Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 789686

Filing Accepted: 10/31/2024

Print Filing

Complainant

Last/Business Name *

KIZZIRE

First Name

ROBERT

Street Address *

38800 STILL LN.

City, State Zip *

NORTH FORT MYERS, FL 33917

Email Address *

LITIGATION@THEFREEMANLAWFIRMPA.COM

Complainant Type: *

Insured

Last/Business Name*		KIZZIRE		First Name		ROBERT
Policy # *		FE-0000772421-05		Claim #*		HO0522416553

Attorney

Attorney is Applicable

Last Name*	FREEMAN First Name * BRIAN Initial
Street Address*		4245 FOWLER STREET
City, State Zip*		FORT MYERS , FLORIDA 33901
Email Address *		LITIGATION@THEFREEMANLAWFIRMPA.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		MONARCH NATIONAL INSURANCE COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 15715

Name of individual responsible for violation (if any):* NETTA BUTLER
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Denial
	Claim Delay
	Unfair Trade Practice
	Other : Bad Faith

* 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)(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 Insured is in possession of a copy of the subject insurance policy and believes his insurance policy language relevant to the violations includes all applicable insurance policy coverages, loss payment provisions, valuation provisions and ot his terms and conditions of Insurance Policy No. FE-0000772421-05. In particular, the Insured refers to the following insurance policy coverages included in his insurance policy: COVERAGE A – Dwelling 1. We cover: a. The dwelling on the “residence premises” shown in the Declarations, including structures attached to the dwelling; b. Materials and supplies located on or next to the “residence premises” used to construct, alter or repair the dwelling or other structures on the “residence premises”; and c. In-ground swimming pools on the “residence premises”. 2. We do not cover land, including land on which the dwelling is located. COVERAGE B – Other Structures 1. We cover other structures on the “residence premises” set apart from the dwelling by clear space. This includes structures connected to the dwelling by only a fence, utility line, or similar connection. This coverage does not apply to inground swimming pools. 2. We do not cover: a. Land, including land on which the other structures are located; b. Other structures rented or held for rental to any person not a tenant of the dwelling, unless used solely as a private garage; c. Other structures from which any “business” is conducted; or d. Other structures used to store “business” property. However, we do cover a structure that contains “business” property solely owned by an “insured” or a tenant of the dwelling provided that “business” property does not include gaseous or liquid fuel, other than fuel in a permanently installed fuel tank of a vehicle or craft parked or stored in the structure. 3. The limit of liability for this coverage will not be more than the limit shown in the Declarations for Coverage B. Use of this coverage does not reduce the Coverage A limit of liability. COVERAGE A – Dwelling and COVERAGE B – Other Structures Cosmetic and Aesthetic Damage to Floors – Special Limit of Liability. The total limit of liability for Coverages A and B combined is $10,000 per policy term for cosmetic and aesthetic damages to floors. 1. Cosmetic or aesthetic damage includes, but is not limited to, chips, scratches, discoloration, dents or any other damage to less than 5% of the total floor surface area and does not prevent typical use of the floor. 2. This limit includes the cost of tearing out and replacing any part of the building necessary to repair the damaged flooring. 3. This limit does not increase the Coverage A or Coverage B limits of liability shown in the Declarations. 4. This limit does not apply to cosmetic or aesthetic damage to floors caused by a Peril Insured Against as named and described under COVERAGE C – PERSONAL PROPERTY. 10. Loss Payment We will adjust all losses with you. Claim payments issued for damage under Coverage A – Dwelling or Coverage B – Other Structures will be made payable to all persons, parties, and entities with an insurable interest in the property covered (including but not limited to, Named Insureds and mortgagees listed on the Declarations page of this Policy), and any assignee, as appropriate. In the event that any repair services were performed under the Our Option provision, we will pay the retained contractor directly for those services or part or portion of any services the retained contractor performs or provides. For all other claim payments, we will pay you unless some other person is named in the policy or is legally entitled to receive payment. We will not be responsible for payment to you or under SECTION I and II – CONDITIONS, 7. Assignment, to any assignee(s) or third parties, for payments on losses that are not covered under this policy. Loss will be payable upon the earlier of the following: a. Twenty (20) days after we receive your proof of loss and reach written agreement with you; or b. Sixty (60) days after we receive your proof of loss and: (1) There is an entry of a final judgment; or (2) There is a filing of an appraisal award or a mediation settlement with us; or c. Within ninety (90) days after we receive notice of a property insurance claim for you, we shall pay or deny such claim or portion of such claim, unless there are circumstances beyond our control, which reasonably prevent such payment. Our failure to comply with this paragraph shall not form the sole basis for an action against us for breach of contract under this policy or for benefits under this policy. “Emergency mitigation services” will be payable in accordance with SECTION I – PROPERTY COVERAGES, ADDITIONAL COVERAGES, 2. “Emergency Mitigation Services”. 3. Loss Settlement Covered property losses are settled as follows: a. Property of the following types: (1) Personal property; (2) Awnings, carpeting, household appliances, outdoor antennas and outdoor equipment, whether or not attached to buildings; and (3) Structures that are not buildings; at actual cash value at the time of loss but not more than the amount required to repair or replace b. Buildings under Coverage A or B at replacement cost without deduction for depreciation; (1) Subject to: (a) The limit of liability under this policy that applies to the building; (b) The replacement cost of that part of the building damaged for like construction and use on the same premises; or (c) The necessary amount actually spent to repair or replace the damaged building. (d) “Emergency mitigation services” will be adjusted in accordance with ADDITIONAL COVERAGES 2. “Emergency Mitigation Services” of this policy. (e) All repairs, other than “emergency mitigation services”, performed by repair person(s), contractors, or assignees shall not exceed the reasonable and necessary labor, materials, costs or measures to repair the property, unless otherwise specifically covered under the terms and conditions of the policy (i.e., ordinance or law coverage). (f) Any contract entered into by you to perform non-emergency repairs for any loss attributed to a covered peril shall not interfere with the Our Option provision under this policy (2) If, at the time of loss, the amount of insurance in this policy on the damaged building is less than 80% of the full replacement cost of the building immediately before the loss, we will pay the greater of the following amounts, but not more than the limit of liability under this policy that applies to the building: (a) The actual cash value of that part of the building damaged; or (b) That proportion of the cost to repair or replace, after application of deductible and without deduction for depreciation, that part of the building damaged, which the total amount of insurance in this policy on the damaged building bears to 80% of the replacement cost of the building. (3) To determine the amount of insurance required to equal 80% of the full replacement cost of the building immediately before the loss, do not include the value of: (a) Excavations, foundations, piers or any supports which are below the undersurface of the lowest basement floor; (b) Those supports in (a) above which are below the surface of the ground inside the foundation walls, if there is no basement; and (c) Underground flues, pipes, wiring and drains. (4) We will initially pay at least the actual cash value of the insured loss less any applicable deductible. We shall pay any remaining amounts necessary to perform such repairs as work is performed and expenses are incurred, or we will pay a licensed contractor after the insured signs a contract and as repairs are made to the covered property. If a total loss of the covered dwelling occurs, we shall pay the replacement cost coverage without reservation of any depreciation in value, subject to policy limits. (5) If the dwelling where loss or damage occurs has been “vacant” for more than thirty (30) consecutive days before the loss or damage, we will: Not pay for any loss or damage caused by any of the following perils, even if they are Perils Insured Against: (a) Vandalism; (b) Sprinkler leakage, when caused by or arising out of the freezing of a fire protective sprinkler system, unless you have protected the system against freezing; (c) Dwelling glass breakage (d) Water Damage (e) Theft; or (f) Attempted theft. Dwellings under construction are not considered “vacant.” In the event the construction extends greater than 60 days you must notify us. (6) You may disregard the replacement cost loss settlement provisions and make claim under this policy for loss or damage to buildings on an actual cash value basis. You may then make claim within 180 days after loss for any additional liability according to the provision of this Condition 3. Loss Settlement.

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

During the policy period, on September 28, 2022, the Insured’ home located at 38800 Still Lane North Fort Myers, FL 33917, owned by Robert Kizzire ("Insured"), suffered hurricane/windstorm related physical and structural damage as a direct result of Hurricane Ian, a covered loss under the subject insurance policy. Please see insurance policy language above that indicates coverage for hurricane/windstorm damage to the Insured’s home and roof system as a direct result of Hurricane Ian. Subsequent to Hurricane Ian, the Insured immediately reported the loss to his insurance carrier, Monarch National Insurance Company ("Insurer"). Since the beginning of the claims process, the Insured fully cooperated in the Insurer's investigation of the Insured’s hurricane/windstorm damage claim. Despite overwhelming evidence the Insured’s home and roof system had been significantly physically and structurally damaged by Hurricane Ian, all covered losses under the subject insurance policy; the Insurer unreasonably, untimely and improperly investigated, inspected, evaluated and adjusted the amount of damage to the Insured’s home and roof system. The Insurer performed a completely inadequate hurricane/windstorm investigation of the damage to the Insured’s home and roof system. The Insurer retained adjuster Leif Bertelsen (“Mr. Bertelsen”), to inspect the hurricane/windstorm damage to the Insured’s home and roof system. Mr. Bertelsen prepared a damage estimate confirming hurricane/windstorm damage to the exterior, roof system, barn roof, coop roof, shed roof, fencing and personal property of the Insured. However, Mr. Bertelsen completely undervalued the Insured’s hurricane/windstorm damage claim. Mr. Bertelsen’s damage estimate totaled a mere $29,321.81. On December 1, 2023, based solely on Mr. Bertelsen’s completely inadequate inspection and damage estimate, the Insurer sent a coverage determination letter to the Insured partially denying his hurricane/windstorm damage claim. After application of the hurricane deductible and “depreciation,” the Insurer provided payment of only $4,187.49 on the Insured’s claim. The Insured retained Semper fi Public Adjusters (“Semper fi”), to inspect his home and roof system for hurricane/windstorm damage. Semper fi documented extensive hurricane/windstorm damage to the Insured’s home and roof system. Semper fi provided the Insured with an estimate totaling $388,692.82, the amount necessary to replace the Insured’s roof system, repair all of the Hurricane Ian damage to his home and return the Insured’s home to its pre-loss condition. Despite receipt of Semper fi’s damage estimate, the Insurer did not extend coverage for the damage set forth in Semper fi’s damage estimate. The Insurer failed to extend full coverage for the Insured’s clearly evident hurricane/windstorm damage, indicating the Insurer does not have proper standards for investigating the proper scope and amount of damage caused by a covered loss. The Insured provided all the evidence necessary supporting the actual costs associated with the complete replacement of his roof system and all of the other Hurricane Ian related damage to his home in order to restore his home and roof system to their pre-loss condition. However, despite this evidence and information, the Insurer failed and refused to pay for the Insured’s damage in order to restore his home and roof system to their pre-loss condition. Moreover, the Insurer did not perform a legally sufficient hurricane/windstorm damage investigation by failing to perform a substantial structural damage investigation and determination as required by The Florida Building Code. The Insurers failure to perform this very important substantial structural damage determination further indicates the Insurer did not comply with the basic requirements inherent in the proper investigation, inspection, evaluation and adjustment of hurricane/windstorm damage claims, and instead performs inadequate and incomplete investigations in order to improperly partially deny valid claims. The Insured provided the Insurer with an overwhelming amount of evidence to support the extensive damage to his home and roof system as well as a comprehensive damage estimate from Semper fi. Notwithstanding, the Insurer failed and refused to pay the amount necessary to restore his home and roof system to their pre-loss condition. The work of adjusting insurance claims in Florida engages the public trust. In the instant case, the Insurer breached this duty through its complete failure to properly investigate, inspect, adjust and timely pay the hurricane/windstorm damage claim of the Insured. The Insurer's failure to properly inspect, investigate, evaluate, adjust and pay for the damage to the Insured’s home and roof system, failure to communicate with the Insured and improperly handled the Insured’s hurricane/windstorm damage claim of the Insured clearly indicates the Insurer failed to adopt and implement proper standards for the investigation, evaluation and adjustment of claims; failed to properly train, manage, supervise and promote claims adjusters so an Insured receives good faith, fair and prompt adjustment of claims; and failed to conduct a full and fair investigation of this hurricane/windstorm damage claim. The Insurer furthermore failed to provide full reasons and facts to the Insured for the partial denial of his hurricane/windstorm damage claim resulting in the statutory violations as set forth in this notice. The Insurer also breached its duty to the Insured by failing to timely and promptly pay the correct indemnity owed to its Insured. This duty is owed by the Insurer to its Insured and is inherent in the insurance claims process. The Insured promptly provided all necessary documentation, evidence and information for a timely resolution of his hurricane/windstorm damage claim, including an itemized damage estimate from Semper fi and extensive documentation of the damage to the Insurer. To date, the Insurer failed to provide timely and prompt payment for the correct amount of the Insured’s damage. To date, the Insured performed all conditions precedent required of him under his insurance policy with the Insurer and under Florida law. However, the Insurer and its agents failed and refused to properly investigate, inspect, evaluate, adjust and pay the Insured’s hurricane/windstorm damage claim and failed to tender all insurance proceeds due and owing to the Insured under the subject insurance policy. Due to the Insurer's intentional delay and partial denial of the Insured’s hurricane/windstorm damage claim, the Insured was forced to obtain legal counsel at a significant cost and expense to attempt to recover what he is legally owed under his insurance policy with the Insurer. The concept of insurance is that it is the insurer's granting of timely and prompt indemnity or security against a contingent loss. Fla. Stat. § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that an Insured may mitigate his damages and be put back into the position he was in prior to the loss as quickly as possible. Simply put, the Insurer failed to comply with its duty to indemnify the Insured and breached the insurance policy. The Insurer failed and refused to timely investigate, inspect, evaluate, adjust and pay the Insured’s hurricane/windstorm damage claim. The Insurer failed and refused to pay the correct amount of insurance proceeds to date owed to the Insured as required by the insurance policy and Florida law. Refusal and failure to pay the Insured’s claim, when under all the circumstances it could have and should have done so had it acted fairly and honestly towards the Insured is a breach of the insurance policy and a violation of Florida Law. The actions taken by the Insurer in the handling and adjustment of the Insured’s hurricane/windstorm damage claim were willful, wanton, and in disregard for the rights of its Insured and occur with such a frequency as to indicate a general unfair and deceptive business practice in violation of Florida Statutes § 624.155 and § 626.9541. Based on the foregoing actions and omissions, the Insurer engaged in wrongful claims handling conduct, including but not limited to, the following: 1) Improper partial claim denial; 2) Improper claim delays; 3) Not conducting a full and fair investigation of the Insured’s claim; 4) Looking for ways to deny recovery to the Insured; 5) Overlooking covered damages to the Insured’s home and roof system and not retaining a professional engineer if causation was in question; 6) Failing to pay the necessary amounts due and owing to restore the Insured’s home to its pre-loss condition; 7) Not adjusting the claim and not evaluating the loss properly, promptly and fairly so as to provide full and prompt indemnity to its Insured; 8) Failing to implement proper standards for the adjustment and investigation of insurance claims; 9) Failing to pay the requisite monies owed for the Insured’s loss, despite receipt of a detailed damage estimate from Semper fi and supporting documentation; 10) Not training, supervising or managing adjusters and independent contractors properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholders’ interests by attempting to deny or minimize payments owed; 11) Establishing severity control initiatives and otherwise establishing a culture of not fully and promptly paying claims following losses. The Insurer violated the statutes set forth above based on the conduct described herein. The Insurer failed and refused to timely tender insurance proceeds required by its insurance policy with its Insured. In addition, the Insurer failed to reasonably and properly pay and resolve the Insured’s hurricane/windstorm damage claim for money damages when under all the facts and circumstances, it could have and should have done so if it had acted fairly and honestly towards its Insured. The Insurer’s improper actions are well documented and have occurred with such frequency as to constitute a general unfair and deceptive business practice and were made in a reckless disregard for its Insured’s rights. The Insurer placed its interest above and before the Insured’s interest in this matter. Therefore, to cure the defects outlined in this Civil Remedy Notice, the Insurer must do the following: A. Immediately pay the Insured’s hurricane/windstorm damage claim in the amount of the Semper fi’s damage estimate of $388,692.82, less the applicable deductible and depreciation. B. Agree to tender any recoverable depreciation once it has been incurred per the terms of the insurance policy.

Comments

User Id		Date Added		Comment
tacham@hpmanaging.com		12-30-2024		December 30, 2024 Via E-mail & Posting on DFS Website Brian Freeman, Esq. 4245 Fowler St., Fort Myers, Florida 33901 litigation@thefreemanlawfirmpa.com RE: Complainant(s): Robert Kizzire Insured(s): Robert Kizzire Claim No: HO0522416553 Policy No: FE-0000772421-05 DFS Filing Number: 789686 Acceptance Date: October 31, 2024 Insurer: Monarch National Insurance Company To Whom it May Concern: Please allow this correspondence to serve as Monarch National Insurance Company’s (“Monarch”) official response to the Civil Remedy Notice of Insurer Violations (“Notice”). Monarch maintains that it has not been in any violation of the law and that the Notice is defective on its face and fails to comply with the specificity requirements under Florida Statute 624.155. As such, Monarch objects to the Department’s acceptance of the above-referenced Notice. Monarch has acted in good faith and with due regard for the insured’s interests, and denies each and every allegation contained in the Notice. Monarch denies any wrongdoing in the adjustment and handling of the above-referenced claim, and denies any and all allegations that it committed any acts or violated any Florida statutes or law. Monarch has acted in good faith and in accordance with the terms and provisions of the applicable policy of insurance as well as with the law. Please note that nothing herein should be deemed as a waiver by Monarch. Monarch hereby expressly reserves all rights without exception or limitation. If you require additional information, please contact me. Sincerely, /s/ Tyler Acham, Esq. Tyler Acham In-House Counsel Monarch National Insurance Company

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