Civil Remedy Notice of Insurer Violations
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Filing Number:     790861
Filing Accepted:  11/7/2024
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Complainant
Last/Business Name *  
JACKSON   First Name   JUANITA LANDERVILLE
Street Address * 623 RED OAK CIR., UNIT 109
City, State Zip * ALTAMONTE SPRINGS, FL 32701
Email Address * WITHHELD
Complainant Type: * Insured
Insured
Last/Business Name*   JACKSON   First Name   JUANITA LANDERVILLE
Policy # * 1503-2301-9574-02 Claim #* FL24-0200164
Attorney
Attorney is Applicable
Last Name* DANIELS First Name * MONICA Initial E
Street Address* 560 VILLAGE BOULEVARD, SUITE 110
City, State Zip* WEST PALM BEACH , FLORIDA 33409
Email Address * MDANIELS@THEDANIELS-LAWGROUP.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   AMERICAN PLATINUM PROPERTY AND CASUALTY INSURANCE COMPANY
NAIC Company Code 13563
 
Name of individual responsible for violation (if any):* JENNIFER RICHIEZ, DEANTE FIELDS, JARED MCGREEVY, KEVIN CHERNOFF, QUINN STOFFEL, AND ANY AND ALL OTHER ADJUSTERS, MANAGERS, SUPERVISORS, AND INDIVIDUALS ASSOCIATED WITH THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unfair Trade Practice
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)(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.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

SECTION I – PROPERTY COVERAGES A. Coverage A – Dwelling 1. We cover: a. The alterations, appliances, fixtures and improvements which are part of the building contained within the "residence premises"; b. Items of real property which pertain exclusively to the "residence premises"; c. Property which is your insurance responsibility under a corporation or association of property owners agreement; or d. Structures owned solely by you, other than the "residence premises", at the location of the "residence premises". B. Coverage C – Personal Property 1. Covered Property We cover personal property owned or used by an "insured" while it is anywhere in the world. After a loss and at your request, we will cover personal property owned by: a. Others while the property is on the part of the "residence premises" occupied by an "insured"; or b. A guest or a "residence employee", while the property is in any residence occupied by an "insured". SECTION I – CONDITIONS K. Loss Payment We will adjust all losses with you.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Juanita Landerville Jackson (the “Insured”) purchased an insurance policy from American Platinum Property and Casualty Insurance Company (“Insurer”), with Policy number 1503-2301-9574-02 (the “Policy”), to cover property located at 623 Red Oak Cir., Unit 109, Altamonte Springs, FL 32701 (the “Property”). On or about April 5, 2024, the Property suffered damage as the result of a sudden and accidental water loss involving a supply line, which caused extensive damage to the Property that necessitates repairs in the following areas in order to bring the Property back to its pre-loss condition: living area, sitting room, kitchen, dining room and sub-rooms, foyer/entry, bathroom, stairs, storage area/room, hallway with sub-rooms, ensuite, primary bedroom with walk-in closet, bedroom and bathroom, and office with closet. The Insured immediately reported the loss to the Insurer, mitigated the damages, and complied with all applicable post-loss obligations. The Insured ultimately retained a public adjuster to assist with this difficult experience. The Insurer acknowledged the loss and assigned claim number FL24-0200164 (the “Claim”) to the Claim, as well as claims examiners Jennifer Richiez, DeAnte Fields, Jared McGreevy, Kevin Chernoff, and Quinn Stoffel to handle the Claim. The Insurer identified covered damage to several areas throughout the Insured’s Property. The Insured provided the Insurer a true and accurate estimate of the damages, photographs of the Property, a sworn proof of loss, and complied with all of the Insurer’s requests for information and documentation. It is clear that the Insured did everything in her power to comply with all applicable post-loss obligations. However, the coverage determination included a woefully deficient estimate of the Insured’s damages inadequate to repair the Property to its pre-loss condition. After application of the deductible and recoverable depreciation, the Insurer made payment to the Insured in the amount of $13,315.19. In contrast, the Insured’s public adjuster outlined related damage to the Insured’s Property in the amount of $72,254.86. The handling of the Claim up until this date and the amount of indemnity offered by the Insurer is an insult to the Insured who is unable to perform the repairs necessary to restore the Property to its pre-loss condition. The Insurer has failed to properly indemnify the Insured for the loss, paying out a fraction of the Insured’s damages from this covered loss. The Insured has understandably become extremely frustrated by the Insurer’s clear delay tactics, failure to properly indemnify his for this Claim in a timely fashion, and failure to adjust the Claim in good-faith. To combat any further attempts by the Insurer to delay the Claim and its failure to make the Insured whole, the Insured had no choice but to retain legal counsel to assist with the Claim. The Insured is 86 years old, and has had to put her fully disabled veteran husband in the VA as a result of the condition of their property. She, herself, has also been to the hospital at least five times now as a result of the condition of her home. The Insured has been forced to file a Complaint with the Florida Department of Financial Services given the Insurer’s actions in this claim, which include their preferred vendor performing demolition to her home and packing away her personal property without providing the Insured with the funds necessary to build back her demolished home. The Insurer’s refusal to properly investigate, adjust and fully compensate the Insured for this Claim undoubtedly evidences the Insurer’s violation of Section 626.9541(1)(i)(3)(a), Florida Statutes, which requires the Insurer to “adopt and implement standards for the proper investigation of claims.” All available information leads to one conclusion – the Property was damaged by a covered cause of loss for which the Insured is entitled to full and complete compensation. The Insurer’s obligation to promptly settle the Insured’s claim is undeniable, and therefore, the Insurer has also violated Fla. Stat. Section 624.155(1)(b)(1) and 624.155(1)(b)(3). The Insurer’s conduct continues to be egregious because the Insurer retained biased and inexperienced individuals who approached the loss with an eye towards underpayment. The actions taken by the Insurer in the handling and adjustment of the Claim are willful, wanton, and in disregard for the rights of the Insured, and have occurred with such frequency as to indicate a general business practice in violation of the law. This practice includes the Insurer hiring biased and inexperienced adjusters and failing to properly and timely pay for obvious damages owed to its Insured. The Insurer’s actions amount to, but are not limited to: A. “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 the insured and with due regard for his or his interests;” B. “Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue”; C. “Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear;” D. “Failing to adopt and implement standards for the proper investigation of claims;” E. Claim Delay; F. Unsatisfactory Settlement Offers; and G. Unfair Trade Practices. In addition to the above statutory violations, the Insurer’s adjuster violated the following ethical requirements of the Florida Administrative Code 69B-220.201: (3) Code of Ethics . . . An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance. The following are standards of conduct that define ethical behavior, and shall constitute a code of ethics that shall be binding on all adjusters: (b) An adjuster shall treat all claimants equally. 2. An adjuster shall adjust all claims strictly in accordance with the insurance contract. (c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured. (d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. (e) An adjuster shall handle every adjustment and settlement with honesty and integrity, and allow a fair adjustment or settlement to all parties without any remuneration to himself except that to which he is legally entitled. (f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim. (o) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise. To summarize, the Insured is a dutiful customer who made it a priority to pay her insurance premiums and to ensure that in such an event as the one here, the Property would be covered. The Insured timely filed the claim and fulfilled all of her post-loss obligations. Insurer acknowledged the loss, assigned a claim number, inspected the property, admitted that the Property was damaged as a result of a covered water loss, and then grossly undervalued the Claim. Insurer has clearly failed to provide the Insured with qualified representatives to ensure the Claim was initially adjusted, evaluated, and paid properly. To deny the Insured the benefit of the bargain after she has satisfied all of her obligations is morally and ethically reprehensible, and reeks of Unfair Trade Practice. Insurer is putting its profits ahead of its contractual and statutory obligations. Florida Statute § 624.02 defines “insurance” as a contract where the one undertakes to indemnify another or pay or allow specified amounts, or determinable benefit, upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly. This timely and prompt payment allows the insured to mitigate the damages and place her back to the position she was in prior to the loss, as quickly as possible. The Insurer breached this duty. The Insurer has refused and failed to tender all insurance proceeds to the Insured upon demand. The Insurer’s refusal and/or failure to settle the insurance claim when it, under all circumstances, should have done so, is wrongful conduct. The Insurer is failing to promptly settle the Insured’s claim as it is required to do so by contract and Florida law. To cure the defects outlined in this civil remedy notice, the Insurer must (1) immediately, and under no circumstances no later than sixty days from the date of this civil remedy notice, tender all insurance monies due and owing to the Insured, specifically $49,888.42 pursuant to the estimate submitted to Insurer, less applicable deductible and prior payment; (2) tender all insurance monies due and owing to the Insured for Mitigation/Remediation services incurred as a result of the Claim and as previously submitted to Insurer; (3) ensure that payment made would be adequate to place the Insured and her Property back in the pre-loss condition; and (4) reimburse the Insured’s attorneys’ fees and costs, since the Insured was forced to hire legal counsel and engage in protracted litigation in order to receive adequate payment. Should the Insurer fail to comply with the demands set forth in this civil remedy notice, the Insurer must prepare to pay the full cost of its failure to rightfully indemnify the Insured, including all future damages that come about as a result of the Insurer’s failure to comply with the demands set forth in this civil remedy notice. This Notice is giving in order to perfect the right to pursue the civil remedy authorized by section 624.155(3)(b), Florida Statutes.
Comments
User Id Date Added Comment
sm1130@universalproperty.com 12-20-2024 December 20, 2024 VIA ELECTRONIC FILING Florida Department of Financial Services Bureau of Consumer Assistance Civil Remedy Section 200 East Gaines Street Tallahassee, FL 32399-0322 Re: DFS File No.: 790861 Filing Date: 11/7/2024 Complainant(s): Juanita Landerville Jackson Insured(s): Juanita Landerville Jackson Policy No.: 1503-2301-9574-02 Claim No.: FL24-0200164 Dear Sir/Madam: Please allow this to serve as American Platinum Property & Casualty Insurance Company’s (“American Platinum”) formal response to the above-referenced Civil Remedy Notice (“Notice”) filed by attorney, Monica E Daniels, on behalf of the Complainant, Juanita Landerville Jackson (also referenced as “Insured”). The Notice alleges violations of Florida Statutes, Sections 624.155 and 626.9541, and Florida Administrative Code Section 69B-220.201. American Platinum specifically denies each allegation contained in the Notice. Additionally, American Platinum denies that it violated these or any statutes, Florida law, or policy provisions regarding the claim adjustment of this matter. With that said, American Platinum asserts that the Notice fails to comply with the specific notice and information requirements as set forth in Civil Remedy Notice of Insurer Violation document provisions, Florida Statute §624.155 and Florida law. The Notice is deficient as a matter of law as it fails to comply with Fla. Stat. §624.155. See 316, Inc. v. Maryland Cas. Ins. Co., 625 F. Supp. 2d 1187 (N.D. Fla. 2008); Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059 (S. D. Fla. 2010); Heritage Corp. of South Fla. v. Nat’l Union Fire Ins. Co. of Pittsburgh, P.A., 580 F. Supp. 2d 1294 (S.D. Fla. 2008); Talat Enterprises, Inc. v. Aetna Cas. & Surety Co., 753 So. 2d 1278 (Fla. 2000). Pursuant to Fla. Stat. §624.155(3)(b), the Notice “shall state with specificity” the following information: 1. The statutory provision, including the specific language, 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...; and 5. a statement that the Notice is given in order to perfect the right to pursue the civil remedy authorized by this section. Moreover, the Florida Department of Financial Services (“DFS”) created form DFS-10-363, which sets out 15 requirements that the Complainant(s) must respond to with specificity. The Florida Supreme Court holds that Fla. Stat. § 624.155 “must be strictly construed.” Talat Enterprises, Inc. v. Aetna Cas. and Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Strict construction is appropriate as “this statute is in derogation of the common law.” Id. When interpreting a statute in derogation of the common law, “[a] court will presume that such a statute was not intended to alter the common law other than as clearly and plainly specified in the statute.” Time Ins. Co., Inc. v. Burger, 712 So. 2d 389, 393 (Fla. 1998). Such an interpretation would mean that statutory bad faith cases cannot proceed unless the Complainant(s) specifically complied with all statutory requirements. Pin-Pon Corp. v. Landmark American Ins. Co., 500 F. Supp. 3d 1336 (S.D. Fla. 2020); Julien v. United Property & Casualty Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2021). To begin, the Notice fails to meet the requirements of Section 624.155, Florida Statutes, on several grounds. First, concerning the requirement to set forth, with specificity, the “facts and circumstances giving rise to the violation,” the Notice fails to specify any facts that would put American Platinum on notice that it violated any policy provision or statute. The Notice asserts general allegations consisting of speculative, boilerplate, and conclusory statements rather than specific allegations of facts regarding any alleged misconduct or statutory violations. As an example, the Notice states, “[t]he Insurer’s conduct continues to be egregious because the Insurer retained biased and inexperienced individuals who approached the loss with an eye towards underpayment. The actions taken by the Insurer in the handling and adjustment of the Claim are willful, wanton, and in disregard for the rights of the Insured [sic], and have occurred with such frequency as to indicate a general business practice in violation of the law.” The Notice does not specify any facts to support these speculative and conclusory statements. The Complainant is required to provide with specificity the facts and circumstances giving rise to the alleged violation strictly related to Complainant’s allegations, not conjecture or speculation of what may be the carrier’s business practices. As an additional example, the Notice states: “The Insurer’s actions amount to, but are not limited to: A. “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 the insured [sic] and with due regard for his or his [sic] interests;” B. “Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue”; C. “Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear;” D. “Failing to adopt and implement standards for the proper investigation of claims;” E. Claim Delay; F. Unsatisfactory Settlement Offers; and G. Unfair Trade Practices.” The Complainant’s boilerplate assertions as outlined above include no facts and do not provide any specificity as to how American Platinum allegedly violated any policy provision or statute. Further, the Notice does not specify any facts regarding any misrepresentations made by American Platinum, does not identify the person or persons who made such misrepresentations, nor does it identify to whom any misrepresentations were made. The Notice is replete with conclusory statements and supposition rather than specific facts to support any of the alleged misconduct or statutory violations to support its conclusory allegations. A written notice which is vague and “shotgun” in nature or is written in general terms fails to satisfy the specificity requirement of the statute. See Heritage Corp. of South Fla., 580 F. Supp. 2d at 1300; 316, Inc., 625 F. Supp. 2d at 1193; see also Rousso, 2010 WL 7367059 at *3-6; Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006). It is evident that the statement of facts falls short of the specificity required by Sec. 624.155, Fla. Stat. As a result, the Complainant fails to comply with the requirements provided in Sec. 624.155(3)(b)(2), Fla. Stat. Second, the Notice fails to satisfy the requirement to identify the person or persons representing the insurer most responsible for or knowledgeable of the facts giving rise to the allegations. In order to comply with the requirements of Section 624.155, Florida Statutes, the Complainant(s) must name the individual(s) involved with specificity as it relates to the purported violation(s) to allow American Platinum to properly investigate the allegations. The Notice lacks the requisite specificity as required by Section 624.155, Florida Statutes. Here, the Notice states “JENNIFER RICHIEZ, DEANTE FIELDS, JARED MCGREEVY, KEVIN CHERNOFF, QUINN STOFFEL…” however, the Notice fails to include any specificity as to what facts the named individuals have knowledge of that gave rise to any purported allegation(s) and/or what, if anything, they did or failed to do as it relates to the claim at issue. The Complainant also attempts a “catch-all” by stating “AND ANY AND ALL OTHER ADJUSTERS, MANAGERS, SUPERVISORS, AND INDIVIDUALS ASSOCIATED WITH THE CLAIM” which significantly prejudices American Platinum because the Complainant is failing to notify Universal of the individuals that purportedly committed statutory violations or the specific statutory violations any individual purportedly committed. The failure to provide the requisite specificity precludes American Platinum from taking any corrective action and potentially curing any purported allegation. Specificity as to a person’s knowledge within American Platinum is of particular importance because, as noted, the Complainant alleges American Platinum “[m]isrepresent[ed] pertinent facts or insurance policy provisions relating to coverages at issue.” The Notice fails to include any specificity as to whom made any misrepresentations, what was misrepresented, when any of these misrepresentations were made and/or to whom any alleged misrepresentation was made to. Accordingly, Complainant’s Notice is insufficient as a matter of law. Third, the Notice fails to satisfy Fla. Statute § 624.155(3)(b)(4) in that it fails to reference any specific policy language relevant to any alleged violation. The Notice cites policy headings, sections titles and provisions without identifying how, if any, of the referenced language relates to any alleged violation or how, if at all, the cited language is relevant to the subject claim identified in the Notice. As such, American Platinum is left to wonder what policy provisions Complainant believes were allegedly violated or breached and why. General, vague, and overbroad references to policy headings, sections and/or provisions do not satisfy the specificity required by Section 624.155(3)(b)(4), Fla. Stat. As such, the Notice is deficient as a matter of law. See generally Julien v. United Property & Casualty Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2021). Lastly, the Notice does not provide a proper means whereby American Platinum can “cure” the alleged defects, without paying additional benefits which are not due and owing to the Insureds. The purpose of a Civil Remedy Notice 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). Section 624.155, Florida Statutes, however, does not impose on an insurer the obligation to pay whatever amount its insured demands. Talat, 753 So. 2d at 1282. To the contrary, the Florida Supreme Court holds that the scope of what can be “cured” in responding to a civil remedy notice, is limited to contractual amounts due to the insured(s). See Talat, 753 So. 2d at 1281. The Notice demands among other things, that to cure the alleged defects, American Platinum must “reimburse the Insured’s [sic] attorneys’ fees and costs …” Thus, the Notice is deficient as it does not provide American Platinum an opportunity to “cure” the alleged violations without paying extra-contractual damages. American Platinum is only obligated to pay contractual amounts owed to cure a civil remedy. See Id. at 1278 In summation, the Complainant failed to respond to each of the fields set forth on the DFS Form with the requisite specificity as stated herein, including but not limited to, Failing to identify all named policyholders, failing to identify the person or persons representing the insurer who are most responsible for/knowledgeable of the facts giving rise to the allegations in the Notice, failing to reference specific policy language relevant to any alleged violation, failing to provide a proper cure as proscribed by Florida law and failing to sufficiently allege facts and circumstances giving rise to any alleged violation. Therefore, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. See Julien v. United Property & Casualty Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2021). For the aforementioned reasons, the Notice is deficient as a matter of law. Nonetheless, and without waiving the above-referenced deficiencies, the following shall provide you with American Platinum’s response to the Notice. On April 9, 2024, American Platinum was notified by the Insured, Juanita Jackson, that the insured location was damaged on April 5, 2024. American Platinum inspected the property and documented any visible damage. On or about April 21, 2024, American platinum, in accordance with the terms and conditions of the Policy, issued payment in the full amount of its estimate, less recoverable depreciation and applicable deductible. Under the terms of the Policy, American Platinum will initially pay at least the actual cash value of the insured loss, less any applicable deductible. It will then pay any remaining amounts necessary to perform such repairs as work is performed and expenses are incurred. On May 30, 2024, the Insureds submitted a competing estimate totaling $73,657.55 prepared by Five Star Claims Adjusting on their behalf. In a good faith effort to amicably resolve any remaining dispute, American Platinum invoked the mediation provision under the terms of the Policy. On September 13, 2024, the parties participated in mediation, however it resulted in an impasse. On or about November 1, 2024, American Platinum advised the Insureds it was issuing a supplemental undisputed payment. To date, American Platinum has not received any documentation showing the amount necessary to perform such repairs or that expenses have been incurred in excess of the payments issued by American Platinum to the Insured. American Platinum did not breach any duty to its Insureds. An Insurer has no obligation to pay whatever amount its insureds demand. The alleged statutory violations and factual allegations of wrongdoing set forth in the Notice lack factual support and are without merit. Therefore, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. American Platinum complied with all policy provisions and applicable Florida Statutes and law regarding the adjustment of this claim. We trust that the foregoing is sufficient to advise you of American Platinum’s position regarding this matter and fully responds to the Notice filed by the Complainants. Sincerely, /s/ Stephen Methe Stephen Methe
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