Civil Remedy Notice of Insurer Violations
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Filing Number:     790401
Filing Accepted:  11/5/2024
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Complainant
Last/Business Name *  
ANGELICA LUZARDO AND NESTOR LUZARDO   First Name  
Street Address * 2758 BANCHORY DRIVE
City, State Zip * WINTER PARK, FL 32702
Email Address * ANGELIKAMORILLO@HOTMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   ANGELICA LUZARDO AND NESTOR LUZARDO   First Name  
Policy # * FPH4212673-04 Claim #* FPI242158
Attorney
Attorney is Applicable
Last Name* FOSKY First Name * JORDAN Initial
Street Address* 925 FEDERAL HWY
City, State Zip* BOCA RATON , FL 33432
Email Address * JFOSKY@KPATTORNEY.COM
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):* RUSSELL TERRY
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unsatisfactory Settlement Offer
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.
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)(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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

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

The carrier was put on notice of the insureds’ property water damage and mold growth in areas of the house. The carrier initially attempted to low-ball the claim. Subsequently, the insureds prepared a loss package in the amount of $53,483.22 needed to restore the property back to its pre-loss condition. Whereas, the carrier furnished a wrongful estimate and, having withheld the deductible, offered a deficient payment in the amount of $18,285.38 only, leaving a remainder in the amount of $35,197.84 to be paid in order to cure the breach, less any applicable policy deductible. Additionally, the carrier did not appropriately address the need for the replacement of the insureds’ roof, allegedly relying on the wrongful findings of a representative who it is believed was instructed to look for any signs of damage that could be attributed to any causes of loss excluded under the policy and to disregard any evidence of wind damage to the roof, for the purpose of wrongfully low-balling the claim as a whole. The insureds have complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insured. About three hundred and five days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of damage sustained by the insureds’ property and has not taken any meaningful ensuing action. It is clear that the carrier is not treating the insureds with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insureds; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insureds’ interests; refusing to pay the full amount owed to the insureds despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insureds, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $53,483.22, less any prior payments and less any applicable policy deductible; and 2.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier. Please do not hesitate to contact the undersigned or Devin Pruitt at (239) 488-6829 if you have any questions or concerns. Sincerely, Jordon Fosky Attorney at Law
Comments
User Id Date Added Comment
jbosch@qpwblaw.com 12-23-2024 VIA DFS WEBSITE Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Complainant: Angelica Luzardo and Nestor Luzardo Claim No: FPI242158 (“subject claim”) Policy No: FPH4212673-04 (“policy”) Loss Location: 2758 Banchory Drive, Winter Park, FL 32702 (“property”) CRN Filing No: 790401 CRN Acceptance Date: 11/5/2024 RE: CIVIL REMEDY NOTICE - DFS FILING NUMBER 790401 Dear Sir or Madam: The undersigned counsel represents Florida Peninsula Insurance Company (“Florida Peninsula”) in regard to the alleged dispute as to the subject claim number listed above involving an alleged windstorm with a date of loss of on or January 9, 2024, made under the Policy of insurance Florida Peninsula issued to the Insureds listed above. This correspondence constitutes Florida Peninsula Insurance Company’s response to the Civil Remedy Notice of Insurer Violations (“Notice” or “CRN”) filed on behalf of Angelica Luzardo and Nestor Luzardo (referenced herein as “Insureds” or “Complainants”) regarding the claim listed above. Based on the below response, the Civil Remedy Notice should be rejected and returned by the Department of Financial Services as it is substantively defective and objectionable for the reasons stated herein, and, without waiving objections, as it completely misstates the facts surrounding this claim. ALLEGED STATUTORY VIOLATIONS 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. Florida Peninsula specifically denies the allegation that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. The CRN does not include any facts to support this allegation. Florida Peninsula conducted a thorough investigation in good faith and issued payments accordingly. 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. Florida Peninsula specifically denies the allegation that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. The CRN does not include any facts to support this allegation. Florida Peninsula conducted a thorough investigation in good faith and issued payments accordingly. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. Florida Peninsula specifically denies the Complainants’ allegation that it has violated the above referenced statute. The CRN does not include any facts to support this allegation. Florida Peninsula did not fail to adopt and implement standards for the proper investigation of the claim. 626.9541(1)(i)(3)(b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. Florida Peninsula specifically denies the allegation that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. The CRN does not include any facts to support this allegation. Florida Peninsula conducted a thorough investigation in good faith and issued payments accordingly. 626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims. Florida Peninsula specifically denies the Complainants’ allegation that it has violated the above referenced statute. The CRN includes only broad sweeping allegations of Florida Peninsula’s failures to communicate with the Complainant and does not include any specific facts to support this allegation. 626.9541(1)(i)(3)(f): Failing to promptly provide a reasonable explanation in writing to the insured of the basis of the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement. Florida Peninsula specifically denies the Complainants’ allegation that it has violated the above referenced statute. The CRN does not include any facts to support this allegation. Florida Peninsula conducted thorough investigations in good faith and issued its coverage determination based on the Policy’s provisions, conditions, exclusions and endorsements. This Coverage Determination correspondence specifically referenced all claimed damages and conclusions regarding each, and enclosed additional information relating to the claim, as well as information relating to the Department of Financial Services mediation services. This allegation is without merit. In addition to the allegations specifically denied above, Florida Peninsula generally denies all allegations presented in this CRN, as Florida Peninsula has not violated any statute, Code or Rule. SPECIFICITY REQUIREMENTS Florida Statute requires that a CRN state the facts and circumstances giving rise to the alleged violations with specificity sufficient to allow an insurer to “cure” the alleged violations within the sixty-day statutory period. See Fla. Stat. § 624. 155(3)(b)(2). See also Lane v. Westfield Ins. Co., 862 So. 2d 774, 777 (Fla. 5th DCA 2003), Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). However, here, the CRN is deficient and defective in that it fails to state with sufficient specificity the necessary facts in support of the Insureds’ contentions, including but not limited to, those that would be necessary for Florida Peninsula to “cure” the alleged violations. Further, the subject CRN provides what appears to be several boilerplate and conclusory statements, which fail to describe any accurate facts constituting violations of the statutes cited therein. Thus, because the allegations in the CRN are incomplete and incorrect, they fail to provide actual notice of the specific allegations and the actions that Florida Peninsula could undertake to cure any alleged violations. 316, Inc. v. Maryland Cas. Co., 625 F. Supp. 2d 1187, 1193 (N. D. Fla. 2008). 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). For the reasons set forth herein, Florida Peninsula hereby objects to the subject CRN and states it does not intend to waive, ratify or otherwise accept the deficiencies in the CRN, and reserves the right to contest the legal adequacy of the CRN hereinafter as appropriate. As to the content of the CRN here, it is important to note that said CRN is a nullity and should be rejected because the CRN fails to comply with the specific requirements mandated by Florida Statutes §624.155. Specifically, Fla. Stat. § 624.155(3)(b)(2) requires the Complainant to set forth with specificity, sufficient factual allegations to state a prima facie case of an insurer violation, so as to put the insurer on notice and be afforded the opportunity to cure the deficiency. However, the Insureds failed to do so in the subject CRN and instead only included conclusory statements, which lack even minimal specificity and/or lack the underlying factual basis to support them. The Insured’s failure to describe any actual facts or circumstances to support the alleged statutory violations in the CRN precludes Florida Peninsula from evaluating what error, if any, allegedly occurred during the claim process. 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 only provides unsupported and incorrect allegations with no basis in fact or circumstances. Consequently, the CRN lacks the requisite minimal specificity and Florida Peninsula is unable to determine what specifically the Complainant is claiming was done by or on behalf of Florida Peninsula that constitutes the bad faith alleged. Due to the absence of specific and accurate information regarding the alleged acts or omissions by Florida Peninsula which allegedly give rise to any violation of the Civil Remedy Statute, Florida Peninsula is limited in its ability to set forth specific facts to address and/or refute these unsubstantiated assertions. Notwithstanding, Florida Peninsula explicitly denies violations of any applicable Florida Statute in the adjustment of the subject claim and realleges and re-asserts its specific denials to the alleged violations in the subject CRN as set forth above. Florida Peninsula 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. Further, Florida Peninsula wishes to dispel even the inference of any statutory violation and reiterates below the various reasons which clearly show the proper handling of the subject claim by Florida Peninsula. Additionally, the CRN fails to state with specificity the facts relevant to any alleged policy violation. Julien v. United Property and Casualty Insurance Co., 311 So.3d 875 (Fla. 4th DCA 2021). The CRN merely refers to general language without any details as to how any provisions were actually violated. Thus, the CRN does not satisfy the requirements. BACKGROUND FACTS Aside from the fact that the allegations contained in the subject CRN lack specific facts, the tenor and inferences of statutory violations are wholly without merit, and Florida Peninsula denies each and every one. Below are some of the relevant facts regarding the subject claim that the Insureds failed to include in the CRN. On March 18, 2024, Insured’s public adjuster, Luis from Adjustify Claims contacted Florida Peninsula to report a claim for windstorm damage. It was reported that the roof was damaged and missing shingles. Additionally, it was reported that the living room and bathroom were impacted. No further information regarding the alleged damage was provided at the time of the initial reporting of the claim. Immediately, the next day, Florida Peninsula sent correspondence to the Insureds acknowledging receipt of the claim. Upon receiving notice of the Insureds’ claim, Florida Peninsula contacted the Insureds in order to inspect and evaluate the subject property and reported damages. Accordingly, Florida Peninsula conducted its inspection of the subject property on April 3, 2024. On March 25, 2024, Florida Peninsula issued a reservation of rights letter to the Insured informing them of their responsibilities under the policy. In its letter, Florida Peninsula states that there is a question of whether coverage under the policy applies to this loss explaining: Under the policy conditions we need to further investigate this matter to provide a timely response. The nature of the coverage question that exists is whether you have complied with your duties after a loss as noted in Section I Conditions of your policy. Florida Peninsula also included with its letter, the policy excerpt labeled “Your Duties After Loss.” Florida Peninsula issued its coverage determination by letter dated April 15, 2024, informing the Insureds that coverage was afforded. Accordingly, Florida Peninsula issued a net payment in the amount of $18,285.38. In its letter, Florida Peninsula explains that the policy deductible of $2,500.00 was applied to the claim. Additionally, Florida Peninsula states that the claim remains open due to the Emergency Mitigation Services enlisted initially to assist with water mitigation. Florida Peninsula also included with its Coverage Determination Letter, an Estimate, Statement of Loss, and Mediation Statement. On May 13, 2024, Florida Peninsula issued correspondence to Insured and their representatives, stating that payment in the amount of $6,500.00 will be mailed to JG Prime Services, LLC as final payment for the negotiated settlement of Emergency Mitigation Services. On June 4, 2024, Florida Peninsula received an appraisal demand letter from Adjustify claims. On June 30, 2024, Florida Peninsula issued a second coverage determination letter informing the Insured that coverage was afforded. Accordingly, Florida Peninsula issued a net payment in the amount of $1,000 for mold testing. Florida Peninsula also included with its Coverage Determination Letter, an Estimate, Statement of Loss, Mold Testing Invoice #18172, and Mediation Statement. On July 12, 2024, Adjustify claims issued correspondence to Florida Peninsula regarding an appraisal demand letter. On July 17, 2024, Florida Peninsula issued correspondence to Insured’s public adjuster at Adjustify Claims acknowledging receipt of the appraisal demand letter. In its letter, Florida Peninsula states that the Insured’s policy does not have a provision for appraisal, therefore, Florida Peninsula rejects the appraisal demand. On July 15, 2024, Florida Peninsula issued correspondence to the Insured informing them that a replacement check in the amount of $1,000.00. In its letter, Florida Peninsula explains: We received funds back from your bank for this check that was improperly endorsed. The original check has been voided and we have re-issued payment with the same payees for the following reason: Funds pulled back for lack of endorsements. On August 14, 2024, Florida Peninsula issued its Mediation Coverage Letter to the Insured, and its representatives, explaining that no agreement was reached and an impasse was declared by the mediator. On August 22, 2024, Florida Peninsula received a letter of representation from Insured’s attorney representative at Kanner & Pintaluga. On November 5, 2024, Florida Peninsula received this Civil Remedy Notice. As you can see, Florida Peninsula conducted a good faith comprehensive and prompt investigation of this claim. Florida Peninsula consistently and promptly communicated with the Insureds and their representatives and conducted an inspection of the property. Florida Peninsula afforded coverage based on an inspection and thorough investigation of the claim. Florida Peninsula respectfully denies any wrongdoing in the adjustment and handling of the Subject Claim, and further denies any and all allegations that it violated any statutes. Instead, Florida Peninsula acted quickly and responsibly and in accordance with the terms and provisions of the applicable Policy of insurance as well as with F.S. §624.155 and §626.9541 and its sub-parts. INACCURACY OF ALLEGATIONS IN THE SUBJECT CRN The case specific facts related to Florida Peninsula’s handling of the subject claim provided above implicitly address many of the vague allegations contained within the Insureds’ CRN and further establish that Florida Peninsula undertook a thorough investigation in accordance with applicable statutory requirements and professional standards of care. It is important to note that the Insureds have not provided any factual support for any of the above allegations. Instead, the facts support that Florida Peninsula promptly contacted the Insureds, inspected the claim shortly after it was reported, and issued a coverage determination based on a thorough investigation. When additional information was provided, Florida Peninsula conducted additional investigations. The circumstances support that Florida Peninsula conducted a good faith, thorough, prompt investigation with the information provided. The Insureds are alleging bad faith in a scenario where Florida Peninsula conducted a comprehensive, prompt investigation in good faith. 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 Civil Remedy Notice itself only provides completely false allegations with no basis in fact or circumstances. This CRN is simply based on a matter where the Insureds disagree with the amount of damage determined by Florida Peninsula. As clearly set forth above and contrary to the allegations set forth in the Notice, Florida Peninsula’s investigations and adjusting of its Insureds’ claim were prompt, thorough, and complete. When additional information was provided, the claim was reopened. Furthermore, the Insureds have included absolutely no facts or evidence to support any claims in the Notice. All of these baseless claims support Florida Peninsula’s position that the claim was properly adjusted, and the Insureds do not actually have any concrete facts to support a bad faith allegation. As mentioned, mere disagreement as to the amount of coverage does not equate to bad faith. The Civil Remedy Notice does not show how Florida Peninsula has failed to comply with the statutory provisions alleged to have been violated. Evidently, this Civil Remedy Notice was filed in bad faith, as it is being used as an improper mechanism designed solely for the purpose of intimidating Florida Peninsula into potentially overpaying the Insureds. For the aforementioned reasons, Florida Peninsula categorically denies that it has acted with bad faith in connection with this claim. CONCLUSION The purpose of a CRN is to provide the insurer an opportunity to “cure” the alleged wrongdoing. Talat Enterprises, Inc. v. Aetna Casualty and Surety Co. , 753 So. 2d 1278 (Fla. 2000). However, the CRN here does not serve this purpose because it does not provide any means as to how FPIC can “cure” the alleged defects. This failure to provide a proper opportunity to cure renders the CRN improper. Longpoint Condominium Associations v. Allstate Insurance Co. , 2005 WL 131580 (N. D. Fla. June 2, 2005). Moreover, the method for curing the violations alleged in a civil remedy notice are not determined by the insured. In Talat Enterprises, Inc. v. Aetna Casualty and Surety Co. , 753 So. 2d 1278 (Fla. 2000), the Florida Supreme Court accepted and quoted the reasoning of the court below in its opinion which stated in relevant part, as follows: Section 624. 155 does not impose on an insurer the obligation to pay whatever the insured demands. . . . Section 624. 155(2)(d) would have no effect or purpose under such an interpretation. The law does not support such an expansive and illogical reading of Fla. Stat. Ann. §624. 155(2)(d). . . . To cure an alleged violation and to avoid a civil action, an insurer must pay the claim . . . before the sixty days expire. Talat, 753 So2d at 1282 citing Talat Enterprises Inc. v. Aetna Cas. & Sur. Co., 952 F. Supp. 773, 777-778 (M. D. Fla. 1996). Here, Florida Peninsula properly denied coverage for the subject claim as it investigated the loss within the statutory time frame. Florida Peninsula denies all of the allegations contained in the subject CRN, which is defective and improper, as Florida Peninsula has not violated any of the subject statutes. Florida Peninsula further states that the accusations made against it in the subject CRN are patently false. In closing, Florida Peninsula first believes that the Civil Remedy Notice should be rejected and returned by the Department of Financial Services due to its failure to comply with Florida Statute §624.155 and Florida Case law. Due to the lack of any factual and circumstantial basis to support the allegations therein, Florida Peninsula respectfully requests, through this response, that the DFS return and reject the CRN for lack of specificity pursuant to Florida Statutes. Regardless of the rejection, Florida Peninsula denies all allegations contained in the Civil Remedy Notice and submits there are no violations. While Florida Peninsula’s response herein is meant to address the allegations in the Insureds’ Notice, it is based upon the limited information provided in the Civil Remedy Notice and the information presented to date. If the Insured feels that Florida Peninsula is not in possession of all the facts, please inform the undersigned immediately. Please note that Florida Peninsula’s response is not necessarily exhaustive and does not preclude Florida Peninsula or anyone on Florida Peninsula’s behalf from asserting any other valid reason for seeking rejection and return of the Civil Remedy Notice. Also, this letter or any act or failure to act on the part of Florida Peninsula or any agent or representative of Florida Peninsula should not be construed as a waiver of any rights or defenses available to it by contract or at law, as all such rights and defenses are hereby specifically reserved. On behalf of Florida Peninsula, we trust that this response addresses the allegations in the Civil Remedy Notice of Insurer Violation. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Very Truly Yours, QUINTAIROS, PRIETO, WOOD & BOYER, P.A.
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