Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 789353

Filing Accepted: 10/30/2024

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Complainant

Last/Business Name *

HILLTOP CAFÉ C/O LAURA DIAKAKIS

First Name

Street Address *

9322 LITTLE RD.

City, State Zip *

NEW PORT RICHEY, FL 34654

Email Address *

HILLTOPCAFE@AOL.COM

Complainant Type: *

Insured

Last/Business Name*		HILLTOP CAFÉ C/O LAURA DIAKAKIS		First Name		KYLE
Policy # *		BPG7606Q		Claim #*		1007803109

Attorney

Attorney is Applicable

Last Name*	STAGGS First Name * KYLE Initial B
Street Address*		1715 W. CLEVELAND STREET
City, State Zip*		TAMPA , FLORIDA 33606
Email Address *		COURTDOCS@WILLIAMSPA.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		MAIN STREET AMERICA PROTECTION INSURANCE COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 13026

Name of individual responsible for violation (if any):* ALL ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY MAIN STREET AMERICA PROTECTION INSURANCE COMPANY IN THIS CLAIM.
Type of Insurance * Commercial Property & Casualty

Reason for Notice *

	Claim Denial
	Claim Delay
	Unsatisfactory Settlement Offer
	Unfair Trade Practice
	Other : Failure to Properly Investigate Claim and with Due Regard to Insured's Interest
	Other : Failure to Pay the Claim in Full

* 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)(d)		Denying claims without conducting reasonable investigations based upon available information.

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

RELEVANT POLICY LANGUAGE The specific policy language that is believed to be relevant to the violations includes, but is not limited to, the following: See Subject Policy: Main Street America Protection Insurance Company Policy No.: BPG7606Q loss payment provision, policy definitions, and policy exclusions section.

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

Insureds' Address: 9322 Little Rd., New Port Richey, FL 34654 Insurer’s Address: 4601 Touchton Road East, Ste. 3400, Jacksonville, FL 32246 This complaint is made on behalf of Hilltop Café c/o Laura Diakakis (“Insureds”) against Main Street America Protection Insurance Company. In consideration of the premium paid to it by the Insureds, Main Street America is-sued Policy No.: BPG7606Q (the “Policy”). On or about June 23, 2024, while the Policy was in full force and effect, the Insureds suffered a water loss at the property located at 9322 Little Rd., New Port Richey, FL 34654, due to an icemaker drain line leak. This leak caused significant damage to various areas of the property, including but not limited to the bar, tile floor, carpet, base-boards, and booths. Despite being provided with a full opportunity to investigate the loss, Main Street America Protection Insurance Company conducted an inadequate investigation. It produced two grossly insufficient estimates, one for $10,352.43 and another for $23,781.13. These estimates are significantly be-low the $80,350.94 estimate provided by Ask An Adjuster, which represents the true scope of the damages. Main Street America’s estimates fail to account for the full extent of damage to the property and reflect a blatant attempt to underpay the Insureds’ claim. Moreover, Main Street America Protection Insurance Company rejected the Sworn Proof of Loss submitted by the Insureds in bad faith. This rejection further demonstrates Main Street America’s clear intention to avoid its obligations under the Policy. The insurer’s actions have forced the Insureds to ex-pend additional resources to pursue the compensation they are rightfully owed, including time, legal fees, and loss of use of funds, all of which have compounded the Insureds’ damages. Main Street America’s conduct is not only a breach of the insurance contract but also a failure to act in good faith. Its handling of this claim is an attempt to avoid paying what is contractually owed, causing significant financial harm to the Insureds. To remedy these clear violations and cure the defects outlined in this Civil Remedy Notice, Main Street America Protection Insurance Company must immediately pay the Insureds’ claim in full, in the amount of $80,350.94, along with any applicable interest and additional costs incurred due to the insurer’s delay and underpayment.

Comments

User Id		Date Added		Comment
tiyarollelaw@gmail.com		12-23-2024		LAW OFFICE OF REBECCA WOLTJER ALL ATTORNEYS AND STAFF ARE EMPLOYEES OF AMERICAN FAMILY INSURANCE CO., S.I. NOT A LEGAL PARTNERSHIP OR PROFESSIONAL CORPORATION PO BOX 77055 MADISON, WISCONSIN 53707 TELEPHONE: 800-692-6326 FACSIMILE: (844) 556-7209 Direct Dial No.: (305) 763-7321. EMAIL: tiya.rolle@amfam.com December 23, 2024 Kyle Hilltop Café C/O Laura Diakakis c/o Kyle B Staggs, Esq. 1715 W. Cleveland Street Tampa, FL 33606 COURTDOCS@WILIAMSPA.COM Re: Civil Remedy Notice Claim No.: 01-007-803109 Date of Loss: 6-23-24 Insureds: Kyle Hilltop Café C/O Laura Diakakis Policy No.: BPG7606Q Dear Kaci Line, We are in receipt of your Civil Remedy Notice of Insurer Violations (hereinafter “Notice”). Main Street America Protection Insurance Company (“MSA”) Insurance Company responds to the substance of your Civil Remedy Notice of Insurer Violations as follows: This correspondence will serve as the response of MSA to the Notice, DFS number 789353. MSA hereby responds to the factual assertions set forth in the Notice without waiving any rights under Florida law to object to the legal deficiencies and inadequacies of the Notice. In the Civil Remedy Notice, you have asserted the following as the reasons for filing the Notice – (1) Claim Denial, (2) Claim Delay, (3) Unsatisfactory Settlement Offer, (4) Unfair Trade Practice, (5) Failure to Properly Investigate Claim and with Due Regard to Insured’s Interest, and (6) Failure to Pay the Claim in Full. You have also cited several sections of the Florida Statutes alleging, in part, that MSA has acted in bad faith and failed to settle the claim promptly. These allegations are broad and unspecified, to which a specific and detailed response is impossible given the vagueness of the allegations. Notwithstanding, MSA categorically denies these allegations both as to any general practice and with regard to this particular claim. Without waiving any rights under Florida law regarding the deficiencies and inadequacies of the Notice, MSA hereby responds to the assertions set forth in the Notice as follows: Response to Reason for Notice You state that the reasons for the Notice are due to the following: (1) Claim Denial, (2) Claim Delay, (3) Unsatisfactory Settlement Offer, (4) Unfair Trade Practice, (5) Failure to Properly Investigate Claim and with Due Regard to Insured’s Interest, and (6) Failure to Pay the Claim in Full. MSA responds by stating that these allegations are without basis and are therefore denied. MSA further states that the alleged 06/23/2024 loss was first reported to MSA on July 2, 2024. Thereafter, the claim was investigated, the property was inspected, and ultimately MSA issued checks in the amount of $22,781.13 and $10,352.43 to the insured. Response to Statutory Provisions Allegedly Violated The Civil Remedy Notice statute requires that a complainant “indicate all statutory provisions alleged to have been violated,” and you have listed several Florida Statutes. These allegations are overbroad and non-specific, apparently based upon conjecture or speculation to which a response is impossible given the uncertainty of the allegations. Notwithstanding, MSA categorically denies each alleged violations of statutes or rules asserted by you, both as to any general practice and with regard to this specific claim, as well. With respect to the statutes cited in this section of the Notice, MSA denies having violated the referenced statutes and responds to each of the alleged violations 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 been done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests. This allegation is denied. MSA has both a duty and a right to fully investigate this loss, which it did. MSA responds by stating that this allegation is without basis and therefore denied. Following the notice of loss, MSA properly performed an inspection, evaluated the claim accordingly, and issued payment. §626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information. This allegation is denied. MSA has both a duty and a right to fully investigate this loss, which it did. MSA responds by stating that this allegation is without basis and therefore denied. Following the notice of loss, MSA properly performed an inspection, evaluated the claim accordingly, and issued payment. The Notice Fails to Reference Specific Policy Language The statutory provision governing Civil Remedy Notices requires complainants to “[b]riefly reference the specific policy language that is relevant to the violation, if any.” §624.155(3)(b)4, Fla. Stat. The Notice filed on your behalf fails to cite to a policy provision providing the specific language relevant to the violation. Essentially, you cite no policy language that supports any of the allegations made against MSA. A detailed and specific response to the cited policy language is impossible, given the vagueness of the allegations cited in the Notice. Notwithstanding, MSA has both a duty and a right to fully investigate this loss, which it did. MSA acted immediately upon Notice of the complainant’s claim. Response to Facts/Circumstances Cited as Giving Rise to Alleged Violation The governing statute requires Civil Remedy Notices to “state with specificity . . . [t]he facts and circumstances giving rise to the violation.” Fla. Stat. §624.155(3)(b)2. The Notice contains a section requiring the following: “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.” However, the Notice lists alleged violations that are vague, overbroad and unsubstantiated that MSA is precluded from being able to respond in any specific manner. Nevertheless, MSA asserts that all actions that have been taken in responding to your claim have been performed properly, in good faith and for the purpose of reaching a fair and appropriate claim decision. MSA therefore denies all allegations set forth as the “facts and circumstances giving rise to the violations” in the Notice. MSA denies it has engaged in bad faith conduct in this matter. MSA denies any undue delay in adjusting the claim. MSA promptly and timely responded to the loss Notice and report of claim, retained an adjuster to assess the damages, and promptly began its investigation of the claim. MSA denies any allegation that it did not adopt or implement standards for proper investigation of the claim. MSA stands by its adjustment and investigative practices generally and the adjustment and investigation of this claim specifically. MSA has acted properly, promptly and in accordance with the terms of the policy of insurance and applicable law in the investigation of this claim. MSA asserts that all actions taken have been made in good faith and for the purpose of fair, equitable and timely resolution of this matter. MSA has acted appropriately at all times regarding the handling of this claim. MSA has not violated any applicable statutory provisions in relation to this claim and expressly denies all of the allegations set forth as the “facts and circumstances giving rise to the violations.” Conclusion MSA promptly investigated the claim, and contrary to the allegations in the Notice, the facts show that MSA has consistently complied with all legal and professional standards for the investigation and adjustment of this claim. MSA investigated and evaluated your claim pursuant to the policy of insurance and subject to the policy limitations, exclusions, forms and endorsements applicable to the policy and in accordance with Florida law. Notwithstanding the deficiencies in the Notice, MSA denies it violated the statutes cited in the Notice. MSA hereby denies each and every allegation contained in the Notice, either explicitly or implicitly, and denies any wrongdoing in the handling of the subject claim. MSA has acted fairly and with due diligence throughout the entire investigation and handling of this claim. To the extent that this response does not fully address and respond to the allegations set forth in the Notice, such deficiency is the direct result of the lack of specificity and the overall vague nature of the allegations contained therein. Contrary to the allegations in the Notice, MSA has fully complied with its obligations under Florida Statutes and the policy of insurance with regard to the investigation and adjustment of this claim. MSA categorically denies all allegations contained in the Notice. In sum, MSA has evaluated this claim in good faith and all allegations of violation are statutorily deficient and without merit. I trust that the foregoing, without waiver of arguments regarding the lack of validity of the Civil Remedy Notice of Insurer Violations, adequately addresses any concerns that the insureds may have regarding this matter. Please do not hesitate to contact the undersigned if you require more information. Respectfully submitted, /s/ Tiya Rolle Tiya Rolle, Esq.

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