Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 790137

Filing Accepted: 11/4/2024

Print Filing

Complainant

Last/Business Name *

KATES

First Name

KEVIN

Street Address *

807 EDGEFOREST TERRACE

City, State Zip *

SANFORD, FL 32771

Email Address *

PURDUEPILOT4@YAHOO.COM

Complainant Type: *

Insured

Last/Business Name*		KATES		First Name		KEVIN
Policy # *		734271		Claim #*		011940

Attorney

Attorney is Applicable

Last Name*	HAMMACK-BARBER First Name * TAMMY Initial
Street Address*		2300 MAITLAND CENTER PARKWAY STE. 106
City, State Zip*		MAITLAND , FLORIDA 32751
Email Address *		THAMMACK@SERRANOCAGAN.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		VYRD INSURANCE COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 17153

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

Reason for Notice *

	Claim Denial
	Unsatisfactory Settlement Offer

* 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)(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.

SECTION I – PERILS INSURED AGAINST COVERAGE A- DWELLING and COVERAGE B – OTHER STRUCTURES 1. We insure for sudden and accidental direct loss to property described in Coverage A and B only if that loss is a physical loss to covered property. This includes the peril of “catastrophic ground cover collapse” as provided in Part A. below. The following policy language is relevant in that it was quoted in Vyrd’s coverage letter: 2. We do not insure, however, for loss: b. Caused by: (9) Any of the following: (a) Wear and tear, marring, deterioration; (b) Inherent vice, latent defect, defect or mechanical breakdown; (c) Smog, rust, “spalling,” decay or other corrosion; … (f) Settling, shrinking, bulging or expansion, including resultant cracking of pavements, patios, foundations, walls, floors, roofs or ceilings; SECTION I – EXCLUSIONS 1. We do not insure for loss caused by directly or indirectly by any of the following. Such loss is excluded regardless of the any other cause or event contributing concurrently or in any sequence to the loss. These exclusions apply whether or not the loss event results in widespread damage or affects a substantial area. k. Existing Damage (1) Damages which occurred prop rot eh policy inception regardless of whether such damages were apparent at the time of inception of the policy of discovered at a later date. Or (2) Claims for damages arising out of workmanship, repairs or lack of repairs arising from damage which occurred prior to policy inception. However, any ensuing loss arising out of workmanship, repairs or lack of repairs, caused by a peril insured against, to property described under Section I- Property Coverage, is covered unless the loss is otherwise excluded in the policy.

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

Kevin Kates submitted a claim for damage to his home to Vyrd Insurance Company after his home sustained a covered direct physical loss due to a storm. Prior to the loss, Insurer issued a policy of insurance, policy # 734271 which afforded coverage for the aforementioned property for losses caused by the covered peril. The policy was in full force and effect when the loss occurred. After sending an adjuster out to inspect, Vyrd acknowledged that they found damage to the home and that this damage is covered under the policy. However, Vyrd falsely claimed that the damages were below the insured’s deductible and failed to make any payment. Due to this Insured had no choice but to retain legal representation, as the Insurer refused to pay the full amount due and owed to its Insured. Insurer has continually failed to negotiate this claim with Insured’s attorney and/or failed to provide a satisfactory settlement offer to resolve the subject claim. This has severely harmed the Insured's ability to remedy their losses and continue with repairs to the property. The only purpose for Insurer's refusal to negotiate the claim is to increase profits and harm their insured. This is either done intentionally as a pattern and practice of Insurer to deny coverage and harm their insureds, or Insurer has failed to properly train and supervise its adjusters to the harm and detriment of their insured. This pattern and practice is done for only one reason, which again, is to maximize profits and harm their insured. Insurer has violated the following statutory provisions: 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)(i): Unfair claim settlement practices. Insurer can cure its bad faith conduct by: 1) accepting the insured’s claim as compensable, and agreeing to pay the claim in accordance with its loss settlement provision prior to the expiration of the cure period, or 2) reaching an amicable settlement of the pending claim prior to the expiration of the cure period, or 3) tender payment in the amount of $190,714.68 less any applicable deductible and prior payment to the Insured to complete the repairs for the Insured property. By doing any one of these three things, the insurer will cure its bad faith in this case, and extinguish any and all of its liability for all bad faith damages which could be sought pursuant to this Civil Remedy Notice.

Comments

User Id		Date Added		Comment
thammack@serranocagan.com		02-06-2025		This civil remedy notice is withdrawn.
alabbe@kelleykronenberg.com		01-14-2025		Please accept this correspondence as VYRD Insurance Company’s (“VYRD”) supplemental response to the Civil Remedy Notice (“CRN”) number 790137, filed by the complainant, Kevin Kates (“Complainant”). VYRD’s initial response was provided on November 6, 2024. From the outset, VYRD denies that any of its actions taken regarding the Insureds’ claim have resulted in a violation of Florida’s bad faith laws, including 624.155 and 626.9541, as alleged in the CRN. Rather, VYRD has acted, at all times, in good faith in its investigation and handling of this claim and with regard to the best interest of its Insured. While VYRD welcomes the opportunity to respond to this CRN and specifically denies each and every allegation contained in the CRN referenced above, VYRD requests the CRN be rejected as it fails to comply with several of the requirements of the Civil Remedy Notice of Insurer Violation document provisions as set forth in Florida Statute § 624.155, as well as pursuant to Florida case law. Setting forth the factual background, the subject claim for alleged hailstorm damage was initially reported to VYRD on June 20, 2024, for an alleged date of loss of June 6, 2024. To investigate the claim and cause and origin of the alleged damage, VYRD retained Edgewood Engineering who inspected the Property on July 2, 2024, with a licensed engineer. Based on the results of the engineering inspection, it was determined that there was no direct wind or hail-caused damage to the roof, and rather was deemed attributable to wear and tear, installation/maintenance deficiencies, manufacturing deficiencies, and/or mechanical damage. These are excluded causes of loss under the Policy. The engineer did find an isolated chip to the window which he could not rule out as being caused by hail. An independent field adjuster prepared an estimate of what it would cost to repair the window, amounting to $537.53 RCV / $506.49 ACV / $0.00 Net Claim after application of the Policy’s $2,500.00 All Other Perils Deductible. Based on the results of the inspection, and VYRD’s overall investigation into the claim, VYRD denied coverage for the claim, with the exception of the window repair which fell below deductible. The coverage letter was issued by VYRD on August 19, 2024, within the statutorily imposed 90-day deadline to adjust a claim. As such, not only was a coverage determination issued in accordance with the terms, conditions, limitations, exclusions, and endorsements which make up the subject Policy of insurance, it was done so based upon the inspection of a professional engineer. VYRD’s investigation into the claim was extensive and performed with case and due diligence. The facts, as set forth above, demonstrate quite clearly that VYRD acted in good faith. VYRD acted fairly and honestly, acknowledged and acted promptly upon receipt of the claim, determined coverage for the claim pursuant to the terms of the policy, and took reasonable steps to investigate the claim and inspect the Property. Accordingly, the CRN does not provide the contemplated and mandated notice of bad faith that is required as a condition precedent to any civil claim for bad faith pursuant to Fla. Stat. § 624.155. A such, the CRN fails at its inception. Pursuant to Fla. Stat. § 624.155, a complainant is required to “indicate all statutory provisions alleged to have been violated.” The subject CRN, however, includes statutory provisions that could be claimed against any insurance company, regardless of whether they are relevant or applicable to the alleged facts contained in the CRN. Because the CRN fails to identify the specific facts applicable to the listed statutes that were allegedly violated with respect to the subject claim, VYRD is unable to properly respond and said CRN should be rejected and returned. As such, it is VYRD’s position that the CRN is statutorily deficient in that it cites various statutory violations and does not provide the requisite specificity as to how they were violated. Furthermore, contrary to the requirement to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time,” the purpose of which is “to enable the insurer to investigate and resolve the claim,” the CRN itself provides unsupported, vague, ambiguous, and incorrect allegations with no basis in fact or circumstances. The CRN fails to apprise VYRD of any actions that rise to the level of a statutory violation other than boilerplate allegations. The CRN is purposefully drafted in a manner which does not allow VYRD proper notice of the allegations or any meaningful opportunity to respond and/or evaluate the claims being asserted. Based upon the foregoing, the CRN is insufficient on its face and should be rejected. Talat Enterprises Inc. vs. Aetna Cas. & Sur. Co., 753 So.2d 1278 (Fla. 2000); Lane v. Westfield Ins. Company, 862 So.2d 744 (Fla. 5th DCA 2003). Aside from the fact that the CRN is insufficient on its face, the tenor and inferences of the allegations are wholly without merit and VYRD denies each and every one. An insurer possesses a non-delegable duty to completely and accurately investigate a claim in order to evaluate the claim on behalf of the policyholder. American Fidelity & Cas. Co. vs. Greyhound Corp., 258 F. 2d 709, 710-11 (5th Cir. 1958). However, the insurer’s statutory obligation to settle claims in good faith only requires the insurer to timely evaluate and pay benefits under the insurance policy if such payments are warranted. Id. The insurer also has a right and obligation to issue payments only as contemplated by the terms, conditions, exclusions, limitations, and endorsements contained within the subject Policy of insurance. Notwithstanding the above-mentioned deficiencies/discrepancies, the following are VYRD’s responses to each of the alleged violations noticed in the CRN: VYRD conducted a complete, thorough, and timely investigation of the alleged loss relying on inspection, Policy terms, and statutory requirements to inform VYRD’s coverage determination, which was made in accordance with, and as contemplated by, the terms and conditions of the subject Policy. VYRD acted fairly and honestly toward the Insured and the Plaintiff in its handling of the claim. Thus, there is no violation of § 624.155(1)(b)(1). VYRD has not failed to pay personal injury protection insurance claims within statutory time periods. In fact, this is not a personal injury claim so this allegation is inapplicable to VYRD form the outset. Thus, there is no violation of § 626.9541(1)(i)(3)(i). In closing, VYRD’s actions in handling the subject insurance claim were prompt, thorough, conducted in accordance with the Policy and Florida law and—most importantly—in good faith. Furthermore, VYRD complied with all obligations under the Policy and the Florida Statutes, promptly investigated the claim, and promptly issued a coverage determination. Thus, VYRD denies each and every allegation contained in the CRN and respectfully requests that the CRN is rejected due to its failure to comply with Florida Statute §624.155 and Florida case law. We trust this response adequately addresses the allegations of violation alleged in the CRN.

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