Civil Remedy Notice of Insurer Violations
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Filing Number:     789297
Filing Accepted:  10/29/2024
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Complainant
Last/Business Name *  
DUSART   First Name   JASON
Street Address * 3333 S ORANGE AVE STE. 104
City, State Zip * ORLANDO, FL 32806
Email Address * MICAH@MYLAWYERCAN.COM
Complainant Type: * Insured
Insured
Last/Business Name*   DUSART   First Name   JASON
Policy # * 0763198705 Claim #* 01000109159
Attorney
Attorney is Applicable
Last Name* BAXTER-MILLER First Name * MICAH Initial
Street Address* 3333 S. ORANGE AVE STE. 104
City, State Zip* ORLANDO , FLORIDA 32806
Email Address * MICAH@MYLAWYERCAN.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   FIRST PROTECTIVE INSURANCE COMPANY
NAIC Company Code 10897
 
Name of individual responsible for violation (if any):* YAIMA FIALLO
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Cancellation
Claim Denial
Unsatisfactory Settlement Offer
* 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.
626.9541(1)(i)(3)(a) 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.
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.
* 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 A. Coverage A – Dwelling And Coverage B – Other Structures 1. We insure against direct physical loss to property described in Coverages A and B.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On February 4, 2024, a storm hit Oviedo, Florida, including the insured’s residence at 1785 Carillon Park Dr., Oviedo, FL 32765. News 6 reporter Jacob Langston documented the storm’s effects through an article titled “PinIt! Viewers share photos, videos of hail, severe weather in Central Florida,” which featured photos from local residents capturing the hailstorm. The storms came in multiples and there were persistent attacks against the landscaping and structures existing in its path. Unfortunately, this destruction included the insured property and roof located at 1785 Carillon Park Dr., Oviedo, FL 32765. In February 2024, storm-related damage was discovered at the home, clearly attributable to recent acute impacts rather than to long-term wear and tear. Upon becoming aware of these issues, the insured filed Claim No. 01000109159 with First Protective Insurance Company, d/b/a Frontline Homeowners Insurance (Frontline Insurance) in February 2024. Inspections were conducted on February 12, 2024, and February 28, 2024. During the initial inspection, the field adjuster attributed roof damages to blistering, not hail. The coverage determination letter noted one missing ridge shingle but did not specify the cause attributed to this damage. On March 16, 2024, prior to issuing a coverage decision, Frontline Insurance sent a letter to the insured’s residence stating, “your roof is, or will be 20 years old. Roofs of this age, especially in the Southeast, are nearing the end of their useful life due to the almost year-round UV exposure, heavy rain, intense heat, and wind. Within the next year we will require the replacement of your roof in order to be offered the option to renew and continuation of your policy. The coverage determination letter sent the following month contradicts the March 16, 2024 letter. On April 19, 2024, Yaima Fiallo issued a denial letter to the insured, stating that the wind damage occurred between June 14, 2022, and November 22, 2022. This assertion is inaccurate and contrary to the evidence. The letter further states, “Please note, the observed wind damage did not occur on the reported date of loss, per our investigation and review of the weather report, the wind damage occurred on November 10, 2022, during Hurricane Nicole and if you wish to report these damages, a new claim must be filed.” This communication appears to be a deliberate attempt by Frontline Insurance to mislead the insured and encourage filing under a separate and much higher deductible, thereby limiting Frontline’s obligation to fully indemnify the insured. A repair estimate for the subject roof, provided to Frontline Insurance by a reputable Florida roofing company, totals $77,279.95. To date, Frontline Insurance has failed to honor its contractual obligations under the applicable policy and provide coverage for the damage sustained from the February 4, 2024 storm—a covered loss. Frontline’s ongoing failure to address this claim has delayed the insured’s recovery of owed sums and caused personal hardship as well as continued additional damage to the insured’s home and property. This refusal to resolve the dispute and extend coverage constitutes bad faith and a failure to fulfill Frontline’s statutory responsibilities.
Comments
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