Civil Remedy Notice of Insurer Violations
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Filing Number:     790381
Filing Accepted:  11/5/2024
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Complainant
Last/Business Name *  
MCINTOSH   First Name   JOSH
Street Address * 11305 4TH STREET EAST
City, State Zip * TREASURE ISLAND, FL 33706
Email Address * JJJJMC16@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   MCINTOSH   First Name   JOSH
Policy # * CIT08716263 Claim #* FPI250436
Attorney
Attorney is Applicable
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   FLORIDA PENINSULA INSURANCE COMPANY
NAIC Company Code 10132
 
Name of individual responsible for violation (if any):* ANITA ALEXANDER, MATT LUSK AND OTHER AGENTS, REPRESENTATIVES AND EMPLOYEES OF FLORIDA PENINSULA INSURANCE COMPANY
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
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.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
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 Policy is unavailable to the Insured at this time, but nonetheless, coverage for a windstorm is covered under the terms and conditions of the subject policy. **FAILURE TO PROVIDE SPECIFIC POLICY LANGUAGE IS NOT A FATAL OMISSION IN COMPLYING WITH FLA. STAT. 625.155.**
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On or about October 9, 2024, the Insured, JOHN MCINTOSH (the "Insured"), sustained damages to his property as a result of Hurricane Milton, which was a historical. devastating and catastrophic Category 3 Hurricane. Damages caused by a windstorm are covered under the subject residential insurance policy. The Insured promptly reported his claim for Hurricane Milton damages to Florida Peninsula Insurance Company. The actions Florida Peninsula Insurance Company is intending and attempting to take in its investigation of the relevant claim leave no room to doubt that Florida Peninsula Insurance Company has failed to adopt and implement standards for the proper investigation of claims and has engaged in unfair claim settlement practices. Here, following the first notice of loss, Florida Peninsula deployed its own choice vendor, All Claims Repairs and Consulting, to install a tarp to the Insured's roof. On the date of the joint inspection scheduled between the field/independent adjuster and Insured's public adjuster, the Insured's public adjuster learned that Florida Peninsula Insurance Company REFUSED to have its vendor pull back the installed tarp for the inspection because, as per the field/independent adjuster, "They don't do pullbacks." The Insured's public adjuster further learned from Anita Alexander that the tarp wouldn't be pulled back because it is Florida Peninsula Insurance Company's "protocol" to not pull back the tarp out of fear of further damaging the roof. Anita Alexander further stated that Florida Peninsula Insurance Company would rely on its vendor's photos to assess the damages to the Insured's roof, to which the Insured's public adjuster explained to Anita Alexander that the vendor is merely a laborer who does not know how to inspect a roof for damage, was not looking for damages when tapping the roof and is not a licensed adjuster. The Insured's public adjuster further told Anita Alexander that Florida Peninsula Insurance Company's approach was not an accurate investigation of the claim because neither he nor the field/independent adjuster were able to inspect the roof. Anita Alexander responded to the Insured's public adjuster by saying that Florida Peninsula Insurance Company would prepare its estimate and that THEN if the Insured disputed the estimate, that's when same could be addressed. The Insured's public adjuster expressed to Anita Alexander that this approach of not being able to properly inspect the roof and now having to wait on the carrier's estimate only served to intentionally delay the claim investigation and settlement process. Alarmingly, the field/independent adjuster seemed to care less about the investigation and adjusting of the relevant claim. During communications between the Insured's public adjuster and the field/independent adjuster about the tarp issue, the Insured's public adjuster offered to pull back the tarp himself for the inspection and the field/independent adjuster told the Insured's public adjuster that he doesn't trust public adjusters! Even more alarmingly, when the Insured's public adjuster expressed to the field/independent adjuster that Florida Peninsula Insurance Company was not doing right by the Insured by not pulling the tarp back and consequently being forced to submit an incomplete report, the field/independent adjuster told the Insured's public adjuster that it wasn't his problem and that he was leaving town in a few days. The above facts are alarming and discouraging to the insurance claims process. On one hand, this claim has been assigned to a field/independent adjuster who could care less about the claim and on the other, the claim is not a getting fair and unbiased desk review because the carrier intends to solely rely on photos taken not only by someone it hired but also by someone who is not trained on how to inspect for damage or photograph damage and is not licensed to inspect for damage. It is arguable that Florida Peninsula Insurance Company knowingly CONDONES the UNLICENSED investigation and adjustment of a claim and intends to allow for an unlicensed person to directly affect the ultimate coverage determination of the relevant claim for damages. Here, Florida Peninsula Insurance Company's actions begs the question of to how many other claims it has applied this entirely unfair and one-sided claims investigation and adjustment....how many Insureds claims have been negatively impacted by the bad faith practices Florida Peninsula has implemented to this claim? There is no doubt that here, Florida Peninsula Insurance Company has not attempted to act fairly and honestly towards its Insured or with due regard for his interests, has failed to promptly settle this claim, has failed to implement standard for the proper investigation of this claim and has engaged in unfair claim settlement practices. In order to remedy its violations of Florida Statutes, Florida Peninsula Insurance Company must engage in the bilateral claims process and allow for the tarp it installed to be pulled back in order to allow for a proper inspection for damages within sixty (60) days of this Civil Remedy Notice.
Comments
User Id Date Added Comment
pcole@conroysimberg.com 01-03-2025 We are in receipt of a Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of Florida Peninsula Insurance Company’s Named Insured, Josh McIntosh, which was accepted by the Department of Financial Services on November 5, 2024, and assigned Filing No. 790381. The CRN revolves around a claim (FPI250436) filed for alleged damage from a windstorm, named Hurricane Milton, that occurred on October 9, 2024 at the Insured’s single-family residence located at 11305 4th Street East, Treasure Island, Florida 33706. The residence was built in 1956 and is comprised of a shingle roof that appears to have been installed in 2022. At the time of loss, the Insured’s residence was covered under an HO3 Policy, Policy number CIT08716263, issued by Citizens Property Insurance Corporation and assumed by Florida Peninsula Insurance Company (“The Company”). At the outset, it should be stated that the CRN is defective and does not conform with the requirements of filing a CRN as it contains inaccurate factual allegations, lacks the required specificity and does not provide an opportunity for the Company to reasonably respond to the alleged violations contained in the CRN. The CRN merely contains conclusory reasons for the Notice, such as failing to settle claims in good faith, failing to implement standards for the proper investigation, and failing to acknowledge and act promptly upon communications, to name a few. For example, the Notice alleges that the Company violated the following statutory provisions of Florida Statutes §624.155: • §624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all other 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)(a) Failing to adopt and implement standards for the proper investigation of claims. • §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). The CRN fails to identify specific facts as related to the broad and conclusory allegations. Blanket references to policy provisions and statutes without specification deems the Civil Remedy Notice deficient. Julien v. United Property and Casualty Insurance Co., 311 So.3d 875 (Fla. 4th DCA 2021). Notwithstanding, the Company explicitly denies violations of any applicable Florida Statute in the adjustment of the referenced claims. The Company specifically denies that it has not attempted in good faith to settle the Insured’s claim when under all the circumstances it could and should have done so and it denies that it has failed to act fairly and honestly toward its Insured’s interests. Moreover, the Company specifically denies that it refused to properly investigate the claim or refused to tender all insurance proceeds without waiver of its objections, rights and defenses, the Company maintains that it has acted and continues at all times to act in good faith during the investigation and adjustment of the Insured’s claim, and wishes to dispel even the inference of any violation, and reiterates below the reasons which clearly show the proper handling of the Insured’s claim. Additionally, the Civil Remedy Notice demands “cures” for the alleged defects that are improper under Florida case law. In Talat Enter., Inc., v. Aetna Cas. And Sur. Co., 753 So.2d 1278, 1281 (Fla. 2000), the Supreme Court of Florida held that the scope of what can be “cured” is limited to the alleged non-payment of the contractual amount due to an insured. As a result, Florida Peninsula Insurance Company objects to the CRN as it is defective and should be rejected. In order to understand the deficiencies of this Notice, however, and reserving all objections to the subject CRN, the background of this case is necessary. On October 19, 2024, the insured reported this Hurricane Milton claim as having occurred on October 9, 2024. The insured reported that the roof and gutters had been damaged, including a hole in the roof, and that there was water coming from the ceiling. It is important to note that from the start, Florida Peninsula Insurance Company (the “Company”) communicated with its Insured and/or his representatives on a regular basis. In fact, when the claim was reported on October 19, 2024, a first notice of loss letter acknowledging the claim was immediately sent out to the insured advising the homeowner of his Bill of Rights as an Insured, and his pre-suit mediation opportunities. Further, later in the claim adjustment process, the Insured was advised of those same rights again, so it was very clear that the Insured was informed of what he could do to protect himself under the circumstances should he disagree with the Carrier’s handling and decision. The insured then retained a public adjuster (“PA”) from Firehouse Adjusters who provided a letter of representation on October 22, 2024. Upon reporting of the loss, the Company assigned the claim to a field adjuster (the “FA”). On October 27, 2024, the FA conducted an inspection of the subject property. The FA carefully assessed and evaluated the claimed damage, which included a thorough inspection of the exterior and interior of the property. At the time of the inspection the roof was covered by a tarp which had been installed by All Claims Repairs Inc. on or around October 21, 2024. As such, the FA was unable to inspect the roof of the residence. The insured retained counsel who then filed the Civil Remedy Notice with the Department on behalf of the Insured on November 5, 2024. By letter dated November 18, 2024, the Company sent a coverage determination letter to the insured advising that payment in the amount of $1,115.15 under Coverage A was being issued. However, the November 18th letter was sent in error as the covered damage amount fell below the insured’s contractual deductible which was $4,451.00. This was rectified when the Company sent a second correspondence to the insured by letter dated November 27, 2024. The November 27th coverage determination advised the insured that the damages fell below the deductible of $4,451.00 and as such the Company was unable to make a payment for the claim. The coverage determination further advised that the policy did not include coverage resulting from flood even if the hurricane winds and rain caused the floor to occur, and without separate flood insurance coverage, the insured may have uncovered losses caused by flood. The letter also advised the insured that the policy did not include coverage for prior water damage for old water damage in the dining room and kitchen. The insured’s Hurricane Milton claim remains open and is in the investigation process as to the claimed damage to the roof of the residence. The Insured’s counsel complains that the Company has failed to implement standard for the proper investigation of this claim. Certainly, as is noted above through the chronology of this loss, an appropriate claims handling procedure was and is in place to give due consideration to the claim. Florida Peninsula Insurance Company has communicated with its Insured and his representatives as required. Florida Peninsula Insurance Company has inspected the loss and damages and continues to investigate the insured’s claim. The fact that Florida Peninsula Insurance Company As demonstrated above, the Company has, thus far, undertaken a thorough adjustment process and investigation, and continues to do so. The Company has, at all times, acted fairly and promptly toward its Insured and with full regard to her interests, and has complied with its obligations in this claim process. Any further information which may be required is available upon request.
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