Civil Remedy Notice of Insurer Violations
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Filing Number:     789492
Filing Accepted:  10/30/2024
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Complainant
Last/Business Name *  
O'CONNOR   First Name   SUSAN & JOHN
Street Address * 96006 SERENITY LANGE
City, State Zip * FERNANDINA BEACH, FL 32034
Email Address * UNKNOWN
Complainant Type: * Insured
Insured
Last/Business Name*   O'CONNOR   First Name   SUSAN & JOHN
Policy # * PFL029643-15 Claim #* CFL24602719
Attorney
Attorney is Applicable
Last Name* MULLINAX First Name * MATTHEW Initial
Street Address* 908 W HORATIO ST
City, State Zip* TAMPA , FL 33606
Email Address * MATT@MAKRISMULLINAX.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   PEOPLE'S TRUST INSURANCE COMPANY
NAIC Company Code 13125
 
Name of individual responsible for violation (if any):* SUSANNA MORROE
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Unreasonable Investigation
* 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)(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)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* 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 PERILS INSURED AGAINST SECTION. THE LOSS PAYMENT PROVISION. THE LOSS SETTLEMENT PROVISION. THE POLICY PROVISIONS CITED IN PEOPLE’S TRUST INSURANCE COMPANY’S (“PTIC”) LETTER DATED AUGUST 12, 2024. ANY OTHER PROVISIONS OF THE POLICY WHICH PTIC BELIEVES LIMIT OR PROVIDE COVERAGE FOR THE INSUREDS’ LOSS.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

ON OR ABOUT JULY 1, 2024, WHILE THE POLICY WAS IN FULL FORCE AND EFFECT, THE SUBJECT PROPERTY SUSTAINED A COVERED LOSS TO THE PROPERTY. THIS RESULTED IN DAMAGE TO THE INTERIOR OF THE HOME INCLUDING CABINETRY AND KITCHEN AREAS. THE INSUREDS PROVIDED TIMELY NOTICE OF THE LOSS TO PTIC AND PTIC ASSIGNED CLAIM NUMBER CFL24602719 TO THE CLAIM. PTIC INSPECTED, ADJUSTED, AND IMPROPERLY DENIED THE CLAIM. PTIC IMPROPERLY AND WITHOUT PROPER JUSTIFICATION, ASSERTED THAT THE DAMAGE HAD BEEN ONGOING FOR MORE THAN 14 DAYS. THE INSUREDS RETAINED THEIR OWN PROFESSIONALS, WHO DOCUMENTED THE LOSS, PHOTOGRAPHED, AND DISPUTED THE DENIAL. THE INSUREDS PROVIDED PTIC WITH THIS DOCUMENTATION REGARDING EXTENT AND COST OF REPAIRS, BUT PTC HAS MAINTAINED ITS REFUSAL TO ACCEPT FULL COVERAGE FOR THE LOSS AND ISSUE PAYMENT FOR THE COST TO RESTORE THE PROPERTY TO ITS PRELOSS CONDITION. IN FAILING TO ACCEPT FULL COVERAGE AND ISSUE THE COST OF REPAIRS FOR THE DAMAGE, PTIC HAS IMPROPERLY DENIED THIS CLAIM. UPON INFORMATION AND BELIEF, THIS IMPROPER DENIAL IS THE RESULT OF A FAILURE TO ADJUST THIS CLAIM IN GOOD FAITH, AND THE ACTIONS TAKEN IN THIS CLAIM MAY OCCUR IN OTHER PTIC CLAIMS TO THE LEVEL THAT CONSTITUTES A GENERAL BUSINESS PRACTICE. THE FOLLOWING IS ALLEGED UPON INFORMATION AND BELIEF. THESE ACTIONS DESCRIBED ABOVE, AND OTHERS THAT OCCURRED IN THIS CLAIM, AMOUNT TO A FAILURE TO ADJUST THE INSUREDS’ CLAIM IN GOOD FAITH. PTIC’S REFUSAL TO CONDUCT A REASONABLE INVESTIGATION BASED UPON AVAILABLE INFORMATION AND FAILURE TO PAY THE INSUREDS FOR THE DAMAGE AND COVERED LOSS UNDER THE POLICY ISSUED BY PTIC EXHIBITS BAD FAITH. FURTHER, PTIC FAILED TO COMPLY WITH ITS LOSS SETTLEMENT PROVISION. RATHER THAN ISSUING THE PROPER PAYMENT OR ATTEMPTING TO REACH AN AGREEMENT WITH ITS INSUREDS, PTIC DENIED THE CLAIM. UPON INFORMATION AND BELIEF, PTIC PERFORMS THE SUBJECT ACTIONS AS A BUSINESS PRACTICE, INCLUDING DELAYING THE CLAIM AND PARTIALLY DENYING THE CLAIM IN AN ATTEMPT TO DISSUADE ITS INSUREDS FROM PURSUING THE CLAIM TO THE DETRIMENT OF ITS INSUREDS TO INCREASE FINANCIAL PROFITS. IN THE EVENT PTIC BELIEVES THIS CIVIL REMEDY NOTICE LACKS INFORMATION NECESSARY FOR PTIC TO CURE THE DEFECTS OUTLINED IN THIS NOTICE, OR THAT IT LACKS REQUIRED SPECIFICS IN ANY WAY, PTIC SHOULD CONTACT THE FILER OF THIS NOTICE DIRECTLY AND ALERT THEM TO THAT AS SOON AS POSSIBLE, PRIOR TO ANY FORMAL RESPONSE. THIS NOTICE IS FILED AND GIVEN TO PTIC TO PERFECT THE RIGHT TO PURSUE THE CIVIL REMEDY THAT SECTION 624.155 AUTHORIZES. TO CURE THE DEFECTS OUTLINED IN THIS CIVIL REMEDY NOTICE, PTIC MUST: (1). ADMIT FULL COVERAGE FOR THE INSUREDS’ LOSS; (2). PAY IN THE PROPER AMOUNT NECESSARY TO RESTORE THE PROPERTY TO ITS PRELOSS CONDITIONS; AND (3). PAY STATUTORY INTEREST ON THE AMOUNT OF UNPAID CONTRACT DAMAGES FROM THE DATE OF THE LOSS TO THE PRESENT TIME PURSUANT TO F.S. §627.70131. A COPY OF THIS FORM SUBMITTED TO THE FDFS HAS BEEN PROVIDED TO THE FOLLOWING PARTIES PROVIDING THEM NOTICE OF THE FILING OF THE CIVIL REMEDY NOTICE: PEOPLE’S TRUST INSURNACE COMPANY VIA EMAIL TO: SMORROE@PTI.INSURE ATTN: SUSANNA MORROE, LICENSE W480352
Comments
User Id Date Added Comment
bfrankel@gmail.com 12-11-2024 The Legal Department has been requested by People’s Trust Insurance Company (“PTI”) to assist it in responding to a Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of its Insureds, Susan and John O’Connor (“Insureds”). In direct response to the CRN filing, PTI maintains that it has not been in any violation of the law and that the CRN is defective on its face and fails to comply with the specificity requirements under Florida Statute 624.155. As such, PTI objects to the Department’s acceptance of the above-referenced CRN. To be more specific, the CRN requirements set forth by Section 624.155 are that the notice be filed on a form provided by the department stating with specificity the following information, and such other information the department may require: (1) The statutory provision, including the specific language of the statute, 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. If the person bringing the civil action is a third-party claimant, she or he shall not be required to reference the specific policy language if the authorized insurer has not provided a copy of the policy to the third-party claimant pursuant to written request. (5) A statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. In light of the instant CRN, PTI will provide a simple review of the facts and claims handling in support of its position there was no “bad faith” in the handling of this claim and detail how and why PTI acted property and within the letter of the law while handling the subject insurance claim. Following the claims summary, PTI will then address each respective statutory violation alleged in the Insureds’ CRN and respond accordingly in order to highlight why the CRN fails to perfect the Claimant’s right to pursue civil remedies under Florida Statutes. ? 1) On 7/2/2024 the Insureds contacted PTI to report water damage due to a failed dishwasher. Per the Insureds, the hardwood floors on the first floor were warping and there was mold to the cabinets behind the dishwasher. The Insureds also reported water damage to the back side of the cabinet section of the kitchen island. The Insureds stated that the issue had going on for awhile and they had sprayed bleach on the mold. There was no content damage reported and no contractor had been called during the time of reporting. Following the reporting of the loss PTI sent the Homeowner’s Bill of Rights, as well as a What to Expect Form detailing the claims investigation process about to commence. 2) Thereafter, on 7/12/2024, PTI’s Field Adjuster inspected the home in order to determine the cause of loss and scope of damages. At the time of the inspection, the Insured, John O’Connor, was present and PTI’s Field Adjuster observed water damage to the kitchen cabinets, drywall, baseboards, and wood flooring of the living room and kitchen. As a result of the investigation and inspection, PTI issued its coverage determination letter on 8/12/2024 advising that the loss is not covered by the policy. The letter explained that the policy excludes coverage for constant or repeated seepage or leakage. As shown, PTI has not acted in bad faith but has observed the terms and conditions of the Policy and Florida law. PTI further maintains that its practices and/or guidelines for response to claims are adequate to provide for the proper investigation and resolution of all claims. While the CRN references “claim denial, claim delay, unsatisfactory settlement offer, unfair trade practice and unreasonable investigation” as reasons for the notice, it fails to mention specific policy language or factual support in support of said allegations. To the contrary, the above-referenced timeline of events shows that PTI acted timely in its adjustment of the claim and communications with the Insured and/or Insured representatives, and thoroughly investigated the claim by way of an initial inspection in order to confirm there was no coverage under the subject policy that would warrant a payment and/or settlement offer. As it relates to unfair trade practice, the CRN does not provide any information in support of this and therefore PTI denies said allegations. As for “claim denial” alleged as a reason for notice, PTI maintains that the denial was issued in accordance with its findings during the investigation of the claim and pursuant to the terms of the policy at issue. Additionally, PTI notes that the CRN states the Insureds retained their own professionals, who documented the loss, photographed, and disputed the denial and that this information was provided to PTI; however, PTI has received no such documentation as of today’s date. Moreover, the Notice of Intent to Initiate Litigation, Notice No.: 218380, contains no estimate of damages and stated the amount is “unknown.” Turning to the statutory sections alleged to be violated, PTI responds as follows: GENERAL DENIAL PTI denies of all the statutory violations alleged in the Insureds’ CRN. 1) ALLEGED VIOLATION §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: RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. As stated above, the investigation of the claim failed to reveal any damages to trigger coverage under the policy at issue. 2) ALLEGED VIOLATION §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. RESPONSE PTI denies this alleged statutory violation. As shown in the claims summary above, there was no coverage under the policy at issue and therefore no obligation to settle the claim. Moreover, the Insured does not indicate what portion(s) of the policy coverage became reasonably clear nor what portion(s) of the policy were used to influence settlement. Accordingly, it is impossible to further respond to this allegation. 3) ALLEGED VIOLATION §626.9541(1)(i)(3)(a) – Failing to adopt and implement standards for the proper investigation of claims. RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. PTI advises that this allegation requires specific facts regarding the method of the investigation; the reasons the investigation was improper or otherwise inadequate; the reasons why this alleged inadequacy is due to the failure to adopt and implement standards for the proper investigation of claims, and the facts supporting these conclusions. To allege an inadequate investigation, the Notice must include specific facts regarding the method, rather than merely the results. Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006) As the Insureds have not advised PTI as to how it failed to investigate the claim and/or what standards were not adopted or implemented, this alleged violation is emphatically denied. 4) ALLEGED VIOLATION §626.9541(1)(i)(3)(b) – Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. RESPONSE The Insured does not indicate what facts and/or policy provisions were misrepresented. Hence, PTI denies this alleged statutory violation. 5) ALLEGED VIOLATION §626.9541(1)(i)(3)(d) – Denying claims without conducting reasonable investigations based upon available information. RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. As mentioned above, the Insureds have not advised PTI as to how it failed to investigate the claim and/or what standards were not adopted or implemented. Furthermore, PTI promptly investigated the claim, and a favorable coverage decision was made within 30 days after the post-loss property inspection. 6) ALLEGED VIOLATION §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. RESPONSE PTI denies this alleged statutory allegation in its entirety. As indicated in the numbered paragraphs above, PTI issued a denial of coverage letter following its inspection by the Field Adjuster at the outset of the claim. Within the letter, the findings of the Field Adjuster were communicated, as well as the relevant policy provisions upon which PTI was relying on. 7) ALLEGED VIOALTION §626.9541(1)(i)(3)(i) – Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b). RESPONSE The subject claim and instant CRN involves a homeowner’s insurance policy and dispute and does not involve any allegations and/or facts related to personal injury. For that reason, PTI advises this alleged violation is irrelevant and hereby denied. CONCLUSION /SUMMATION As outlined above, PTI maintains that it has not been in violation of any law and that payment is not due or owing pursuant to the investigation findings, as well as the terms of the policy at issue. The CRN alleges that in order to “cure” the alleged violation, PTI must admit full coverage, pay the proper amount necessary to restore the property, and pay statutory interest. However, PTI stands by its claim decision, has at all times acted in good faith with regard to the claim, and has not breached any duty owed. PTI further maintains that the CRN, as filed, is defective on its face as it fails to meet the specificity requirements of Florida Statute 624.155. Should the Department require additional information, please do not hesitate to contact us. Very truly yours, /S/ Cosima Ortiz Cosima Ortiz, Esq. Corporate Counsel People’s Trust Insurance Company Cc: Matthew Mullinax Esq. 908 W. Horatio St. Tampa, FL 33606 E-mail: matt@makrismullinax.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.

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