Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 790392

Filing Accepted: 11/5/2024

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Complainant

Last/Business Name *

CURTO

First Name

ROBERT

Street Address *

9514 MELODY CIRCLE

City, State Zip *

PORT CHARLOTTE, FL 33981

Email Address *

CRICKET_DAKOTA@YAHOO.COM

Complainant Type: *

Insured

Last/Business Name*		CURTO		First Name		ROBERT
Policy # *		0047334946		Claim #*		01000068550

Attorney

Attorney is Applicable

Last Name*	KRAPF First Name * GRANT Initial W
Street Address*		2790 SUNSET POINT RD
City, State Zip*		CLEARWATER , FL 33759
Email Address *		GRANT@KRAPFLEGAL.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		FIRST PROTECTIVE INSURANCE COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 10897

Name of individual responsible for violation (if any):* JARNAE GREGORY, JAMES CARPENTER, MARIA BURGOS, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, FIRST PROTECTIVE INSURANCE COMPANY, WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Delay
	Unfair Trade Practice
	Other : Not treating the Insured with good faith claims conduct
	Other : Looking for ways to deny full recovery to the Insured
	Other : Looking for ways to delay full recovery to the Insured
	Other : Failing to properly investigate the Insured's loss
	Other : Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
	Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made,
	Other : Not adjusting claims and evaluating loss properly
	Other : Shifting the burden of insuring the loss to the Insured
	Other : Failing to implement proper standards for the adjustment and investigation of claims

* 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)(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)(3)(a)		Failing to adopt and implement standards for the proper investigation of claims.
	626.9541(1)(i)(3)(c)		Failing to acknowledge and act promptly upon communications with respect to claims.
	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).
	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.

627.444(2)(a) Notwithstanding any other law, an insurer shall provide to an insured within 15 calendar days after an individual or entity designated by the insurer receives the insured's written request, either: A loss run statement. Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language.

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

First Protective Insurance Company (the "Insurer") has committed the following in handling the Insured's claim: 1) failing to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) shifting the burden of investigating the loss onto the Insureds; and 9) failing to acknowledge and act promptly upon communications with respect to claims. On or about September 28, 2022, while the subject policy was in full force and effect, the Insured's property was severely damaged by Hurricane Ian. The roof, pool cage, garage, laundry room, great room, kitchen, dining area, living areas, hallways, pantry, stairs, bedrooms, bathrooms, closets, attic, and contents of those areas were impacted by the storm. The Insured timely submitted a claim on September 30, 2022, to the Insurer for damages and ensuing damage therefrom. Thereafter, the Insurer assigned claim number 01000068550 to the loss and sent a field adjuster to inspect the property on October 7, 2022. In a letter dated December 14, 2022, the Insurer incorrectly determined that the cost to restore the Insured's property to its pre-loss condition was $115,179.01. Given the scope and nature of the damage resulting from the storm, the Insured retained contractors who prepared estimates reflecting the true cost to restore the property. The Insured's contractors estimated upwards of $175,525.94 as the realistic cost of restoring the property to its pre-loss condition. The Insurer's adjuster undervalued the true cost to repair the Insured's property, which was an attempt to place the financial interest of the Insurer over that of the Insured, which in turn has delayed the Insured's claim and his efforts to restore the property. Although there was interior water damage, the adjuster did not sufficiently inspect for mold, which in turn shifted the burden to inspect for mold onto the Insured. A meter to detect mold can be purchased online from Amazon for around $44 before tax. The Insurer has the means to purchase such a meter and assess thousands of properties with this minimal expense. The Insurer's adjuster should have all the tools necessary to thoroughly investigate claims, especially after a large natural disaster, such as a Category Four hurricane. As a result of the inadequate investigation performed by the Insurer's adjuster, the Insured sought the necessary testing to determine whether his home had mold. Unsurprisingly, the mold assessor retained by the Insured found high levels of mold throughout the home, which led to an entire bathroom being demolished due to the mold. The damage sustained by this storm caused the Insured to incur additional living expenses, as the home is currently uninhabitable. Despite the extensive damage and the presence of mold, the Insurer has taken the position that the Insured did not need to vacate. In order to protect the safety and wellbeing of himself and his family, the Insured rented living space and two storage units, both of which the Insurer deems unnecessary. The Insurer believes that since the property has electricity and running water, the Insured can remain in the home, completely ignoring the various health hazards the Insured faces. The Insurer's lack of concern for the health and safety of its insureds is evident, as the Insurer expects the Insured to remain living in an environment that could cause long-term health problems for the Insured and his family. To date, the Insured has incurred more than $20,000 for their rental property, the water and electric bills incurred while living at that property, and two storage units. The Insurer has refused to pay for these additional living expenses, further frustrating and delaying the Insured's claim. In addition to additional living expenses, the Insurer has also refused to pay for contents in the home damaged by Hurricane Ian. Rugs, blinds, ceiling fans, couches, and light fixtures are among some of the items damaged, all of which the Insurer has failed to pay for. The Insured cannot begin restoring the property to its pre-loss condition until the Insurer pays what is owed under the policy. Furthermore, the Insurer and its agents failed to comply with Fla. Stat. 627.444 by not providing the Insured and the Insured's representatives with a loss run statement. On November 11, 2022, the Insured's legal counsel provided the Insurer with a letter of representation. Within the letter, legal counsel requested a copy of a loss run statement. It was not until October 7, 2024, six-hundred ninety-six (696) days after the Insured requested the loss run report, that the Insurer complied with the request. Upon an Insurer receiving a written request for a loss run statement, the Insurer is required, within fifteen (15) calendar days, to provide either a loss run statement or information on how to obtain a loss run statement at no charge through a consumer reporting agency. There has been no response within fifteen (15) calendar days of the Insured's written request and the Insurer has not provided information on how to obtain a loss run statement at no charge through a consumer reporting agency. This Insurer has breached its duty to settle claims in good faith when, under all the circumstances, it could and should have done so. The Insurer and its agents have not acted fairly and honestly toward the Insured and the Insured's representative and have moreover failed or refused to promptly acknowledge the Insured's communications in an attempt to frustrate and delay the resolution of the Insured's claim. Moreover, on June 11, 2024, the Insurer issued a letter requesting information from its Insured. The Insured's legal counsel then responded in a letter, dated July 2, 2024, in which it provided all documentation and information requested by the Insurer, including but not limited to estimates, contracts, payment receipts, and invoices. Despite having been provided with the requested information, the Insurer subsequently issued a second letter, dated August 9, 2024, in which it requested the same documentation that had already been provided to them. This is the result of the Insurer's unwillingness to handle claims timely, effectively, and in good faith to its Insured. The Insurer has manufactured delay by ignoring information provided to them and reissuing the same request. To resolve the subject claim, the Insured retained legal counsel who issued its Intent to Initiate Litigation on September 14, 2023. Within this letter, Insured's legal counsel requested to invoke appraisal, detailing a period of ninety (90) days for the Insurer to cooperate with and complete the appraisal process. The Insurer responded, in a letter dated October 3, 2023, in which it notified the Insured it was agreeing to proceed with the appraisal process, therefore beginning this process. To date, the Insurer has failed to take the necessary steps to have the appraisal process completed in a timely manner in violation of Fla. Statute 627.70152(4)(b). The Insureds and the Insurer entered into the contract with the understanding that, when invoked by either party, the appraisal process is mandatory. At the close of the appraisal process, the Insured were awarded an appraisal amount that included amounts owed to the Insured as recoverable depreciation. Despite the clear obligation to pay the full amount awarded to the Insured in the appraisal, the Insurer has to date failed to issue the full amounts. On October 16, 2024, the Insurer was again provided with documentation affirming the Insured is owed recoverable depreciation as they had paid for and had completed all repairs necessary to qualify for payment. The Insurer continues to delay full and final resolution of the subject claim, unnecessarily prolonging the claims process despite every obligation to pay the full amount required to restore the property to its pre-loss condition having been made extensively clear. In short, the Insurer is not acting with due regard for the Insureds' interests. The Insurer is only looking out for its own interests and looking to pay as little as possible on the claim instead of paying the amount required to restore the insured property to its pre-loss condition after application of any policy deductible. The Insurer's actions amount to but are not limited to the following: 1. Claim delay 2. Not treating the Insured with good faith claims conduct 3. Looking for way to reduce recovery to the Insured 4. Looking for ways to deny recovery to the Insured 5. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 6. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's' interests 7. Placing the financial interest of the Insurer over that of the health and safety of the Insured 8. Shifting the burden of investigating onto the Insured 9. Conducting inadequate investigations 10. Treat represented and unrepresented Insured differently 11. Failing to provide a loss run statement Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1). Admit full coverage for the Insured's loss. (2). Tender full benefits owed to the Insured under the insurance contract. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. Via E-mail: First Protective Insurance Company 500 International Parkway Lake Mary, FL 32746 info@flhi.com

Comments

User Id		Date Added		Comment
grant@krapflegal.com		12-20-2024		The details herein have been amicably resolved between the parties; therefore, we withdraw this Civil Remedy Notice. This Civil Remedy Notice is hereby withdrawn.

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