Civil Remedy Notice of Insurer Violations
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Filing Number:     789364
Filing Accepted:  10/30/2024
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Complainant
Last/Business Name *  
ROJAS   First Name   MARCELA
Street Address * 342 CALCUTTA AVE NW
City, State Zip * PALM BAY, FL 32907
Email Address * WITHHELD
Complainant Type: * Insured
Insured
Last/Business Name*   ROJAS   First Name   MARCELA
Policy # * FPH5328427-01 Claim #* FPI234777
Attorney
Attorney is Applicable
Last Name* GUTIERREZ First Name * DANIEL Initial
Street Address* 924 DELANEY AVENUE
City, State Zip* ORLANDO , FLORIDA 32806
Email Address * SERVICE@DGPALAW.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):* TERELL WEBB, DON ANDERSON, BRENT BUCKENDAHL, SABRINA WHITE
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Claim Denial
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)(2) 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.
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)(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.
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The coverage decision correspondence does not reference any policy language as a limitation for coverage. However, they have failed to properly adjust and pay the claim pursuant to the Section I – Conditions, Loss Settlement provision and the Section I – Conditions, 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.

On September 28, 2022, the home of Marcela Rojas (hereinafter referred to the “Insured”) was damaged by Hurricane Ian. Specifically, the roof and exterior were damaged and interior water damages ensued. The Insured reported these damages to their homeowners’ insurance company, Florida Peninsula Insurance Company (hereinafter referred to as “Insurer”). The Insurer responded to the claim and inspected the damages. The Insurer inspected the property on November 16, 2022. In correspondence dated December 10, 2022, the Insurer advised that they had determined that the repairs for covered damages were under the deductible and no payment would be made for the claim. The insurer stated that they observed no evidence of any peril created damage causing an opening to the exterior walls or windows which would have allowed rainwater to enter the kitchen, living room, hallway, and family room of the dwelling. Also, they believed it was evident that the upstairs bathroom did not result from damage caused by wind and is not covered by the policy. This correspondence was from supervising adjuster, Terell Webb, and the estimate was prepared by Brent Buckendahl with Don Anderson listed as the desk adjuster. The letter does not provide any explanation as to how the water did enter the home or how they determined there was no storm created openings. Therefore, the Insurer failed to provide the basis in the insurance policy, in relation to the facts, for denial of most of the damages reported. Further, there was no identification of who they were relying on for the determination that the roof damage was not caused by the storm. Interestingly, the coverage that was acknowledged (but under the deductible) was related to roof damages, yet, they found no peril created openings for the extensive interior damages. The Insured retained an adjuster to assist with her claim and prepared an estimate of storm damages totaling storm damages totaling $66,312.07 RCV and $64,945.01 ACV, which far exceeds that $6,120 deductible. The Insured submitted their estimate and notified the Insurer of their disagreement with their coverage decision; however, the Insurer responded and reiterated their original claims decision. This correspondence was from supervising adjuster, Sabrina White. They did not conduct an additional inspection or make any efforts to further evaluate the claim. If there was any additional information necessary for the Insurer to reconsider their decision, then the Insurer failed to advise of what information is necessary for the processing of the claim and why it is necessary. It is clear that the carrier is not treating the Insured with good faith claims conduct by failing to pay a claim clearly owed, not adjusting the claim and evaluating the loss properly, failing to promptly and fairly provide full and prompt indemnity to the Insured, failing to advise of any information necessary for further processing of the claim, failing to provide a reasonable explanation in writing of the basis in the insurance policy in relation to the facts for the denial of the claim, and failing to implement proper standards for the adjustment and investigation of claims by its adjusters. This Insurer is placing the company’s interests before the Insured’s interests when a reasonable carrier in a similar position would have provided full coverage. In particular, it is a business practice of the Insurer to severely lowball storm damage claims with their initial claim adjustment with the intent of effecting settlement of such claims on less favorable terms than those provided by the policy. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the Insured’s rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $60,192.07 ACV, which reflects application of the deductible 2.) Pay the Insured’s attorneys’ fees and costs as they have been forced to retain counsel; 3.) Pay the statutory interest on the amount of unpaid damages from the date the loss was reported to the date payment is finally made. A copy of this form has been submitted to the FDFS and has been printed out and mailed to the following parties providing them notice of the filing of the Civil Remedy Notice: Florida Peninsula Insurance Company P.O. Box 273349 Boca Raton, Florida 33427 Certified Return Receipt # 9589 0710 5270 1009 7571 52
Comments
User Id Date Added Comment
pcole@conroysimberg.com 12-27-2024 We are in receipt of a Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of Florida Peninsula Insurance Company’s Named Insured, Marcela Rojas, which was accepted by the Department of Financial Services on October 30, 2024, and assigned Filing No. 789364. The CRN revolves around a claim (FPI234777) filed for alleged damage from a windstorm, named Hurricane Ian, that occurred on September 28, 2022 at the Insured’s single-family residence located at 342 Calcutta Avenue NW, Palm Bay, Florida 32907. The residence was built in 1981 and is comprised of a shingle roof that was installed in 2005. At the time of loss, the Insured’s unit was covered under an HO3 Policy, Policy number FPH5328427-01, issued by Florida Peninsula Insurance Company (“The Company”). At the outset, it should be stated that the CRN is defective and does not conform with the requirements of filing a CRN as it contains inaccurate factual allegations, lacks the required specificity and does not provide an opportunity for the Company to reasonably respond to the alleged violations contained in the CRN. The CRN merely contains conclusory reasons for the Notice, such as failing to settle claims in good faith, failing to implement standards for the proper investigation, and failing to acknowledge and act promptly upon communications, to name a few. For example, the Notice alleges that the Company violated the following statutory provisions of Florida Statutes §624.155: • §624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all other 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)(2) 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. • §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)(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. • §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. The CRN fails to identify specific facts as related to the broad and conclusory allegations. 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). Notwithstanding, the Company explicitly denies violations of any applicable Florida Statute in the adjustment of the referenced claims. The Company specifically denies that it has not attempted in good faith to settle the Insured’s claim when under all the circumstances it could and should have done so and it denies that it has failed to act fairly and honestly toward its Insured’s interests. Moreover, the Company specifically denies that it refused to properly investigate the claim or refused to tender all insurance proceeds without waiver of its objections, rights and defenses, the Company 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, and wishes to dispel even the inference of any violation, and reiterates below the reasons which clearly show the proper handling of the Insured’s claim. Additionally, the Civil Remedy Notice demands “cures” for the alleged defects that are improper under Florida case law. In Talat Enter., Inc., v. Aetna Cas. And Sur. Co., 753 So.2d 1278, 1281 (Fla. 2000), the Supreme Court of Florida held that the scope of what can be “cured” is limited to the alleged non-payment of the contractual amount due to an insured. As a result, Florida Peninsula Insurance Company objects to the CRN as it is defective and should be rejected. In order to understand the deficiencies of this Notice, however, and reserving all objections to the subject CRN, the background of this case is necessary. On November 9, 2022, a public adjuster from Nejame Claims Adjusting reported this Hurricane Ian claim on behalf of the insured as having occurred on September 28, 2022. The PA reported that the windstorm caused damage to roof including missing and creased shingles, and that there was a leak in the kitchen. The PA provided its letter of representation on November 9, 2022, and a certified copy of the policy was provided to the PA on November 28, 2022 as requested. It is important to note that from the start, Florida Peninsula Insurance Company (the “Company”) communicated with its Insured and/or her representatives on a regular basis. In fact, when the claim was reported on November 9, 2022, a first notice of loss letter acknowledging the claim was immediately sent out to the insured advising the homeowner of her Bill of Rights as an Insured, and her pre-suit mediation opportunities. Further, later in the claim adjustment process, the Insured was advised of those same rights again, so it was very clear that the Insured was informed of what she could do to protect herself under the circumstances should she disagree with the Carrier’s handling and decision. Upon reporting of the loss, the Company assigned the claim to a field adjuster (the “FA”). On November 16, 2022, the FA conducted an inspection of the subject property. The FA carefully assessed and evaluated the claimed damage, which included a thorough inspection of the roof, exterior, and interior of the property. By letter dated December 10, 2022, a coverage determination was issued wherein the Insured was advised that based on the estimate the damage to the property was less than the insured’s contractual deductible which was $6,120.00. The coverage determination also advised that, based on the investigation of the claim and the terms of the policy, there was no coverage for part of the claim. Specifically, the Company advised that at the time of its loss site inspection on November 16, 2022, it observed no evidence of any peril created damage causing an opening to the exterior walls or windows of the home which would have allowed rainwater to enter the kitchen, living room, hallway, and family room of the dwelling, and that it was evident that the rainwater intrusion to the upstairs bathroom did not result from damage caused by wind. As such, that damage was not covered under the terms of the policy. With the December 10th coverage determination, the Company provided the insured with its estimate and an excerpt detailing the applicable policy language clarifying the Company’s decision. On February 1, 2023, the PA submitted its estimate in the amount of $64,945.01, which included interior damages and roof replacement. By letter dated March 23, 2023, the Company issued a supplemental coverage determination wherein the insured was advised that it had completed the investigation and evaluation of the insured’s supplement claim. The Company explained that it received the PA’s estimate for the claim and the Company’s prior determination outlined damages which were not covered due to wind driven rain, with no peril-created opening in the roof, exterior walls, windows, or doors. Additionally, the Company advised that the roof was repairable, however, the PA’s estimate was written for a complete roof replacement. As such, the Company advised that it was standing with its original coverage decision. The insured then retained counsel who filed provided a letter of representation on October 21, 2024. The Company provided counsel with all coverage determination correspondence on October 23, 2024 as requested. Counsel then filed the Civil Remedy Notice with the Department on behalf of the Insured on October 30, 2024. Thereafter, counsel filed a Notice of Intent to Initiate Litigation on December 9, 2024 which contained a demand in the amount of $60,512.00. The Company responded to the NOIL by letter dated December 18, 2024. The Insured’s counsel complains that there is a disagreement as to scope and pricing in this case, among other items. While that might be true, that does not rise to the level of a statutory violation, it is merely a disagreement with the value of the loss. Certainly, as is noted above through the chronology of this loss, an appropriate claims handling procedure was in place to give due consideration to the claim. Florida Peninsula Insurance Company has communicated with its Insured and his representatives as required. Florida Peninsula Insurance Company has inspected the loss and damages thoroughly and given a thorough assessment of its findings and conclusions made. The fact that Florida Peninsula Insurance Company was not in agreement with the position of the Insured or her representatives and the estimates prepared on her behalf, does not rise to the level of statutory violations. Certainly, as is noted above through the chronology of this loss, an appropriate claims handling procedure was in place to give due consideration to the claim. As demonstrated above, the Company has, thus far, undertaken a thorough adjustment process and investigation, and the decision that it has made as to what is compensable and what is not has been amply explained to the Insured. The Company has, at all times, acted fairly and promptly toward its Insured and with full regard to her interests, and has complied with its obligations in this claim process. Any further information which may be required is available upon request.
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