Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 790312

Filing Accepted: 11/5/2024

Print Filing

Complainant

Last/Business Name *

JOSEPH

First Name

NAMPHIE

Street Address *

14401 NW 13TH ROAD

City, State Zip *

MIAMI, FL 33617

Email Address *

LSTEPHAN@MINEOLAW.COM

Complainant Type: *

Insured

Last/Business Name*		JOSEPH		First Name		NAMPHIE
Policy # *		12-1047357-03		Claim #*		12-3019699-23

Attorney

Attorney is Applicable

Last Name*	STEPHAN First Name * LANCE Initial
Street Address*		5600 DAVIE ROAD
City, State Zip*		DAVIE , FLORIDA 33314
Email Address *		LSTEPHAN@MINEOLAW.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		TYPTAP INSURANCE COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 15885

Name of individual responsible for violation (if any):* ALL ADJUSTERS, SUPERVISORS, MANAGERS, ATTORNEYS, AND INDIVIDUALS ASSOCIATED WITH AND/OR RETAINED BY TYPTAP INSURANCE COMPANY CONCERNING THE CLAIM AT ISSUE; CHIP WINBORNE; KIMBERLY KNOX; LISA ROBINSON.
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Denial
	Claim Delay
	Unsatisfactory Settlement Offer
	Unfair Trade Practice
	Other : VIOLATION OF CODE OF ETHICS

* 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)(2)		Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
	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)(1)		Attempting to settle claims on the basis of an application, when serving as a binder or intended to become a part of the policy, or any other material document which was altered without notice to, or knowledge or consent of, the insured.
	626.9541(1)(i)(2)		A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
	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)(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)(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.

In addition to the breach of the above statutory duties, see Coverage A, Coverage C, and Loss Payment Provisions.

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

TypTap Insurance Company (the “Insurance Company”) issued a homeowners’ insurance policy to its insured, Namphie Joseph (the “Insured”), for the insured property located at 14401 NW 13th Road, Miami, FL 33617. The subject Policy afforded various types of coverages including coverage for damage to dwelling, other structures, personal property, and for loss of use. On or about November 16, 2023, while the subject Policy was in full force and effect, the Insured’s home was damaged as a result of a wind storm event. The Insured subsequently notified the Insurance Company of the loss. Thereafter, the Insurance Company acknowledged the loss and assigned claim number 12-3019699-23 to the loss. The Insured complied with all policy conditions and cooperated with the Insurance Company’s investigation efforts. The Insurance Company performed a cursory inspection, failing to retain the experts necessary to adequately inspect the property to restore the property to its pre-loss condition and issued a “low-ball” payment to the Insured totaling $5,760.98 for repairs. The Insured and Insured’s representative provided the Insurance Company with all claim-related documents including an estimate to repair covered damages in the amount of $35,412.67, and other supporting documentation and/or information. The Insurance Company continues to completely ignore the Insured’s claim and request for supplemental payment. As a direct result of the loss, the Insured contracted with Waterfire Restorations LLC (“Waterfire”), to provide tarp placement and water restoration / repair services at the property. The Insurance Company was provided with the following estimates for services provided by Waterfire: $10,200.91 (water restoration / repairs); and $4,500 (tarp placement). To date, the Insurance Company has failed to provide coverage / indemnify / issue payment to the Insured for the services provided by Waterfire. The Insurance Company’s actions are in violation of the subject policy and Florida law. The Insurance Company did not issue full payment for the subject claim (including all applicable coverages) within sixty (60) days of receiving notice of the loss. The Insurance Company’s actions are in direct violation of section, 627.70131(7)(a), Florida Statutes, which provides that “[w]ithin 60 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer.” Accordingly, the Insurance Company has misrepresented facts and policy language related to the coverages provided under the policy, and has accordingly collected a premium for insurance that has not been provided in full. The obligation to pay the full value of Insured’s claim has been made clear based on the facts and evidence available, yet the Insurance Company has failed to pay the full value of the Insured’s claim. This is caused in part by the Insurance Company’s failure to adopt and implement standards for the proper investigation of claims. The Insured provided the Insurance Company with documentation evaluating the loss, and rather than issuing the proper payment or attempting to reach an agreement with its Insured, the Insurance Company is delaying and denying the claim. Upon information and belief, the Insurance Company performs the subject actions as a business practice, including delaying the claim and/or 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 order to remedy the above defects, the Insurance Company must do the following: 1. Immediately admit coverage and pay the Insured the full value of the claim: i.e., $35,412.67, for dwelling repairs (less the applicable deductible and prior payment; $10,200.91 (water restoration / repair services); and $4,500 (tarp placement services). 2. Pay statutory interest on the amount of unpaid damages from the date of loss. 3. Act fairly and honestly toward its Insured with due regard for the Insured’s interests in attempting to resolve the claim. 4. Cease and desist all present and future bad faith actions with regard to this claim. 5. Implement standards for the proper investigation of claims. 6. Stipulate to the Insured’s entitlement to attorney’s fees and court costs, and pay the amount of fees and costs incurred.

Comments

User Id		Date Added		Comment
claims@typtap.com		12-29-2024		This is TypTap Insurance Company’s (“TypTap”) response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed on behalf of Namphie Joseph (“Insured”). TypTap reviewed this CRN and conducted a thorough review of the subject claim (“claim”) and confirmed it handled the claim properly. Regarding an aspect of the claim, TypTap issued payment for it on the information available to TypTap and the circumstances at the time of such payment. TypTap handled the claim in accordance with the policy and all statutory and regulatory requirements. TypTap denies each allegation of bad faith and improper conduct in the CRN. At all times, TypTap acted in good faith, fairly and honestly toward the Insured and with due regard for the Insured’s interests. Otherwise, the CRN is deficient. Generally, pursuant to Florida Statutes, Section 624.155, CRNs must identify and set forth statutory provisions insurers allegedly violated in handling insureds’ insurance claims along with specific, relevant insurance contract language and facts and circumstances. The foregoing provides insurers with notice of alleged statutory violations AND the opportunity to cure such alleged violations. Instead of complying with Florida Statutes, Section 624.155, the Insured’s attorney in the CRN contained an inaccurate recitation of the facts, failed to reference specific, relevant insurance policy language; cited irrelevant statutes; and relied on inaccurate and conclusory statements. The Insured’s laundry list of inapplicable statutes is insufficient. Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). Furthermore, the Insured’s attorney filed a lawsuit based on the claim prior to the filing of this CRN. Regardless of the fact there were no violations in this claim, any action by TypTap to cure violations alleged in the CRN could have been used against TypTap in the lawsuit. The foregoing shows abuse by the Insured and the Insured’s attorney of the CRN and legal processes. Also and generally, the CRN constitutes an abuse of the CRN process, contravenes the purpose of CRNs, which is to promote resolution of issues in insurance claims. The CRN must be rejected, and it cannot serve as the basis of any action against TypTap. Upon request by the Florida Department of Financial Services, TypTap will provide to the DFS detailed correspondence TypTap provided regarding the claim.

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