Civil Remedy Notice of Insurer Violations
Login

Filing Number:     789618
Filing Accepted:  10/31/2024
         Print Filing
Complainant
Last/Business Name *  
RODRIGUEZ   First Name   ROBERT AND ILEANA
Street Address * 15090 SW 16TH STREET
City, State Zip * WESTON, FL 33326
Email Address * BOLYR@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   RODRIGUEZ   First Name   ROBERT AND ILEANA
Policy # * 79-CC-Q213-8 Claim #* 59-70R9-31J
Attorney
Attorney is Applicable
Last Name* LEVINE First Name * HOWARD Initial J
Street Address* 927 LINCOLN ROAD, SUITE 200
City, State Zip* MIAMI BEACH , FLORIDA 33139
Email Address * HLEVINE@LEVINEFELLIGLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   STATE FARM FLORIDA INSURANCE COMPANY
NAIC Company Code 10739
 
Name of individual responsible for violation (if any):* GINA RODRIGUEZ
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Claim Denial
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)(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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
* 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 – LOSSES INSURED COVERAGE A – DWELLING We will pay for accidental direct physical loss to the property described in Coverage A, unless the loss is excluded or limited in SECTION I – LOSSES NOT INSURED or otherwise excluded or limited in this policy. SASI prepared a Xactimate estimate with an Actual Cash Value damage estimate in the amount of $166,388.62. In a further good faith effort to verify the real-world accuracy of its damage estimate, SASI consulted ACE Construction and elicited an actual bid from this licensed general contractor for the repairs of covered damage. * * * SECTION I – ADDITIONAL COVERAGES 14. Tear Out. If a loss insured to Coverage A property is caused by water, steam, or sewage escaping from a system or appliance, we will also pay the reasonable cost you incur to tear out and replace only that particular part of the building structure necessary to gain access to the specific point of that system or appliance from which the water, steam, or sewage escaped. We will not pay for the cost of repairing or replacing the system or appliance itself. This coverage does not increase the limit applying the Coverage A property. * * * SECTION I -- LOSS SETTLEMENT Only the Loss Settlement Provisions shown in the Declarations apply. We will settle covered property losses according to the following. However, the valuation of any covered property losses does not include, and we will not pay, any amount for diminution in value. COVERAGE A – DWELLING 1. A 1 - Replacement Cost Loss Settlement- Similar Construction. a. we will pay the cost to repair or replace with similar construction and for the same use on the premises shown in the Declarations, the damaged part of the property covered under SECTION I - PROPERTY COVERAGES, COVERAGE A - DWELLING, except for wood fences, subject to the following: (1) we will pay only the actual cash value at the time of the loss prior to repair or replacement of the damaged part of the property, up to the applicable limit of liability shown in the Declarations, not to exceed the cost to repair or replace the damaged part of the property; (2) in addition, we will pay any remaining covered additional amounts you actually and necessarily incur to perform such repair or replacement as work is performed and expenses are incurred and submitted, or an amount up to the applicable limit of liability shown in the Declarations, whichever is less. There will be no deduction for depreciation; * * * Coverage C – Loss of Use The most we will pay for the sum of all losses combined under Additional Living Expense, Fair Rental Value, and Prohibited Use is the limit of liability shown in the Declarations for Coverage C – Loss of Use. 1. Additional Living Expense. When a loss caused by a peril described in SECTION I – LOSSES INSURED causes the residence premises to become uninhabitable, we will pay the reasonable and necessary increase in cost incurred by a insured to maintain their normal standard of living for up to 24 months. Our payment is limited to incurred costs for the shortest of: a. The time required to repair or replace the premises; b. The time required for your household to settle elsewhere; or c. 24 months. This period of time is not limited by the expiration of this policy.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Insureds, ROBERT and ILEANA RODRIGUEZ (collectively, “Rodriguez”) are owners of residential property located at 15090 SW 16th Street, Weston, FL 33326 (the “Property”). Rodriguez procured an open peril homeowner’s property insurance policy with State Farm Florida Insurance Company (“State Farm”), bearing policy no. 79-CC-Q213-8, with effective dates of May 16, 2024 through May 16, 2025 (the “Policy”). The Policy insured the Property against, amongst other things, water damage. On or about July 11, 2024, while the Policy was in full force and effect, Rodriguez suffered significant damage to the Property caused by a failure of the plumbing manifold located between the den and the kitchen on the main level of the residence. The accidental discharge of water resulted in damage throughout the main level or the residence, including damage to the living room, dining room, kitchen, den, office, bathroom, hallway and foyer. Rodriguez promptly notified State Farm of the loss. State Farm assigned claim number 59-70R9-31J and inspected the Property on July 29, 2024. Rodriguez selected Strategic Adjusting Services, Inc. (“SASI”) as its public adjuster to inspect the Property and to evaluate the damage. SASI prepared a Xactimate estimate with an Actual Cash Value damage estimate in the amount of $166,388.62. In a further good faith effort to verify the real-world accuracy of its damage estimate, SASI consulted ACE Construction and elicited an actual bid from this licensed general contractor for the repairs of covered damage. State Farm is required by §627.70131(7), Fla. Stat. to pay or deny the claim or a portion of the claim within 60 days, unless the failure to pay is caused by factors beyond State Farm’s control. As of September 9, 2024, then, a claim decision was due and owing, but State Farm ignored its statutory obligation, while failing to indicate that any articulable factors justified its unreasonable delay in reaching a claims decision. All the while, Rodriguez has fully cooperated with State Farm by providing State Farm with prompt notice of the loss, by allowing State Farm to inspect and document the damage, which should have made reasonably clear to State Farm of its obligation to pay according to the Policy’s coverages, and by making multiple attempts to assist State Farm in scheduling their recorded statements (which offers have been ignored by State Farm). State Farm’s failure to render a claims decision is thus inexplicable. Based on the ACE Construction estimate, Rodriguez submitted a sworn proof of loss on October 2, 2024 in the amount of $137,892.26, after a reduction of $4,501.33 for recoverable depreciation and $3,000 for the Policy deductible. Rodriguez anticipated that the submission of the sworn proof of loss would nudge State Farm towards compliance with its duty to render a claim decision in good faith. On October 9, 2024, however, Gina Rodriguez authored a poorly formulated rejection of Rodriguez’ sworn proof of loss. Mainly, the letter raised petty form objections to the submission, some of which were outright unfounded (such as the failure to state the Property’s mortgagee), and none of which could plausibly support colorable argument that either the sworn proof of loss was not substantially compliant with the Policy’s requirements or that, if it was, State Farm was prejudiced by any such alleged non-compliance. More significantly, with respect to State Farm’s overdue substantive claim decision, the October 9, 2024 rejection of the sworn proof of loss merely kicked the proverbial can down the road, avoiding entirely the issue by stating only that “we disagree with the estimate provided by Five Star Claims Adjusting.” Given that Rodriguez has no association with Five Star Claims Adjusting or any knowledge of any estimate provided by such an entity, this one and only “substantive” assertion purporting to directly respond to the sworn proof of loss is a feckless nullity. To the extent that State Farm’s intent was to express disagreement with the Ace Construction estimate which provided the underlying support for Rodriguez’ damage estimate, State Farm’s October 9, 2024 failed to articulate any cognizable or itemized basis of such disagreement. Instead, State Farm disregarded its obligation to pay that portion of the loss which was undisputed; failed to affirm or deny the dollar amount of partial coverage; and failed to provide a reasonable explanation for the non-offer of a compromise settlement. As such, the October 9, 2024 letter is in bad faith, as it constitutes an unequivocal violation of §§626.9541(1)(i)(3)(e) and (f), and §626.9541(1)(i)(4), Fla. Stat. While State Farm shirked its duty to render a claim decision, the avoidance of its obligations implicitly constitutes a constructive claim denial without conducting a reasonable investigation based on available information, in violation of §626.9541(1)(i)(3)(d), Fla. Stat. In addition to the misconduct described above, State Farm has committed the following acts of bad faith: SASI made multiple requests, on 7/15/24, 8/7/24, 8/26/24 and 9/9/24 for State Farm to produce a certified copy of the Policy, in order for Rodriguez to be able to fully evaluate their rights and obligations under the Policy with certainty. State Farm’s statutory duty to provide that certified copy of the policy arises under §627.70131(2), Florida Statute. The first three of SASI’s requests went unheeded by State Farm. In response to the 9/9/24 correspondence, State Farm finally provided a copy of the Policy, but it was uncertified. Accordingly, undersigned counsel renewed its request for a certified copy of the policy in its Letter of Representation, sent on 10/14/24 to State Farm’s assigned Claim Specialist, Gina Rodriguez. State Farm has failed to acknowledge undersigned’s letter of representation and has failed to respond to the claim communication, in violation of §627.70131(1), Fla. Stat. State Farm’s continuing unresponsiveness to claim-related communications constitutes an enumerated act of statutory bad faith, see §626.9541(1)(i)(3)(c), Fla. Stat., which in turn betrays State Farm’s failure to adopt and implement standards for the proper investigation of claims. See §626.9541(1)(i)(3)(a), Fla. Stat. During State Farm’s inspection of the property on 7/29/24, Gina Rodriguez informed William Coffman, c/ SASI, that for the claim to proceed, Rodriguez would be required to detail with specificity the location of the loss. This assertion constitutes a misrepresentation of the terms and provisions of the Policy, in violation of §626.9541(1)(i)(3)(b), which prohibits the misrepresentation of insurance policy provisions relating to coverages at issue. Under an Open Peril policy, the insured is required to demonstrate that the loss has occurred within the policy period and the repair costs arising from that loss, but is not required to undertake the insurer’s investigative duties. Non-contractual obligations cannot be arbitrarily imposed on Rodriguez, and imposing such a false obligation constitutes bad faith. Rodriguez has been without water in their kitchen since the date of loss. Despite its knowledge of this fact that the Property has been unfit for its normal use, State Farm has offered no ALE benefits, in violation of §624.155(1)(b)(1), which requires that State Farm 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. As of the filing of this Civil Remedy Notice, (1) State Farm has not paid the replacement cost of the loss claimed under the Policy; (2) State Farm has not paid the actual cash value of the loss claimed under the Policy; (3) State Farm has not issued undisputed payments of any kind; (4) State Farm has failed to demonstrate any due regard for the interests and entitlements of Rodriguez under the Policy or to offer Rodriguez any assistance of whatever nature; and (5) State Farm has entirely failed to undertake any cognizable effort to adjust the loss. In order to cure its bad faith conduct, State Farm must pay within sixty (60) days the cure amount of $137,892.26, as reflected on the Sworn Proof of Loss.
Comments
User Id Date Added Comment
admin@bernstein-chackman.com 12-20-2024 Dear Robert Rodriguez and Ileana Rodriguez: This letter is to advise you that my firm represents State Farm Florida Insurance Company (hereinafter “State Farm”) in the matter referenced above. This shall serve as State Farm’s response to civil remedy notice number 789618, which was submitted to the Department of Financial Services on behalf of Robert Rodriguez and Ileana Rodriguez on October 31, 2024. The civil remedy notice states that State Farm violated §624.155 and §626.9541 by doing the following: not attempting in good faith to settle claims; failing to promptly settle claims; failing to adopt standards for proper claim investigation; and other alleged wrongdoings. State Farm denies all allegations of wrongdoing or violation of Florida Law. State Farm has acted in accordance with Florida law and the subject policy in its handling of this claim. Additionally, the civil remedy notice fails to comply with the requirements of Florida Statute §624.155. State Farm does not waive any deficiencies in the civil remedy notice with the filing of this response. The notice neglects to include facts which demonstrate that State Farm violated Florida law, fails to identify the specific policy language that was allegedly violated, or include a reasonable cure for the alleged violations. The purpose of the civil remedy notice is to grant the insurer an opportunity to cure the alleged violations of Florida law. Therefore, complainants must identify the specific policy provisions and statutory language that were violated. In addition, complainants must identify what actions the insurer did that violated such provisions and identify what actions must be taken to cure the violations. As such, Florida Statute §624.155(3)(b) states: The notice shall be on a form provided by the department and shall state with specificity the following information, and such other information as 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 this instance, civil remedy notice 789618 does not include specific facts and circumstances that demonstrate a violation as required by §624.155(3)(b)(2). The notice contains conclusory allegations that State Farm improperly and insufficiently adjusted the claim. As such, the notice fails to comply with §624.155(3)(b)(4). See Talat Enters. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278 (Fla. 2000) & Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). The Insureds procured policy no.: 79-CC-Q213-8, for their home located at 15090 SW 16th Street, Weston, FL., 33326. The policy was in effect from May 16, 2024, through May 16, 2025. There was a prior related loss for a pipe leak in the bathroom wall with a date of loss of May 10, 2024. Claim no: 59-67H6-07P. The homeowner reported water coming up through wood in closet of guest bedroom that backs up to bathroom. They were paid $7,503.03 for that plumbing leak claim. This claim was reported to State Farm on July 12, 2024, with an alleged date of loss of July 11, 2024. The claim was reported by the public adjuster. During the quality first contact the public adjuster advised that: Damage to sheet rock in guest bedroom/ bathroom from break in line, Kitchen has access damage from locating the leak inside the manifold of the kitchen island. The rooms that the notes say it was coming from the bathroom. No dry out or emergency mitigation services took place. The Plaintiffs submitted a proposal from Joe Hillman Plumbers in the amount of $9,400. The scope of work on the proposal states that they will chip out and remove tile flooring and concrete floor. They will dig and trench from the old location of the kitchen by the refrigerator. They will locate the manifold behind daughters bathroom and run it along the wall. The public adjuster submitted two estimates. One in the amount of $40,825.42. The other estimate from the public adjuster’s is in the amount of $171,980.57. The public adjuster also received an estimate from Ace Construction. The estimate is in the amount of $145,393.59. Gina Rodriguez inspected the property on July 30, 2024. She noted that there was a prior related loss for a pipe leak in the bathroom wall with a date of loss of May 10, 2024. During her inspection the public adjuster informed her that he is not sure if the insureds ever saw water on the floor. She requested a recorded statement. The plumber advised her that the plumbing under the slab has developed leaks. They are normally sleeved under the slab. The plumber advised that the manifold is in the kitchen. The plumber advised that the insureds did not want to re-route, despite them doing that for the prior claim. This claim was denied by letter dated October 31, 2024. The denial letter states that there was no covered ADPL to the property. The damage was the result of continuous and repeated seepage or leakage. A civil remedy notice was submitted to the department on October 31, 2024. A notice of intent was submitted to the department on December 1, 2024. State Farm responded by standing by its denial of the claim. At this time, nothing has been presented to State Farm that would change its coverage determination. In this Civil Remedy Notice the claimant alleges that State Farm violated §624.155(1)(b)(1) and §624.155(1)(b)(3) by 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 his interests and failing to promptly settle claims. However, this claim was properly denied. There is no coverage under this policy for the claim made. The claimant alleges that State Farm violated §626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly upon communications. In this claim, State Farm timely acknowledged the claim and acted promptly after the reporting of the claim. The claim was then properly denied. The claimant alleges that State Farm violated §626.9541(1)(i)(3)(a) by failing to adopt and implement standards for the proper investigation of the claim. In this claim, based on State Farm’s inspection and evaluation of the claim, it was determined that there was no coverage for the damages being claimed. The claimant alleges that State Farm violated §626.9541(1)(i)(3)(d) by denying claims without conducting reasonable investigations. However, State Farm did conduct a reasonable investigation. Although the insured removed and discarded some of the damaged items/materials, State Farm performed an in-person inspection and then reviewed all of the documents submitted. Based on that it was determined that there is no coverage under the policy for this claim. The claimant alleges that State Farm violated §626.9541(1)(i)(3)(f) by 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. In this case, no additional information was necessary. State Farm also provided a detailed claim determination letter, which set forth the facts and policy provisions as to why there is no coverage under the policy for this claim. The claimant alleges that State Farm violated §626.9541(1)(i)(3)(b) by misrepresenting pertinent facts or insurance policy provisions relating to the coverages at issue. However, no such misrepresentations were made. The claim determination letter sets forth the facts and policy provisions that exclude coverage for the claim. The claimant alleges that State Farm violated §626.9541(1)(i)(3)(e) by failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed. However, investigation into this claim concluded when State Farm sent its claim determination letter. The claim determination was specific that this was a denied claim and no monies would be owed. The claimant alleges that State Farm violated §626.9541(1)(i)(4) by Failing to pay undisputed amounts of partial or full benefits owed under first party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5). However, this claim was reported to State Farm on July 12, 2024, with an alleged date of loss of July 11, 2024. This claim was denied by letter dated October 31, 2024. The claim was denied at that time because State Farm was in the middle of gathering information from the public adjuster in order to make a complete evaluation of the claim. State Farm denies all allegations of non-compliance with Florida law or the subject policy. Furthermore, the civil remedy notice is deficient in that it does not comply with the requirements of Florida Statute §624.155(3)(b). State Farm does not waive any such deficiencies in the filing of this response. Regardless, the accusations raised within the notice are devoid of merit. Thank you for your attention to the above. Very truly yours, /s/ Brian A. Chackman Brian A. Chackman
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