Civil Remedy Notice of Insurer Violations
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Filing Number:     790292
Filing Accepted:  11/5/2024
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Complainant
Last/Business Name *  
MCBRIDE   First Name   CHARMAINE
Street Address * 7730 UDINE AVENUE
City, State Zip * ORLANDO, FL 32819
Email Address * JJS@WEKLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   MCBRIDE   First Name   CHARMAINE
Policy # * PFL406029-02 Claim #* CFL22590044
Attorney
Attorney is Applicable
Last Name* SAIDENSTAT First Name * JEFFREY Initial
Street Address* 800 EAST BROWARD BLVD. SUITE 510
City, State Zip* FORT LAUDERDALE , FL 33301
Email Address * JJS@WEKLAW.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):* PHYLLIS BIBBY; LICENSE # E036204
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
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.
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.
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 Loss Payment provision found in the homeowner's policy authorizes payment in the event of a covered loss to insured property.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

At all times material hereto, People’s Trust Insurance Company insured Charmaine McBride’s home under a policy of insurance. The subject policy provides coverage for sudden and accidental losses and damages arising from windstorms, and more specifically, hurricanes. The loss payment provision and governing law provides that the insurer has a fiduciary duty to in good faith promptly investigate, adjust, and issue payment of the undisputed amount of the loss and damages. See Doe v. Allstate Ins. Co., 653 So. 2d 371, 374 (Fla. 1995) (stating that the obligation of insurance company toward insured is a "fiduciary duty requiring the exercise of good faith"). People’s Trust Insurance Company failed to pay the insured's claim under the homeowner's insurance policy when, under all of the circumstances, it could and should have done so, had it acted fairly and honestly and with due regard for the interests of insured. People’s Trust Insurance Company failed to act with diligence and thoroughness in investigating the facts specifically pertinent to coverage. People’s Trust Insurance Company failed to attempt to settle the liability claim in the face of the coverage dispute. People’s Trust Insurance Company failed to assess the substance of the coverage dispute or the weight of legal authority on the coverage issue. People’s Trust Insurance Company has a regular business practice of failing to adequately evaluate its policyholder’s claims and undervalues the claims to save itself money. It is clear that the insurer’s general business practice of willful, wanton, immoral, deceptive and bad faith claim handling policies, procedures, adjusting, investigating has caused the insured to suffer further harm and extra-contractual damages which have accrued, and will continue to accrue. People’s Trust Insurance Company also has a regular business practice of retaining unreliable vendors, including adjusters and engineers, to assist in its intentional effort to deny its policyholder rightful benefits. That said, and even though People’s Trust Insurance Company knows that it has a fiduciary duty to promptly adjust insurance claims, it failed to institute the necessary policies, procedures, guidelines and protocols to adjust insurance claims promptly and pursuant to the policy’s Loss Payment Provision. By way of the cited legal authorities and considerations, People’s Trust Insurance Company knew that it had an obligation to treat all insureds equally and honestly. However, and for their own financial interest, they will only start to fully consider their obligations as stated herein if the insured retains legal representation and pursues a legal action which exposes them to liabilities and costs. Even then, they will withhold monies owed in an unjust effort to limit/delay their liabilities in relation to the statutory considerations and otherwise. To cure the above stated immoral, deceptive, unlawful and generally described bad faith conduct which is part of a general business practice that is knowingly being utilized by People’s Trust Insurance Company for self-gain, People’s Trust Insurance Company must: (1) accept coverage for the subject claim; (2) promptly make payment pursuant to the policy’s Loss Payment Provision for covered damages in the amount of $101,513.00 (3) tender interest on any overdue payments; and (4) acknowledge liability for taxable cost and reasonable attorneys in the pending lawsuit.
Comments
User Id Date Added Comment
bfrankel@gmail.com 12-23-2024 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 Insured, Charmaine McBride (“Insured”). 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 Insured’s 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 10/3/2022, PTI was advised of a water loss resulting in damage to the flooring, walls, and baseboards in the master bedroom. Subsequently, on 10/15/2024, a Field Adjuster inspected the property to determine the nature and scope of the reported damage. At the time of the inspection, the Insured, Charmaine McBride, was present and confirmed the home was built in 1958. PTI’s Field Adjuster did not observe any claim related damage to the exterior of the home or the roofing system, and the interior conditions were attributable to water coming from the ground level, as opposed to a roof leak. 2) Upon completion of its investigation, PTI issued a coverage determination letter on 11/18/2022. Within the letter, the Insured was advised that there was no coverage under the policy at issue and cited the relevant policy language. Specifically, the inspection revealed no evidence of any wind or hail damage to the roof or exterior of the property and no storm-created openings through which water entered the interior and caused resulting damages. The letter further explained that the policy does not provide coverage for damages caused by flood water, ground water, or storm surge. 3) Following the issuance of the coverage letter, there were no communications on the matter until a year and a half later when PTI received documents from Elevate Claim Adjusters (“Insured’s Public Adjuster”) via email on 4/16/2024. PTI promptly responded to their correspondence on 4/23/2024 by advising of its prior coverage letter and that it was standing by its position. Additionally, a certified copy of the policy was provided to the Public Adjuster on 4/24/2024. Thereafter, a Notice of Intent to Litigate was filed on 5/23/2024 and responded to on 6/5/2024. 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, and unsatisfactory settlement offer, as reasons for the notice, it fails to mention specific policy language or factual support in support of said allegations. Moreover, said allegations are contrary to the facts discussed above. 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 and that the denial letter adequately explained the basis of the denial as well as the relevant policy language. 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 Insured’s 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 evidence of weather-related damage to the roofing system and/or a weather-related opening through which water entered in order 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)(c) – Failing to acknowledge and act promptly upon communications with respect to claims. RESPONSE PTI denies that this alleged statutory violation. As indicated in the numbered paragraphs above, all communications were not only promptly responded to but also promptly acted upon. 6) 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 coverage decision was made within 34 days after the post-loss property inspection. 7) 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. 8) ALLEGED VIOLATION §626.9541(1)(i)(3)(g) – Failing to promptly notify the insured of any additional information necessary for the processing of a claim. RESPONSE PTI denies this statutory allegation in its entirety and notes that it is completely contradicted by the Coverage Determination letter sent to the Insureds on 11/18/2022, in which PTI advised that if the Insured had any additional information not previously provided, or additional information which would require PTI to reassess its claims decision, to submit that information. 9) ALLEGED VIOLATION §626.9541(1)(i)(3)(h) – Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. RESPONSE The Insureds do not clarify what information they are referring to and/or how PTI failed to clearly explain anything. PTI denies this alleged violation. See also Response to Allegation # 8. 10) 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 As is evident, section 626.9541(1)(i)(3)(i) is entirely inapplicable and irrelevant to the claim and/or to the CRN, and PTI denies violating its provisions. 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 accept coverage for the subject claim and promptly make payment in the amount of $101,513.00. 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: Jeffrey Saidenstat, Esq. 800 East Broward Blvd., Suite 510 Fort Lauderdale, Fl 33301 E-mail: jjs@weklaw.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