Civil Remedy Notice of Insurer Violations
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Filing Number:     791092
Filing Accepted:  11/8/2024
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Complainant
Last/Business Name *  
LAWS   First Name   JUDY C.
Street Address * 117 FOREST HILLS BLVD.
City, State Zip * NAPLES, FL 34113
Email Address * JUDYLAWS3366@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   LAWS   First Name   JUDY C.
Policy # * 64050920DE Claim #* 60010209507
Attorney
Attorney is Applicable
Last Name* SULISUFAY, First Name * LAURA Initial T
Street Address* 3411 W. FLETCHER AVE, STE. B,
City, State Zip* TAMPA , FL 33618
Email Address * PRESUIT@SULILAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   AMICA MUTUAL INSURANCE COMPANY
NAIC Company Code 19976
 
Name of individual responsible for violation (if any):* EMILY F. HIRST AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, AMICA MUTUAL INSURANCE COMPANY, WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unfair Trade Practice
Unsatisfactory Settlement Offer
Claim Delay
Claim Denial
Other : Violation of Code of Ethics
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.
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)(d) Denying claims without conducting reasonable investigations based upon available information.
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.

THE POLICY LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE LOSS PAYMENT AND COVERAGE PROVISIONS OF POLICY NUMBER 64050920DE, INCLUDING THE DECLARATIONS PAGE AND ALL ENDORSEMENTS TO THE POLICY, WITH RESPECT TO COVERAGES A, B, C, AND D. ADDITIONALLY, ANY SECTIONS RELIED UPON BY THE INSURER IN ITS FAILURE TO FULLY PAY THE CLAIM, INCLUDING THE DUTIES IN THE EVENT OF LOSS PROVISIONS AND THE POLICY'S EXCLUSION OF COVERAGE PROVISIONS. THE VIOLATIONS ALLEGED ARE ALSO STATUTORILY BASED AND DO NOT RELY ON ANY SPECIFIC POLICY LANGUAGE. 627.70131(7)(a) Within 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 which reasonably prevent such payment. The insurer shall provide a reasonable explanation in writing to the policyholder of the basis in the insurance policy, in relation to the facts or applicable law, for the payment, denial, or partial denial of a claim. If the insurer’s claim payment is less than specified in any insurer’s detailed estimate of the amount of the loss, the insurer must provide a reasonable explanation in writing of the difference to the policyholder. Any payment of an initial or supplemental claim or portion of such claim made 60 days after the insurer receives notice of the claim, or made more than 15 days after there are no longer factors beyond the control of the insurer which reasonably prevented such payment, whichever is later, bears interest at the rate set forth in s. 55.03. 627.4137(1)(e) – Each insurer which does or may provide liability insurance coverage to pay all or a portion of any claim which might be made shall provide, within 30 days of the written request of the claimant, a statement, under oath, of a corporate officer or the insurer's claims manager or superintendent setting forth the following information with regard to each known policy of insurance, including excess or umbrella insurance: A copy of the policy. 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; 627.70131 (1)(a) - Upon an insurer's receiving a communication with respect to a claim, the insurer shall, within 7 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer. If the acknowledgment is not in writing, a notification indicating acknowledgment shall be made in the insurer's claim file and dated. A communication made to or by a representative of an insurer with respect to a claim shall constitute communication to or by the insurer.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Amica Mutual Insurance Company 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 the Carrier 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. Failing to provide an estimate that complies with the Florida Building Codes. 9. Shifting the burden of investigating the loss onto the Insured. 10. Misrepresenting the terms of the insurance policy. 11. Failing to provide a copy of the insurance policy within 30 days. 12. Failing to provide a loss run statement within 15 days. Judy C. Laws is a homeowner with an all-risks insurance policy issued by Amica Mutual Insurance Company (hereinafter “Carrier”),. On or about September 28, 2022, while the policy was in full force and effect, the Insured’s property located at 117 Forest Hills Blvd Naples, Fl 34113 sustained significant damage as a result of a Hurricane. The insured promptly reported the claim and fully cooperated with the carrier’s investigation. The Carrier assigned claim number 60010209507 to the loss. After reporting the claim, Carrier retained an unqualified and biased field inspector to adjust the loss. This inspector had a financial incentive to adjust the loss in a manner that would minimize Carrier’s losses. Instead of adjusting the claim fairly, honestly, in good faith, and with due regard for the Insured’s interest, the inspector made a conscious effort to ignore evidence of covered losses to the property. Then in a letter dated April 19th 2024, the carrier notified the Insured that it had completed its investigation into the loss and had fully denied the claim. Given the vastly underestimated cost of repairs, the Insured’s disagreement with the coverage decision, and the scope and nature of the damage resulting from the loss, the Insured through its retained representatives disputed the coverage determination and submitted an estimate prepared by Hunter Claims for $166,493.64. Which was a fair and reasonable assessment of the loss. Worst still, Carrier failed to retain qualified experts necessary to identify the repairs necessary to restore the property to its pre-loss condition within reasonable time. Under the circumstances surrounding this claim, had Carrier acted fairly and honestly toward the Insured and with due regard for the Insured’s interests, Carrier could and should have attempted in good faith to settle this claim. Carrier did not and, instead, dishonestly and unfairly placed its own interests well ahead of those of the Insured. In doing so, Carrier violated Section 624.155(1)(b)(1), Florida Statutes. Carrier’s use of unqualified and bias adjusters and inspectors, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition evidence Carrier’s failure to adopt and implement standards for the proper investigation of claims in violation of Section 626.9541(1)(i)(3)(a), Florida Statutes. Carrier’s use of unqualified and bias adjusters and inspectors, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidences Carrier’s failure to conduct a reasonable investigation based upon available information. When applying the facts present here to Florida law, it is clear that Carrier is acting in bad faith. Florida Statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit based on determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. Carrier has breached this duty by refusing to properly and timely adjust the loss. Moreover, Section 69B-220.201 of the Florida Administrative Code defines Carrier’s adjusters conduct here as an unfair claims settlement practice. Specifically, Section 69B-220.201(3) provides that “[a]n adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured” and that “[a]n adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.” As detailed above, Carrier’s investigation and adjustment of this claim was done in a manner prejudicial to Insured, was incomplete, and lacked truthful and unbiased reports of the facts. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. However, when the Insurer conducted its inspection of the insured property, the Insurer’s representatives failed to conduct a thorough and adequate investigation, or the representatives intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss. The conduct outlined above is done within the Insurer’s routine course of the business. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer’s claim file and standards and procedures for the adjustment and investigation of claims. In short, the Insurer is not acting with due regard for the Insured’s interests or safety. In Florida, the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully denied full coverage for the claim. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer’s actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer’s actions amount to but are not limited to the following: 1. Claim Delay: The Carrier has delayed processing the claim, causing frustration and inconvenience to the Insured. 2. Lack of Good Faith Conduct: The Carrier has not treated the Insured with good faith conduct expected when handling claims. 3. Attempt to Reduce Recovery: The Carrier has actively sought ways to minimize the amount owed to the Insured under the policy. 4. Attempt to Deny Recovery: The Carrier has looked for reasons to deny coverage altogether, rather than fulfill its obligations under the policy. 5. Failure to Property Evaluate Loss: Claims have not been assessed accurately or promptly, resulting in delays and incomplete indemnity for the Insured. 6. Inadequate Training and Supervision of Adjusters: The Carrier has not ensured its adjusters are adequately trained to handle claims promptly and fairly. 7. Placing Company Interests over Insured Interests: The Carrier has prioritized its financial interests over the health and safety of the Insured. 8. Failure to Provide Complaint Estimates: Estimates provided by the Carrier do not comply with Florida Building Codes. 9. Shifting Investigation Burden to Insured: The Carrier has unfairly placed the burden of investigating the claim onto the Insured. 10. Conducting Inadequate Investigations: The Carrier’s Investigation into the claim have been insufficient or cursory. Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: 1. Admit full coverage for the Insured’s loss and tender all additional amounts owed under the Policy for the covered loss to the insured property Please email any responses to this civil remedy notice to presuit@sulilaw.com A copy of this form submitted to the FDFS has been sent via email to the following parties, providing them notice of the filing of the civil remedy notice: • Amica Mutual Insurance Company via DFS Filing • Claims Department, Amica Mutual Insurance Company, via email; claims@amica.com • Judy C. Laws via email judylaws3366@yahoo.com
Comments
User Id Date Added Comment
Presuit@sulilaw.com 01-14-2026 This CRN is hereby withdrawn.
akoltnow@kelleykronenberg.com 01-02-2025 On behalf of Amica Mutual Insurance Company (“Amica”), this firm responds to the complainant, Judy Laws’ Civil Remedy Notice of Insurer Violation, No. 791092, filed on November 8, 2024 (the “Notice”). Amica objects to the Notice as legally deficient in that the complainant failed to comply with section 624.155(3)(b)2, Fla. Stat., which requires the Notice include the facts and circumstances giving rise to each violation. While the Notice contains some general statements relating to the loss, there are no facts alleged whatsoever that support or provide notice to the carrier of specific violations regarding the insurance company’s alleged acts of “not attempting in good faith to settle claims”, or “failing to adopt and implement standards for the proper investigation of claims”, or “misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue”, or “denying claims without conducting reasonable investigations based upon available information”; or “failing to promptly provide a reasonable explanation in writing to the insureds of the basis . . . for the denial of a claim or for the offer of a compromise settlement”; or “failing to promptly notify the insured of any additional information necessary for the processing of a claim”. Additionally, the Notice contains boilerplate language purporting to support the alleged violations, many of which have no relevant application to the handling of this claim. For example, the complainant claims Amica failed to provide a copy of the insurance policy within 30 days and failed to provide a loss run statement within 15 days. Yet, there are no facts whatsoever alleged to support these claims, rendering the Notice deficient. The complainant further alleged that Amica’s field adjuster made “a conscious effort to ignore evidence of covered losses to the property” but provides no context or description of the evidence that was purportedly ignored. Such allegation fails to provide notice to Amica of the alleged deficiencies in its investigation. Additionally, the complainant alleged “estimates provided by the Carrier do not comply with Florida Building Codes” but there are no facts to support such allegation, nor was an estimate prepared in this claim since Amica denied coverage for the damage. This is another example of the complainant’s use of a shotgun template that contains purported violations that have no bearing on the facts of this claim, rendering the Notice deficient. In further response to the Notice, Amica denies the allegations and denies that it has violated any Florida Statute in its handling of the insured’s claim, nor has it breached the insurance contract as required pursuant to section 624.1551, Fla. Stat., for an insured to prevail in a claim for extracontractual damages under section 624.155(1)(b), Fla. Stat. The complainant alleged that following Hurricane Ian, she “promptly” reported the damage to Amica. This is not accurate as Ms. Laws first reported the loss to Amica 507 days after Hurricane Ian. The policy requires prompt notice of a loss. The complainant further alleged that Amica conducted a “cursory” investigation and wrongfully denied coverage for the claim. This is not an accurate assessment of the claim investigation or coverage determination. Amica conducted a reasonable and diligent investigation to assess the cause of the damage reported. Amica’s assigned field adjuster and engineer both concluded that the roof was not damaged by wind or wind-borne debris associated with Hurricane Ian. Rather, the damage to the roof tiles was caused by slippage due to gravity, impact due to golf-ball strikes, age-related deterioration, foot traffic, and/or construction deficiencies. The following is a chronology of the claim investigation and facts supporting Amica’s coverage determination. On February 16, 2024, the insured and her public adjuster reported roof damage to Amica purportedly caused by Hurricane Ian on September 28, 2022. On March 1, 2024, field adjuster Beth McKinnie, with Advantage Adjustment Group, inspected the residence. She observed no evidence of wind damage to the roof; however, she did observe evidence of prior repairs and golf ball strikes to the roof. She also noted the solar panels were leaking in two areas and she observed golf balls lodged beneath the solar panels. She concluded the cracked tiles appeared to be from golf ball strikes, thermal expansion and contraction as well as normal wear, tear and deterioration on the 20-year-old tile roof. Amica requested Ms. Laws provide information regarding all prior roof repairs but did not receive any documents. On April 4, 2024, Mr. Sergey Turanov, P.E. of DDA Forensics inspected the property to investigate and determine the cause of the roof damage. He concluded the damage was not caused by wind or wind-borne debris associated with Hurricane Ian. Rather, the damage was caused by slippage due to gravity, impact due to golf balls strikes, age-related deterioration, foot traffic and/or construction deficiencies. Additionally, he determined the roof did not require to be replaced. On April 19, 2024, Amica notified the insured that unfortunately, the policy excluded coverage for damage caused by wear and tear, mechanical breakdown, shrinking, bulging or expansion, including resultant cracking of roofs, or faulty, inadequate or defective design, workmanship, repair or maintenance. Amica further advised the insured that she had not provided any additional information or documents evidencing damage due to Hurricane Ian. Amica requested the insured provide any additional information or documentation pertinent to the claim for Amica’s review. Amica further advised the insured that damage caused by inadvertent golf ball impacts would be considered a covered cause of loss under the homeowner policy and inquired if she wanted to open a claim(s) for the golf ball impact damage. The insured did not respond to Amica. Instead, she submitted what appears to be an inflated damage estimate for $166,493.64, purportedly representing the cost of a full roof replacement The insured did not provide any additional information or documents evidencing damage caused by wind or due to Hurricane Ian. Pursuant to section 624.1551, Fla. Stat., enacted into law on May 26, 2022, an insured must establish that the insurer breached the insurance contract to prevail in a claim for extracontractual damages. An insured can no longer base a claim of “bad faith” solely on an insurer’s statutory duty to act reasonably and in good faith. Here, the complainant has not alleged facts to support that Amica breached any term of the policy. Amica conducted a reasonable and diligent investigation to assess the cause of the damage reported. Both the field adjuster and the assigned engineer concluded that the roof was not damaged by a windstorm event. Rather, the damage was from normal wear and tear, deterioration, mechanical breakdown, settling, shrinking or expansion and faulty inadequate or defective workmanship, repair or maintenance—which is not covered by the policy. Amica timely and thoroughly investigated the reported loss and promptly notified the insured of the outcome of its investigation. Amica has promptly communicated with the insured and her representatives throughout the investigation—all within the mandates of Florida law. Throughout the handling of the insured’s insurance claim, Amica has acted in good faith towards the interests of its insured. Amica has investigated the loss in accordance with the policy provisions and standard claims handling practices and has abided by the terms of the insurance contract. Amica, therefore, denies any allegations to the contrary. We trust the foregoing is sufficient to advise you of Amica’s position regarding this matter and fully responds to the civil remedy notice filed by Judy Laws. Respectfully submitted by: Amy L. Koltnow Esq., Kelley Kronenberg
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