the claim. This notice is given in order to perfect the right to pursue the civil remedy authorized by this section.

Comments

User Id		Date Added		Comment
tgoff@bakerdonelson.com		12-20-2024		Dear Sir or Madam: Baker, Donelson, Bearman, Caldwell & Berkowitz PC has been retained by Great Lakes Insurance SE (“GLISE”) to respond to those 45 Civil Remedy Notices (“CRNs”) assigned File Numbers 788785, 788808, 788811, 788818, 788822, 788824, 788826, 788828, 788830, 788836, 788838, 788842, 788845, 788847, 788848, 789133, 789138, 789149, 789154, 789158, 789162, 789164, 789166, 789170, 789174, 789176, 789180, 789185, 789193, 789196, 789339, 789344, 789348, 789351, 789356, 789448, 789476, 789480, 789483, 789487, 789489, 789496, 789501, 789507, and 789512 by the Florida Department of Financial Services and filed by Jacob Resnicow (the “Insured”). The CRNs concern Policy #’s JVS102442, JVS102442A, and JVS102442B, with effective periods from September 23, 2021 to September 23, 2022; September 23, 2022 to September 23, 2023; and September 23, 2023 to September 24, 2024, respectively (collectively the “Policies”), and Claim #’s 160618, 161170, and 161171 (the “Claims”). In response to the CRNs, GLISE states as follows: As a preliminary matter, GLISE denies all allegations set forth in the Insured’s CRNs, submits that no such violations have occurred, and maintains the CRNs should be rejected and returned by the Department of Financial Services due to their failure to comply with Florida law. The CRNs are form-pled, duplicative, generic, intentionally vague, and replete with self-serving and unsupported conclusions of fact and determinations of law. The scant facts stated are repeated in each and every one of the dozens of CRNs, and they are belied by the information and documentation comprising the claim file materials, and which fail to show any bona fide claim for bad faith conduct. The Insured appears to be mistaken concerning material aspects of the claim adjustment, and it is apparent he is misinformed about the actions GLISE took and is taking in adjusting this claim. The material misrepresentations and oversights in the CRNs appear to reflect a failure to comprehend key facts surrounding this claim and the Policy, and the CRNs should be rejected. The CRN form requires that the Complainant, “Pursuant to Section 624.155, F.S. please indicate all statutory provisions alleged to have been violated.” In this section, the Insured appears to cite numerous different statutes, dividing them up and repeating them across the 45 CRNs as Insured has consistently done in prior CRNs, accusing GLISE of: (1) improperly altering or amending an adjuster’s report; (2) failing to provide undisputed coverage; (3) failing to properly and timely acknowledge and act on claim communications; (4) failing to timely make a coverage determination; (5) failing to clearly explain the nature and reasons for requested information; (6) failing to promptly notify the insured of additional information needed; (7) failing to promptly provide explanations for claim denials; (8) failing to timely provide a claim determination after receipt of a proof of loss statement; (9) denying a claim without a reasonable investigation; (10) misrepresenting facts and policy provisions; (11) failing to implement proper investigation standards; (12) material misrepresentations to force settlement; (13) attempting to settle claims on the basis of altered documents; (14) failing to promptly settle claims; (15) making claim payments without specifying coverages; (16) not attempting in good faith to settle claims; and (17) improperly canceling a policy. However, the facts identified in the CRNs, or lack thereof, do not support the alleged violation of these statutory provisions or in most cases even have any relationship to the statutory provisions. As a result, the Insured’s generic claims of bad faith conduct do not sufficiently apprise GLISE of the actual circumstances upon which these CRNs are based. Rather, they are merely “form” notices not specific to the Insured’s claims. The vague and generic nature of the violations alleged highlights the deficient nature of the CRNs and severely hinders GLISE’s ability to meaningfully respond. The CRNs should be rejected and returned accordingly. As for the requirements under Fla. Stat. § 624.155(3)(b)(4), the CRNs attempt to cite relevant policy language refer merely to the “Loss Payment” provisions of the Policies. This vague and overbroad citation, consistent with Insured’s prior CRNs, once again fails to sufficiently inform GLISE as to what specific provisions of the Policies were violated and, as a result, what actions would be needed to correct the violations, much less failing to provide any information as to how these obligations were violated, hindering GLISE’s ability to meaningfully respond. As a result, the CRNs should be rejected and returned. The CRNs’ lack of specificity extends to the “factual” allegations that purportedly gave rise to the issues complained of by the Insured. Florida’s form for Civil Remedy Notice of Insurer Violations instructs complainants, in relevant part, as follows: “To enable the insurer to investigate and resolve your claim, describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time.” The CRNs fall short of these instructions and set forth vague, generic, unsupported, form-driven, and inaccurate allegations and self-serving conclusions – all of which GLISE denies. The CRNs’ failure to specify the facts that purportedly triggered their filing demonstrate yet another reason why the CRNs should be rejected and returned. Accordingly, GLISE respectfully requests the CRNs be rejected for the reasons cited above. Notwithstanding the foregoing, GLISE now responds to the few facts alleged in the CRN. Each of the Policies concern separate coverages for separate periods for the same property located at 106 2nd Rivo Alto Terrace, Miami Beach, FL 33139 (the “Property”), a large single-family home which the Insured has owned since September 2021. The Policies exclude or limit coverage concerning existing damage or damage outside of the policy periods; damage from wear and tear, latent defect or mechanical breakdown; damage due to insects/vermin; loss directly or indirectly caused by neglect; unhidden damage from constant or repeated seepage; faulty, inadequate, or defective design, construction, workmanship, maintenance, materials, etc.; water damage over $10k during the second and third policy periods; interior water damage which does not result from a storm created opening; damage to exterior insulation or stucco; mold damage over $15k or $25k depending on the Policy period; etc. The Policies additionally impose duties after loss including to provide prompt notice, protect the Property from further damage, cooperate with GLISE during the claim adjustment and investigation; show damaged property and keep records concerning the loss, and sit for an examination under oath when requested. Insured provided notice of loss on November 13, 2023, originally claiming a date of loss of the same date, alleging a prior repaired water intrusion issue and recently noticed water and rot damage to the kitchen ceiling (also damaging a lamp above the kitchen island). However, the Insured’s public adjuster (the “PA”) later claimed in its letter of representation that the date of loss was instead June 4, 2022, asserting the damage was due to Tropical Storm Alex. The Property was inspected on November 16, 2023 by GLISE’s adjuster from Johns Eastern (now known as Davies) who observed signs of a roof leak in the Property’s kitchen, noting cracked/compromised beams and roof sheathing water stains, though the kitchen ceiling had already been torn out and so was not available for inspection. It was found that a wooden deck had been previously installed over the kitchen following the initial underwriting inspection, with ponding and retained water in the deck area and its single drainage system (the boards of the deck having also already been removed prior to the inspection). The adjuster also observed water damage likely from HVAC condensation in the Property’s office along the ceiling. The adjuster recommended that a structural engineer be retained to determine safety and causation, with GLISE hiring a structural engineer from ProNet Group, Inc., who inspected the Property on December 1, 2023. The engineer noted that most of the kitchen ceiling drywall had been removed, showing nine of twelve kitchen wood roof joists cracked/broken along with areas of stained and rotted wood plank roof sheathing above the middle and along the north wall of the kitchen. The kitchen roof had no scrapes, gouges or holes in its membrane, and the weather from Tropical Storm Alex was insufficient to inflict wind or debris damage to the Property, with sustained winds of 22 mph and gusts of 30 mph at the airport 7.8 miles away, while a station 1 mile away measuring sustained winds of 40 mph and gusts of 59 mph. The engineer found that the roof joist cracking and failure was the result of an excessive load placed on the deck in combination with wood destroying insect damage, with the water damage the result of a long-term roof leak (as shown by the rotten wood). GLISE’s engineer also reviewed reports prepared for the Insured by American Leak Detection (“ALD”) in June 2022 and July 2023, a year and a half and four months respectively before the loss was reported. In the first report, based on an inspection on June 14, 2022, ALD noted water damage in the master bedroom and hallways, including staining above a door, with a hole cut in the ceiling above the stained wall, and staining on a smoke detector purportedly following heavy rainstorms. ALD also indicated a window at the top of a staircase was leaking, with spray testing on windows and running down the side of the house showing water intrusion in the master bedroom and hallway around windows and a doorframe and electrical components. ALD additionally noted that water in the bedroom was likely coming from a separation between the door frame and stucco, as well as leaking into the room below from running down the side of the house. As for the hallway, ALD found that water came in through an electrical outlet and around windows, with ALD recommending that they be resealed, along with recommending testing in other areas given the widespread nature of the observed issues. In ALD’s second report, following an inspection over a year later on July 20, 2023, ALD again sprayed windows, with wallpaper on a bedroom wall becoming visibly wet from cracks below a window and separation in seals around another, with other intrusion along the bottom edge of a door track, while also raising concerns about intrusions around the roof decking. Noting ALD’s observations of water migrating to the interior through various cracks and gaps in sealants on the walls and at windows and doors, including along the south exterior wall and windows above the second floor patio on the north side of the kitchen, GLISE’s engineer noted that the roof structure along the north side of the kitchen revealed a relatively small area of stained roof sheathing but no damage to the roof joists, along with no path of damage from the roof sheathing stain at the north end of the kitchen to the cracked/broken roof joists. GLISE’s engineer therefore found that the water intrusion along the south side of the residence by American Leak Detection did not compromise the kitchen roof structure. The engineer concluded: • The roof structure and the roof membrane were not damaged by wind or windborne debris during the period of the weather disturbance on or about June 4, 2022. • The cracked/broken roof joists above the kitchen were consistent with excessive loading of the joists as a result of the use of the roof structure as a patio structure in combination with the weakening of the roof joist as a result of wood destroying insect damage. • The rotted wood plank roof sheathing above the kitchen was consistent with a long-term roof leak. The roof leak was consistent with exposure of the roof membrane to the elements over the years of service and foot traffic on the patio deck. • The water intrusion reported along the south side of the residence by American Leak Detection did not compromise the kitchen roof structure. The PA provided the following timeline concerning the loss, claiming: - January 1, 2022: o The hot tub was installed on roof top deck above the kitchen area, seemingly three months after the initial underwriting inspection and done without permits and not in compliance with controlling code, including concerning drainage. - June 4, 2022: o Tropical Storm Alex occurred. Insured claims to have contacted his insurance agent and been instructed to hold off on filing a claim until after his receipts exceeded the applicable policy deductible; however, despite claiming to have evidence of these conversation, it has never been produced nor any other detail been provided. - June 4 – June 6, 2022: o Insured hired a mitigation company (Zezura Restoration) to mitigate damages and dry the property out. - June 14, 2022: o Insured hired ALD to determine the source of water intrusion. - July 27, 2022: o Insured hired a contractor to make repairs to the interior and exterior. - August 2022 – July 2023: o Multiple cycles of rain and storms occur, purportedly without any additional visible leaking noticed. - July 23, 2023: o Insured allegedly noticed leaking again and once more hired ALD, with additional repairs made based on its report. - November 2023: o Insured’s handyman allegedly commented on drywall sloping on the ceiling above the kitchen island, using a moisture meter to determine the drywall was wet and opening the kitchen ceiling to inspect. - November 13, 2023: o Insured filed a claim with GLISE. - November 15, 2023: o Insured signed a public adjuster agreement. - November 16, 2023: o Adjuster inspection of the Property occurred. - November 17, 2023: o GLISE’s adjuster asked the PA to recommend to the Insured to consider installing temporary support columns to prevent the kitchen ceiling from collapsing. Based on the available evidence indicating three separate events of loss, GLISE elected to modify the Insured’s claim into three separate claims: (1) one claim with the DOL of June 4, 2022 for water damage from Tropical Storm Alex, concerning the damage claimed by the first ALD report; (2) a second claim with a DOL for July 23, 2023 for the damage claimed by the second ALD report; and (3) a third claim with a DOL of November 13, 2023 concerning the kitchen ceiling/roof damage. However, after informing the PA of the decision to divide the Insured’s claim in early January 2024, the PA sent letters dated January 17, 2024 protesting against the decision, claiming that the two additional claims were erroneously opened by GLISE and that all damage to the Property was caused by Tropical Storm Alex with a DOL of June 4, 2022. The PA varied thereafter, acknowledging there were two losses while admitting that the source of the damage to the kitchen roof/ceiling was from the additional weight above as GLISE’s engineer found, while also seeking coverage for water intrusion by Tropical Storm Alex. On March 6, 2024, the PA provided two demands/estimates, one claiming a date of loss of June 4, 2022, while the other claimed a date of loss of November 13, 2023. Concerning the former, the PA sought a total of $172,529.02 RCV in Building coverage, including a $16k invoice for water mitigation from Zezura Restoration (dated June 4, 20222), $950 from ALD for its first cause and origin report, and a $53,687.50 invoice from MT Construction Group (dated June 27, 2022) for resealing walls and ceilings, repairing cracks/stucco over wall surface and resealing windows, painting, etc. This part of the Insured’s claim appears to arise entirely from ALD’s findings in its first report. As for the second demand, the PA sought $167,675.00 in un-itemized fashion based on three separate invoices: (1) an MT Construction invoice dated November 18, 2023 for $152,875, for safety columns, drywall removal, demolition of kitchen ceiling and roof and framing and installing new of same, new waterproofing in roof, etc.; (2) a Williams International invoice for a boom truck crane for $1,300 dated November 18, 2023; and (3) a $13,500 invoice dated November 18, 2023 for handyman work for kitchen inspection and multi-day ceiling work, along with removal of deck items, cleaning, and supplies. The PA indicated that repairs in the Property’s office and kitchen had already been completed, while noting that repairs made pursuant to the July 2023 ALD report were minor and less than the applicable deductible. Based on the PA’s demands and provided records, GLISE, through undersigned counsel, in furtherance of its duties to investigate the Insured’s losses, prepared and sent to the Insured a reservation of rights letter dated April 25, 2024. The letter cited relevant policy language and noted that the parties had agreed to a re-inspection of the Property to occur on April 26, 2024, while also requesting that the Insured sit for an examination under oath and provide certain records concerning the alleged losses, including all contracts, estimates, invoices, reports, and work orders for construction and repair work performed at the Property during any of the Policies’ periods; all contracts, estimates, invoices, reports, and work orders for all damages, losses, mitigation, and repairs which Insured claims are covered under the Policies; all photos/videos concerning the losses to the Property; and all photos/videos of the Property prior to the losses. The re-inspection proceeded as planned, with GLISE’s adjuster and engineer and the PA in attendance. The adjuster noted that the kitchen repairs have been completed with no evidence of a new leak or damage, while the roof deck likewise was repaired and built back to its original condition, including with all objects returned to the deck despite prior load concerns and recommendations. On the roof deck, the PA indicated that the deck structure had been reinforced though believed to be done without a permit or engineer supervisions. The other inspected rooms of the house remained the same with no changes since the last inspection, except the dining room and half bathroom which appeared to have new/unrelated water damage to ceilings and walls, with active water mitigation and dry-out, with the PA indicating that it was likely water leaking from above from a shower pan failure in the master bathroom shower, with a plumber purportedly investigating. The adjuster observed no evidence of wind damage or wind created openings to the Property. The PA also again indicated that he again did not believe the roof decks and other structures on top of the flat roofs were done with permits or engineer supervision, and he also said that they did not have any additional documentation to support their claims and that the Insured was retaining counsel to respond to GLISE’s April 25th letter and handle the EUO. Meanwhile, GLISE’s engineer from ProNet again found that there were no signs of damage to the property from wind or windborne debris, with the recorded winds insufficient to damage the building envelope or components (being common for thunderstorms in Florida), and with the PA indicating that the roof was not damaged by winds associated with Tropical Storm Alex. Following repeated follow-up efforts to the Insured, the PA, and the Insured’s counsel, Insured finally sat for an examination under oath on September 10, 2024. Related to the EUO and GLISE’s record requests associated with it, Insured also produced for the first-time records related to his claimed losses both shortly before, during the course of, and weeks after the EUO. GLISE is reviewing Insured’s EUO testimony and newly provided records as part of its ongoing claim adjustment to render a proper claim determination. To assist in this regard, and noting that the Insured had expressed during the EUO that there were additional records which he had not provided and that he had yet to express or specify the full amount and types of coverage which he was pursuing (based on alleged covered damages to the Property which had not yet been provided to GLISE), GLISE sent the Insured, through counsel, a further reservation of rights letter on October 11, 2024, requesting further information and documentation, including a sworn proof of loss statement. As of this date, Insured has yet to fully comply with these requests, including failing to provide a sworn proof of loss statement. Looking at these latest CRNs, they once again accuse GLISE of a host of general and non-specific violations, including: 1) failure to pay claim in full; 2) failure to promptly investigate claim; 3) failure to properly investigate claim; 4) failure to adjust loss; 5) failure to act in due diligence and good faith to resolve claim; 6) placing financial interest of insurer before that of policyholders and claimants; 7) failure to properly train, evaluate and manage adjusters; 8) looking for ways to deny coverage, pay less, delay payment and otherwise “low ball” or “stone wall” claim; 9) The reasons for this may be attributed to improper training, supervision, and/or motivation of adjusters and claims supervisors to promptly and fairly investigate, adjust and pay full benefits available to all beneficiaries. The insurer may have failed to adopt proper standards of investigation and adjustment of losses or is otherwise not implementing those standards because full payment and prompt payment for the loss is not occurring. 10) Conducting an inadequate investigation of Jacob Resnicow Property. Insured also later claims generally that GLISE failed to conduct a thorough unbiased investigation, offering that as a result GLISE significantly underestimated/misrepresented the scope of the loss, engaged in low-balling, and placed its interests over the Insured’s, concluding that GLISE has not paid the Insured all insurance benefits he is owed under the Policy. Insured further asserts that all of the damage to the Property was caused by Tropical Storm Alex and that GLISE improperly divided the claim into three different losses. Finally, Insured alleges that he has provided all records and information to GLISE but yet no claim determination has been made, claiming once more that GLISE has failed to provide coverage owed despite knowing of covered damage. The vast majority of these grounds were previously raised in Insured’s 41 prior CRNs, with 38 filed on May 31, 2024, with GLISE’s responses filed on July 29, 2024, and the remaining 3 CRNs on September 4, 2024, which GLISE responded to on October 16, 2024. As said therein, it is important to note that the adjustment has not been completed for any of the Insured’s losses, with the investigation remaining ongoing having been delayed by the Insured’s delays in sitting for an EUO and providing requested records concerning the losses, in violation of his duties under the Policies. The EUO and receipt of some requested records have only recently occurred, with additional documents requests still remaining pending. GLISE is in the process of reviewing what records have been provided as part of its ongoing investigation, while continuing to follow-up about additional records, including a sworn proof of loss, which have still not been provided. Accordingly, any delays in the claim adjustment have been driven by the Insured’s own actions, with GLISE prejudiced and its investigation complicated and hindered by the Insured’s breach of other duties under the Policies, including through late reporting of the losses (waiting a year and a half after Tropical Storm Alex for example), conducting multiple series of repairs and failing to maintain evidence or records prior to notifying GLISE of the losses, denying GLISE the ability to fully and timely inspect the losses, etc. As for Insured’s accusations of GLISE underestimating or misrepresenting the scope of the losses, lowballing, and refusing to provide owed insurance benefits, these claims are entirely inaccurate and unjustified. As shown above, GLISE has been conducting a thorough investigation of the Insured’s losses, an investigation that remains ongoing with no claim determination yet to date primarily as a result of the Insured’s actions and inactions. Accordingly, GLISE has not engaged in any of the actions claimed by the Insured and intends for its ultimate claim determination to be supported by the available evidence and in full compliance with the governing policy terms and Florida law. As for allegations that GLISE is biased and has placed its interests over the Insured or in some way not conducted a proper investigation, adopted proper standards, or trained/supervised its agents, the record described above demonstrates that GLISE has been conducting a comprehensive and impartial review of the Claims which is still occurring to date. After all, there have been multiple inspections by GLISE’s adjuster and engineer, a detailed examination and consideration of all evidence which the Insured and its agents have submitted to date, repeated records requests, and an EUO of the Insured. GLISE shall continue to engage in all actions necessary to investigate the Insured’s losses so as to ensure that Insured receives all that it is entitled to under the Policies. These actions have been pursuant to GLISE’s internal policies and procedures and Florida law, and as demonstrated by their carefully conducted inspections and detailed findings, GLISE’s agents are exceptionally well trained and dedicated to producing impartial and comprehensive conclusions as to the cause and scope of the Insured’s losses. As for Insured’s assertions that GLISE has in some way violated its duties under the law and Policies by opening multiple claims concerning the Insured’s losses, as said, GLISE’s decision to open multiple claims was driven by all available evidence, including the findings of its adjuster and engineer, Insured’s records and timeline, and the statements of the Insured and his agents to determine the distinctions between the Insured’s losses and relevant dates of loss. Prior to the EUO, the Insured and his agents had been quite inconsistent themselves concerning the causes and dates of loss asserted, varying significantly over time. At the EUO, Insured clarified his position that all of the losses were due to Tropical Storm Alex, with a DOL of June 4, 2024. Accordingly, in order to comply with the Insured’s instructions and serve his best interests under the Policies, GLISE agrees to accept that the Insured does not wish and refuses to pursue separate losses and causes of loss under each of the Policies and instead wishes to only pursue a single claim with a single claimed DOL of June 4, 2022 and single claimed cause of loss of windstorm damage due to Tropical Storm Alex. GLISE has consolidated the Claims into a single claim, bearing Claim No. 161170 under Policy No. JVS102442 and as a claimed Tropical Storm Alex windstorm loss. Insured was previously informed of this by letter dated October 11, 2024. Regardless of the number of claims and dates of loss, GLISE shall continue to endeavor to investigate all of the Insured’s losses and render a fulsome and accurate determination of the causes and covered scope of the Insured’s losses as soon as possible. Insured also reasserts allegations made in the September 4th CRNS with respect to GLISE’s notification of non-renewal. GLISE previously clarified its notice of non-renewal on October 11, 2024, and in response to the Insured’s September 4th CRNs. As noted therein, GLISE did not elect to non-renew the Policy as a result of Insured filing a claim or because that claim was treated as three claims, with the decision in no way punitive for the Insured filing a claim. Nor is GLISE’s motive behind the non-renewal to pressure the Insured into dropping his claim or settling on less that favorable terms. GLISE decided to not renew coverage for the Property because it became known to GLISE that subsequent to the original policy underwriting, the Insured made material modifications to the Property, including the installation of the deck over the kitchen discussed above, which were done without permits, not in compliance with local code, without notice to GLISE, and which directly increased the bargained for risk that GLISE had previously assumed, and directly caused and/or contributed to losses to the subject Property. This decision, the supporting reason, and the timing of it is fully in keeping with GLISE’s policies and procedures and Florida law. Accordingly, any concerns which Insured has with respect to the reasons and adequacy of the explanation of the reasons for the non-renewal have been thoroughly addressed. The fact that GLISE’s claims adjustment is ongoing is irrelevant to the nonrenewal and as shown above is directly the result of the Insured’s own actions and inactions. The new CRNs accuse GLISE of re-writing or misrepresenting the reason for its non-renewal, while also claiming that the non-renewal places a serve burden on the Insured, hindering his ability to find new coverage, all while repeating allegations that GLISE has done so to “financially and emotionally pressure the Insured into dropping the claim or settling for less than the full value of the claim.” They further claim that GLISE’s underwriting department never resolved the Insured’s problems with multiple claims being opened and instead misrepresented the reasons for the non-renewal. GLISE did not intend to change its reasons for non-renewal with its October 11th notice, nor is it misrepresenting its reasons for doing so. The October 11th notice specifies the reasons why GLISE chose to not renew coverage, in compliance with its obligations under Section 626.9201(1), which states, “An insurer issuing a policy providing coverage for property, casualty, surety, or marine insurance must give the first named insured at least 45 days’ advance written notice of nonrenewal. If the policy is not to be renewed, the written notice shall state the reasons as to why the policy is not to be renewed.” Though Insured clearly disagrees with these reasons, he does not dispute that they are accurate, and his claim that they are merely a cover for pressuring the Insured into settling the loss are disingenuous at best, lacking in any support and belied by GLISE’s actions described above throughout the loss adjustment. GLISE has provided the Insured with multiple written accounts as to the reasons for its decisions with respect to opening multiple claims and the non-renewal of coverage, and when the Insured has asked that the claims be consolidated and more information be provided concerning the non-renewal, GLISE has done so. The Insured’s repetition of allegations from prior CRNs, all of which GLISE has properly and promptly responded to and addressed, serves no purpose other than to harass GLISE and further delay the claim adjustment. As was the case with the prior CRNs, Insured provides no suggestion whatsoever in any of the CRNs as to what actions GLISE should take to cure these alleged violations, solely offering, “This notice is given in order to perfect the right to pursue the civil remedy authorized by this section.” This failure to specify any means to cure the alleged violations, suggesting instead that the CRNs are only pursued for the purpose of creating a future lawsuit, demonstrates the bad faith in which the CRNs were filed and the practical inability of GLISE to determine what actions are necessary to correct the alleged violations, much less perform those actions. For this reason, among all others outlined above, the CRNs should be rejected and returned. Accordingly, for the reasons set forth above, GLISE respectfully requests that the CRNs be rejected and returned. While this response is meant to be comprehensive, it is based upon the limited, vague allegations set forth in the Insured’s CRNs and information made available to GLISE to date. Accordingly, this response to the Insured’s CRNs is not necessarily exhaustive and shall not preclude GLISE from asserting any other valid reason(s) for the rejection and return of the Insured’s CRNs. Further, GLISE expressly reserves all available rights and defenses available to it under the subject Policies, as well as Florida law. GLISE has always complied with the provisions of the applicable Policies, while consistently acting fairly, honestly, and in good faith towards the Insured, with the utmost regard for his interests. Neither this response, nor any actions taken by GLISE, should be construed as a waiver of any rights or defenses available under the subject policy, or Florida law. We trust this correspondence adequately addresses the matters raised in the Complainant’s CRNs, but please do not hesitate to contact us with any questions, concerns or requests for additional information concerning this matter. Sincerely, David B. Levin cc: via email Jacob Resnicow c/o Kelly L. Kubiak, Esq. [kubiakpleadings@kubiaklawgroup.com] GLISE Insurance SE Johnson & Johnson, Inc. Matt Woolf, Esq.
Sbaldinelli@kubiaklawgroup.com		12-11-2024		This CRN is withdrawn.

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