Civil Remedy Notice of Insurer Violations
Login

Filing Number:     791097
Filing Accepted:  11/8/2024
         Print Filing
Complainant
Last/Business Name *  
FARHANGI   First Name   HAMID
Street Address * 2012 IMPERIAL WAY
City, State Zip * CLEARWATER, FL 33764
Email Address * HAMIDF53@MSN.COM
Complainant Type: * Insured
Insured
Last/Business Name*   FARHANGI   First Name   HAMID
Policy # * CIT06910859 Claim #* FPI241822
Attorney
Attorney is Applicable
Last Name* PETTINATO First Name * DAVID Initial
Street Address* 1000 W. CASS STREET
City, State Zip* TAMPA , FL 33606
Email Address * DPETTINATO@OLDERLUNDYLAW.COM, DJP-PARALEGALS@OLDER
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):* KIM BROWN, JORGE CLAVELL, SIGURDUR THOMAS KISLUS, AND ALL OTHER ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY FLORIDA PENINSULA INSURANCE COMPANY INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Unfair Trade Practice
Other : Failure to properly investigate claim and with due regard to Insured’s interest
* 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)(d) Denying claims without conducting reasonable investigations based upon available information.
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).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

ADD’L STATUTES VIOLATED §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. 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 after the expiration of any additional timeframe provided to pay or deny a claim or a portion of a claim made pursuant to an order of the office finding factors beyond the control of the insurer, whichever is later, bears interest at the rate set forth in s. 55.03. Interest begins to accrue from the date the insurer receives notice of the claim. The provisions of this subsection may not be waived, voided, or nullified by the terms of the insurance policy. If there is a right to prejudgment interest, the insured must select whether to receive prejudgment interest or interest under this subsection. Interest is payable when the claim or portion of the claim is paid. Failure to comply with this subsection constitutes a violation of this code. However, failure to comply with this subsection does not form the sole basis for a private cause of action. POLICY LANGUAGE The Insured may not be in possession of a complete copy the applicable policy of insurance, however, the specific policy language relevant to the violations outlined below is contained within Florida Peninsula Insurance Company’s Homeowners policy, Policy No. CIT06910859, issued to the Insured including, but is not limited to, the following: Coverage A-Dwelling provisions Additional Coverages provisions - Reasonable Repairs The Declarations Page Loss Payment or Loss Settlement provisions Duties in Event of Loss Policy provisions The insurance policy's definition sections The insurance policy's exclusion of coverage provisions Please advise if there are other applicable policy provisions that are not cited above but would provide coverage to the Insured for the January 9, 2024, wind loss.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

In Florida, the work of adjusting insurance claims engages the Public Trust. FLORIDA PENINSULA INSURANCE COMPANY (“FLORIDA PENINSULA”) has breached this duty by its failure or refusal to acknowledge its Insured’s claim of loss. FLORIDA PENINSULA has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees resulting in statutory violations as set forth above. FLORIDA PENINSULA has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim for damages. To date, notwithstanding the Insured’s pleas, FLORIDA PENINSULA has continued to refuse to acknowledge its obligation to acknowledge and pay the full amount of its Insured’s claim. This complaint is made on behalf of the Insured, Hamid Farhangi (“MR. FARHANGI”). Further, this complaint is a statement that notice is hereby given in order to perfect the right to pursue the civil remedy authorized and pursuant to Florida Statute §624.155. In consideration of the premium paid to it by MR. FARHANGI, Citizens Property Insurance Corporation issued an Homeowners policy, Policy No. CIT06910859 (hereinafter referred to as “the Policy”), to MR. FARHANGI wherein the insurance policy provided coverage for all losses, including wind, except those losses which were expressly excluded. Prior to the subject loss, FLORIDA PENINSULA assumed the policy from Citizens Property and assumed all responsibility for any claims made under the policy issued by Citizens Property. The policy was in full force and effect at the time the damage occurred as a result of wind, and the ensuing damages as a direct result thereof, to the insured premises located at 2012 Imperial Way, Clearwater, FL 33764, on or about January 9, 2024. On or about January 9, 2024, MR. FARHANGI’S property sustained interior and exterior damages as a result of a windstorm, and ensuing damages. On or about January 10, 2024, MR. FARHANGI retained the services of a roofing professional to assess the damage to the insured property. As with typical Florida weather, the water had dried up by the next day and therefore no water was intruding during their visit to the insured property. On or about February 20, 2024, another rainstorm occurred at which time MR. FARHANGI again noticed water intruding through the roof. On February 20, 2024, MR. FARHANGI contacted the roofing professionals to revisit the property and reassess the storm related damage. During their visit, the roofing company installed a tarp to mitigate the intrusion of water into the home and determined that the roof required a full replacement. To date, MR. FARHANGI has incurred out-of-pocket expenses in the amount of $9,159.60 for mitigation of his damages. MR. FARHANGI timely notified FLORIDA PENINSULA of the damages and opened a claim pursuant to the terms and conditions of the Policy. In response, FLORIDA PENINSULA assigned the claim to its representative to adjust and investigate the loss, as well as a field adjuster to inspect the damages. FLORIDA PENINSULA’S representative visited the insured property and performed a cursory and inadequate investigation of the damaged property. On March 21, 2024, FLORIDA PENINSULA conducted a recorded statement of MR. FARHANGI in its investigation of the claim. On April 4, 2024, FLORIDA PENINSULA advised MR. FARHANGI that the investigation and evaluation of his claim was completed and based on the terms of the Policy, no coverage would be afforded. FLORIDA PENINSULA further stated that its inspection found no damage to the roofing materials or exterior elevations caused by wind, hail or any other sudden impact that would allow coverage for the interior water intrusion and damage. Instead, FLORIDA PENINSULA cited the damages were the result of wear and tear and deterioration, inadequate maintenance and materials, expansion and shrinkage resulting in cracking, and inherent vice. FLORIDA PENINSULA has been provided with a copy of the estimate of damages prepared by Utopia on MR. FARHANGI’S behalf in the amount of $108,444.94 (RCV) / $102,614.18 (ACV). To date, FLORIDA PENINSULA has failed to tender any supplemental insurance benefits. FLORIDA PENINSULA has admitted that MR. FARHANGI sustained covered damages as a result of the wind loss that occurred on or about January 9, 2024 but has denied tendering all owed insurance benefits to MR. FARHANGI. Pursuant to Florida Statute §626.9541(1)(i)(4), FLORIDA PENINSULA is required to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after FLORIDA PENINSULA received notice of the residential property insurance claim, determine the amounts of partial or full benefits, and agree 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). As FLORIDA PENINSULA has failed to do so, FLORIDA PENINSULA has wrongfully denied coverage. Here, FLORIDA PENINSULA denied MR. FARHANGI’S claim without conducting a reasonable investigation based upon available information when it denied the claim (by way of claiming that no damage to roofing materials or exterior elevations caused by wind, hail or other sudden impact damage that would be covered by Policy was observed) and advised that the rain intrusion was the result of deterioration of roofing system components. FLORIDA PENINSULA’S representatives performed a cursory and inadequate property inspection, which resulted in a conclusory claim evaluation. Thus, FLORIDA PENINSULA violated Fla. Stat. §626.9541(1)(i)(3)(d). FLORIDA PENINSULA violated 626.9541(1)(i)(3)(d), because its inadequate inspection was not a “reasonable investigation” that FLORIDA PENINSULA then used to justify its refusal to pay MR. FARHANGI his rightfully owed insurance benefits. FLORIDA PENINSULA also conducted one conclusory investigation in which it denied coverage and then closed the claim. Thus, FLORIDA PENINSULA violated §626.9541(1)(i)(3)(a) and 626.9541(1)(i)(3)(d). Since the beginning of the claim, FLORIDA PENINSULA has engaged in a pattern of delay, denial, and reckless disregard for MR. FARHANGI’S rights. The actions of FLORIDA PENINSULA listed herein have been continuing in nature and given the totality of the circumstances, which includes FLORIDA PENINSULA’S adjustment, actions and/or omissions post the filing of this CRN. MR. FARHANGI contends that given the past experience in this matter with FLORIDA PENINSULA, it is reasonably foreseeable that FLORIDA PENINSULA’S current actions will extend to its entire conduct in the handing of his claim, including the acts or omissions of FLORIDA PENINSULA and/or its representatives, until the final resolution of his claim. As such, MR. FARHANGI contends adequate notice has been given should FLORIDA PENINSULA’S actions and violations listed herein continue after the expiration of this notice. FLORIDA PENINSULA has failed and/or refused to settle the claim when it could and should have done so had it acted fairly and honestly towards MR. FARHANGI, and has failed to take into account the information and evidence provided that contradict its decisions. Even upon receipt of additional and supporting evidence to the contrary, FLORIDA PENINSULA has continued to stand by its claim denials. As such, MR. FARHANGI does not anticipate FLORIDA PENINSULA will rescind its denial of his claim. FLORIDA PENINSULA’S conduct has been reckless and unfair to MR. FARHANGI, and has caused and continues to cause additional damages throughout the property. This is evidenced by the delay in paying the claim and the failure of FLORIDA PENINSULA to evaluate the claim in total. To date, FLORIDA PENINSULA has failed and/or refused to provide MR. FARHANGI with all the insurance benefits due and owing and has not tendered the full amount needed to repair the Property despite knowing that MR. FARHANGI has sustained covered damages to his insured property. As FLORIDA PENINSULA must admit, it is implied within every insurance policy a duty of good faith and fair dealings. In an insurance contract, each party is prevented from interfering with the other’s right to benefit from the contract. The obligations of good faith and fair dealings encompass qualities of decency and humanity inherent in its responsibilities as a fiduciary. FLORIDA PENINSULA is bound to conduct itself with the utmost good faith for the benefit of MR. FARHANGI. However, FLORIDA PENINSULA has failed to comply with the obligations in connection with this claim and has never looked at the claim or the contract for insurance with good faith and fair dealing. Instead, FLORIDA PENINSULA has looked for ways not to pay the claim in full, or at all, and these actions have been to the detriment of MR. FARHANGI. The adjusters assigned to this claim have a duty to adjust and treat all claims equally. Since the beginning of this claim the representatives on behalf of FLORIDA PENINSULA have approached this investigation in a manner prejudicial to MR. FARHANGI. FLORIDA PENINSULA is using either untrained or improperly trained adjusters in connection with this claim. FLORIDA PENINSULA should have been adjusting the loss with MR. FARHANGI but instead, it was looking for ways not to pay the claim at all, or pay the claim in full. If FLORIDA PENINSULA handles all the claims in the manner in which MR. FARHANGI’S claim was adjusted, then it is improperly handling all claims. FLORIDA PENINSULA has refused and/or failed to comply with The Policy’s cooperation and/or “Loss Payment” provision. Under The Policy, FLORIDA PENINSULA was to timely tender undisputed insurance benefits to MR. FARHANGI. FLORIDA PENINSULA has failed and/or refused to timely tender owed insurance benefits, undisputed or otherwise. This is a breach of The Policy. FLORIDA PENINSULA has refused and/or failed to cooperate and/or “Adjust the Loss” by cooperating with MR. FARHANGI during the claims adjustment process in compliance with The Policy’s “Loss Payment” provision. This is a breach of The Policy. The concept of insurance is that insurance is the insurer’s granting of timely and prompt indemnity or security against a contingent loss. Florida Statute §624.02 defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that MR. FARHANGI may mitigate his damages and to put him back into the position he was in prior to the loss as quickly as possible. FLORIDA PENINSULA has breached this duty. FLORIDA PENINSULA has refused and/or failed to tender all insurance proceeds to MR. FARHANGI upon demand. FLORIDA PENINSULA’S refusal and/or failure to settle the insurance claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards MR. FARHANGI is wrongful conduct. Furthermore, MR. FARHANGI contends that FLORIDA PENINSULA’S adjusters and/or representatives financially benefit by such wrongful conduct. It is clear that FLORIDA PENINSULA’S adjusters have also failed to adhere to insurance industry rules and guidelines when adjusting a first party claim. It is also evident that FLORIDA PENINSULA violated the Florida unfair claims practices, the adjuster’s ethical code of conduct, and acted irresponsibly in the handling of its insured’s claims. In this case, MR. FARHANGI paid a hefty premium for a service, the service is called claims adjusting (I encourage you to read the book titled, “The Claims Environment” written by James J. Markham, Kevin M. Quinley, and Layne S. Thompson-this book is taught in every first year AIC course). The claim professional must dispense his or her knowledge and skill for the benefit of society. The general public expects claims representatives to pay all legitimate claims promptly and fairly. The claim professional must harness all of his or her knowledge and expertise to accomplish the objectives of the claim function. He or she must also adhere to the highest degree of ethical conduct. In addition to interacting with other insurance personnel and service providers in a professional manner, the claims professional must deal with public’s and regulator’s expectations. Insurance Companies provide such a vital and necessary service to society that the selling and servicing of insurance is imbued with a public trust. James J. Markham, Kevin M. Quinley, Layne S. Thompson, “The Claims Environment”, Insurance Institute of America, 1st ed., 1993. Accordingly, FLORIDA PENINSULA has a contractual and statutory obligation to investigate all possible bases which might support MR. FARHANGI’S claim and cannot deny a claim without thoroughly investigating the foundation for its denial or basis for withholding insurance benefits. FLORIDA PENINSULA violated its obligations here. - FLORIDA PENINSULA has a contractual and statutory obligation to make a perfunctory investigation, not ignoring evidence that would support MR. FARHANGI’S claim. FLORIDA PENINSULA violated its obligations here. - FLORIDA PENINSULA has a contractual and statutory obligation not to look the other way when confronted with facts revealing the possibility of coverage and resisting reasonable interpretations of its policy. FLORIDA PENINSULA violated its obligations here. - FLORIDA PENINSULA has a contractual and statutory obligation not to deny the claim based on standards known to be impermissible or on an interpretation contrary to established law. FLORIDA PENINSULA violated its obligations here. These actions and violations were either done intentionally or as the result of FLORIDA PENINSULA’S failure to adopt and implement the proper standards of the investigation and adjustment of claims. Overall, FLORIDA PENINSULA’S investigation of the claim was inadequate and contrary to its obligations under the insurance policy and Florida law. MR. FARHANGI has done everything legally requested by FLORIDA PENINSULA to date. To cure the violations set forth in this Civil Remedy Notice, FLORIDA PENINSULA must now agree to acknowledge its duties and obligations under the law in adjusting its insured’s claim, and tender rightfully owed insurance benefits to return MR. FARHANGI to his pre-loss condition. Further, to cure the violations set forth in this Civil Remedy Notice, MR. FARHANGI hereby requests that FLORIDA PENINSULA tender at this time, or prior to the expiration of the statutory cure period, the amount of MR. FARHANGI’S damage estimate and demand which accurately reflects the true nature and extent of MR. FARHANGI’S damages. Therefore, FLORIDA PENINSULA should tender $117,604.54 (less any prior payments, depreciation, excess policy limits, and/or deductible) in insurance benefits at this time. Although MR. FARHANGI has made a demand for payment in the amount of $117,604.54 (less any prior payments, depreciation, excess policy limits, and/or deductible) and has provided FLORIDA PENINSULA with all the necessary documentation in support thereof, he is still willing to consider and to potentially accept any reasonable counter-offer made by FLORIDA PENINSULA. Therefore, if FLORIDA PENINSULA is not in agreement with MR. FARHANGI’S reasonable demand for payment of his rightfully owed insurance benefits being submitted at this time, MR. FARHANGI hereby requests that FLORIDA PENINSULA now make a reasonable counter-offer before the expiration of the cure period. MR. FARHANGI still hopes that his claim can be resolved amicably. The concept of insurance is that insurance is the insurer’s granting of timely and prompt indemnity or security against a contingent loss. Florida Statute §624.02 defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that MR. FARHANGI may mitigate his damages and to put him back into the position he was in prior to loss as quickly as possible. FLORIDA PENINSULA breached this duty. This notice is given in order to perfect the right to pursue the civil remedy authorized and pursuant to Florida Statute §624.155, including any and all bad faith/extra contractual, should FLORIDA PENINSULA fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. While no specific “cure amount” is required for this Civil Remedy Notice to be valid, MR. FARHANGI will consider the allegations contained herein “cured” if FLORIDA PENINSULA, without any requirement for a release: (1) Immediately tenders the amount of MR. FARHANGI damage estimate in the amount of $117,604.54 (less any prior payments, depreciation, excess policy limits, and/or deductible), which accurately reflects the true nature and extent of the damages to the Dwelling; (2) Agrees to reimburse MR. FARHANGI for his expenses incurred by having to retain a public adjuster to present his claim; and (3) Immediately tenders the amount of statutory interest due and owing to MR. FARHANGI pursuant to Florida Statute §627.70131(5)(a). (4) Immediately provides MR. FARHANGI with the documentation FLORIDA PENINSULA has used and/or continues to contend, supports the claim determination made by FLORIDA PENINSULA in the adjustment of MR. FARHANGI’S claim. Specifically, FLORIDA PENINSULA must provide MR. FARHANGI with its claim estimate(s), supporting photographs and/or videos, as well as any and all reports of any expert(s) or other individuals retained on behalf of FLORIDA PENINSULA upon which FLORIDA PENINSULA has relied on in reaching and/or further supporting its coverage determination in MR. FARHANGI’S claim. MR. FARHANGI continues to remain open to a fair and reasonable settlement offer from FLORIDA PENINSULA in an effort to avoid additional delay, costs and expenses, and hereby request the same prior to the expiration of the statutory “cure” period. MR. FARHANGI has provided FLORIDA PENINSULA with all necessary estimates, documentation, etc. in support of the claim. FLORIDA PENINSULA must act fairly and honestly in its response to MR. FARHANGI’S request for a prompt, fair and reasonable settlement offer and resolution of the claim.
Comments
User Id Date Added Comment
april@zinoberdiana.com 12-31-2024 We represent Florida Peninsula Insurance Company (hereinafter, “Florida Peninsula”) in the dispute filed by you on behalf of Hamid Farhangi as the Complainant (hereinafter, “Complainant”), against Florida Peninsula for Claim No. FPI241822. This correspondence constitutes Florida Peninsula’s Response to the Civil Remedy Notice of Insurer Violation which your office filed on behalf of the Complainant on November 8, 2024, with the Florida Department of Financial Services (“DFS”), DFS filing number 791097 (hereinafter, the “CRN”). While Florida Peninsula welcomes the opportunity to respond to this CRN, Florida Peninsula specifically denies each and every allegation contained in the CRN filed in relation to this claim. Further, Florida Peninsula asserts that the CRN should be rejected and returned by DFS, as the CRN fails to comply with the specific information requirements as set forth within § 624.155, Florida Statutes, and Florida case law, and is therefore facially invalid and deficient. I. The CRN fails to satisfy the requirements of Florida law. Concerning the contents of the CRN, the law requires strict compliance with the specificity requirements in § 624.155, Florida Statutes, which the CRN fails to satisfy. Both § 624.155(3), Florida Statutes, and the Civil Remedy Notice form require the Complainant to specifically state, among other things, the statutory provisions, including the specific language of the statute, which the insurer allegedly violated, the facts and circumstances giving rise to the violation, the name of any individual involved in the violation, and the specific policy language that is relevant to the violation. Additionally, § 624.155(3)(b) mandates that the Civil Remedy Notice must be “on a form provided by the [Department] and shall state with specificity … such other information as the department may require.” (emphasis added). In the section that requires the Complainant identify the person or persons representing the insurer who are most responsible for or knowledgeable of the facts giving rise to the allegations in this notice, in addition to certain individuals, the Complainant states “and all other adjusters, supervisors, management and individuals associated with or retained by Florida Peninsula Insurance Company involved in the claim.” This is clearly nonspecific, inaccurate, and fails to provide Florida Peninsula with a proper ability to identify the proper individuals. Further, the purpose of the specificity requirement for a civil remedy notice is to put the insurer on notice of an alleged violation, the circumstances surrounding same, and indicate the details of the alleged violation in order to provide an insurer with 60 days to “cure” the alleged claim defects and otherwise avoid litigation. See Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So. 2d 1278, 1283-4 (Fla. 2000); Rousso v. Liberty Surplus Ins. Corp., 2010 U.S. Dist. LEXIS 82328 (S.D. Fla. Aug. 13, 2010). Uninformative recitations that do not inform the insurer of the facts underlying the alleged violations or match up with the statutes that the complainant identifies as the statutes that were purportedly violated are insufficient to fulfill the requirements of § 624.155. Rousso, 2010 U.S. Dist. LEXIS 82328. The CRN fails to meet the specificity requirements of § 624.155, Florida Statutes, and therefore is invalid and deficient. Notably, in contravention of the statutory and form requirements that a complainant must state the specific statutory provisions allegedly violated and the facts and circumstances giving rise to the violation, the CRN identifies numerous statutory provisions (almost every potential statute) including some contained in the narrative section but not included in the designated list section and some identified in the section for the policy language but never further mentioned or expanded upon, though they are not wholly relevant or applicable to the alleged facts or claimed violations contained in the CRN or fail to correlate with any specific facts or circumstances giving rise to the alleged violations. Likewise, the CRN identifies numerous “reason[s] for notice” without providing sufficient facts to support each. Additionally, 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, incomplete, generic, conclusory, and insufficient allegations with no basis in fact or circumstance, as well as omits specific facts to support its allegations of violations. The CRN includes a lengthy commentary on unsupported, conclusory accusations, unqualified opinion, legal conclusions, conjecture, and inaccurate statements of facts cast in the light most favorable to the Complainant and his representatives. In short, the facts alleged are simply inaccurate, fail to paint a complete picture of the handling of this claim, fail to apprise Florida Peninsula of how its actions constituted a violation of said statutes, or were identified without any factual support. II. Despite the deficiencies, Florida Peninsula denies all allegations contained in the CRN. Notwithstanding the deficiencies in the CRN and without waiving the objections above, Florida Peninsula explicitly denies any violation of the Florida Statutes sections referenced in the CRN. Florida Peninsula hereby denies each and every allegation contained in the CRN, either explicitly or implicitly, and denies any wrongdoing in the handling of this matter. Rather, Florida Peninsula handled the claim both diligently and properly under the terms and conditions of the insurance policy, as well as in accord with Florida law. Florida Peninsula denies each and every allegation contained in the CRN and responds to them individually as follows: The Complainant lists the following purported reasons for submitting the CRN which are 1) Claim Denial; 2) Unfair Trade Practice; and 3) Failure to properly investigate claim and due regard to Insured’s interest. As indicated in detail below, the CRN fails to establish or set forth any specific facts that would support the allegations asserted in support of the perceived violations and Florida Peninsula denies each and every allegation. Specifically, Florida Peninsula responds as follows: Allegation of Claim Denial: This allegation is without basis in law or in fact and is therefore denied. Counsel for Complainant should immediately withdraw this allegation from the CRN as it cannot be established by any credible evidence. Florida Peninsula handled the claim both diligently and properly under the terms and conditions of the insurance policy as well as in accord with Florida law, a determination of coverage was made based on a good faith investigation and the terms and conditions of the subject policy, a good faith attempt to investigate this claim has and continues to be made, and at all times material to this claim, Florida Peninsula has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, as it does on every claim. Allegation of Unfair Trade Practice: This allegation is wholly without basis in law or in fact and is therefore denied. Counsel for Complainant should immediately withdraw this allegation from the CRN as it cannot be established by any credible evidence. Florida Peninsula handled the claim both diligently and properly under the terms and conditions of the insurance policy as well as in accord with Florida law, a determination of coverage was made based on a good faith investigation and the terms and conditions of the subject policy, a good faith attempt to investigate this claim has and continues to be made, and at all times material to this claim, Florida Peninsula has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, as it does on every claim. Allegation of Failure to properly investigate claim and due regard to Insured’s interest: This allegation is wholly without basis in law or in fact and is therefore denied. Counsel for Complainants should immediately withdraw this allegation from the CRN as it cannot be established by any credible evidence. Florida Peninsula handled the claim both diligently and properly under the terms and conditions of the insurance policy as well as in accord with Florida law, a determination of coverage was made based on a reasonable and good faith investigation and the terms and conditions of the subject policy, a good faith attempt to investigate this claim has and continues to be made, and at all times material to this claim, Florida Peninsula has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, as it does on every claim. Moreover, the subject CRN cites numerous (virtually every one which is impermissible) statutes Florida Peninsula has allegedly violated. While Florida Peninsula categorically and unequivocally denies violating any statutes, Florida Peninsula will briefly address the specific statutes alleged to have been violated, in an abundance of caution. § 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 denies this allegation. The CRN sets forth no actual facts to support this allegation, only opinions as to how the Complainant believes the claim should have been resolved. The CRN also sets forth several inaccuracies and incomplete information regarding the claim based solely on unsupported opinions. Florida Peninsula retained a qualified independent adjuster to inspect the insured property in the subject claim. Additionally, Florida Peninsula made a determination of coverage on this claim based on the totality of its good faith investigation and the terms and conditions of the subject policy and Florida law and issued a detailed explanation to the Insured regarding its coverage determination. While Florida Peninsula has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, Florida Peninsula is also not obligated to settle a claim in a matter beyond that which is covered under the terms, conditions and exclusions of the subject policy. The remainder of the CRN simply states disparaging and unsubstantiated opinions regarding Florida Peninsula and its agents assisting in the investigation of the subject claim. At no time has Florida Peninsula acted dishonestly or unfairly toward the Insured and/or his representatives. All actions have been performed in good faith for the purpose of moving the claim towards a just and equitable resolution. Florida Peninsula acted in accordance with Florida Statute § 624.155(1)(b)(1) and has in no way violated said statutory provisions. § 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 denies this allegation. The CRN sets forth no actual facts to support this allegation, only opinions as to how the Complainant believes the claim should have been resolved. The CRN also sets forth several inaccuracies and incomplete information regarding the claim based solely on unsupported opinions. Florida Peninsula retained a qualified independent adjuster to inspect the insured property in the subject claim. Additionally, Florida Peninsula made a determination of coverage on this claim based on the totality of its good faith investigation and the terms and conditions of the subject policy and Florida law and issued a detailed explanation to the Insured regarding its coverage determination. While Florida Peninsula has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, Florida Peninsula is also not obligated to settle a claim in a matter beyond that which is covered under the terms, conditions and exclusions of the subject policy. The remainder of the CRN simply states disparaging and unsubstantiated opinions regarding Florida Peninsula and its agents assisting in the investigation of the subject claim. At no time has Florida Peninsula acted dishonestly or unfairly toward the Insured and/or his representatives. Moreover, it is unclear what other portions of the policy coverage Complainant claims Florida Peninsula was trying to influence the settlements of. All actions have been performed in good faith for the purpose of moving the claim towards a just and equitable resolution. Florida Peninsula acted in accordance with Florida Statute § 624.155(1)(b)(3) and has in no way violated said statutory provisions. § 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for proper investigation of claims. Florida Peninsula denies this allegation. The CRN sets forth no actual facts to support this allegation, only opinions as to how the Complainant believes the claim should have been resolved. The CRN also sets forth several inaccuracies and incomplete information regarding the claim based solely on unsupported opinions. Florida Peninsula retained a qualified independent adjuster to inspect the insured property in the subject claim. Additionally, Florida Peninsula made a determination of coverage on this claim based on the totality of its good faith investigation and the terms and conditions of the subject policy and Florida law and issued a detailed explanation to the Insured regarding its coverage determination. While Florida Peninsula has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, Florida Peninsula is also not obligated to settle a claim in a matter beyond that which is covered under the terms, conditions and exclusions of the subject policy. The remainder of the CRN simply states disparaging and unsubstantiated opinions regarding Florida Peninsula and its agents assisting in the investigation of the subject claim. Florida Peninsula has always implemented standards for investigating and adjusting claims commensurate with the requirements of Florida Statutes, and it will continue to do so. All actions have been performed in good faith and for the purpose of moving the claim towards a just and equitable resolution. Florida Peninsula acted in accordance with Florida Statute § 626.9541(1)(i)(3)(a) and has in no way violated said statutory provisions. § 626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. Florida Peninsula denies this allegation. The CRN sets forth no actual facts to support this allegation. The CRN also sets forth several inaccuracies and incomplete information regarding the claim based solely on unsupported opinions. Florida Peninsula retained a qualified independent adjuster to inspect the insured property in the subject claim. Additionally, Florida Peninsula made a determination of coverage on this claim based on the totality of its good faith investigation and the terms and conditions of the subject policy and Florida law and issued an honest and detailed explanation to the Insureds regarding its coverage determination. While Florida Peninsula has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, Florida Peninsula is also not obligated to settle a claim in a matter beyond that which is covered under the terms, conditions and exclusions of the subject policy. The remainder of the CRN simply states disparaging and unsubstantiated opinions regarding Florida Peninsula and its agents assisting in the investigation of the subject claim. At no time has Florida Peninsula acted dishonestly or unfairly toward the Insured and/or his representatives. Florida Peninsula has not made misrepresentations to the Insured and/or his representatives. All actions have been performed in good faith and for the purpose of moving the claim towards a just and equitable resolution. Florida Peninsula acted in accordance with Florida Statute § 626.9541(1)(i)(3)(b) and has in no way violated said statutory provisions. § 626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information. Florida Peninsula denies this allegation. The CRN sets forth no actual facts to support this allegation, only opinions as to how the Complainant believes the claim should have been resolved. The CRN also sets forth several inaccuracies and incomplete information regarding the claim based solely on unsupported opinions. Florida Peninsula retained a qualified independent adjuster to inspect the insured property in the subject claim and conducted a reasonable investigation of the claim. Additionally, Florida Peninsula made a determination of coverage on this claim based on the totality of its good faith investigation and the terms and conditions of the subject policy and Florida law and issued a detailed explanation to the Insured regarding its coverage determination. While Florida Peninsula has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, Florida Peninsula is also not obligated to settle a claim in a matter beyond that which is covered under the terms, conditions and exclusions of the subject policy. The remainder of the CRN simply states disparaging and unsubstantiated opinions regarding Florida Peninsula and its agents assisting in the investigation of the subject claim. Florida Peninsula made the coverage determination after it conducted a reasonable investigation based upon available information. All actions have been performed in good faith for the purpose of moving the claim towards a just and equitable resolution. Florida Peninsula acted in accordance with Florida Statute § 626.9541(1)(i)(3)(d) and has in no way violated said statutory provisions. § 627.70131(7)(a) While this allegation is not provided in the list of purported statutes, it is included in the section of the CRN for providing applicable policy language and therefore Florida Peninsula will respond in an abundance of caution. Florida Peninsula denies this allegation. The CRN sets forth no facts whatsoever to support the application of these allegations of purported violations, only opinions as to how the Complainant believes the claim should have been resolved. Florida Peninsula retained a qualified independent adjuster to inspect the insured property in the subject claim. Additionally, Florida Peninsula promptly and timely made a determination of coverage on this claim based on the totality of its good faith investigation and the terms and conditions of the subject policy and Florida law and issued a timely and detailed explanation to the Insured regarding its coverage determination. While Florida Peninsula has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, Florida Peninsula is also not obligated to settle a claim in a matter beyond that which is covered under the terms, conditions and exclusions of the subject policy. The remainder of the CRN simply states disparaging and unsubstantiated opinions regarding Florida Peninsula and its agents assisting in the investigation of the subject claim. Notably, Florida Peninsula provided the Insured with its detailed coverage determination on April 4, 2024 (after receiving notice of the claim on February 21, 2024), providing the basis for its decision, and the applicable policy language. On the other hand, the Complainant fails to specify how or why the communications from Florida Peninsula were not sufficient other than essentially disagreeing with the decision. All actions have been performed in good faith and for the purpose of moving the claim towards a just and equitable resolution. Florida Peninsula acted in accordance with Florida Statute § 627.70131 and has in no way violated said statutory provisions. Alleged Violations of Policy of Insurance The CRN requires the Complainant to include the specific policy language that is relevant to the violation. Rather than complying with this requirement, the CRN only generally and vaguely refers to “Coverage A-Dwelling provisions, Additional Coverages provisions – Reasonable Repairs, The Declarations Page, Loss Payment or Loss Settlement provisions, Duties in Event of Loss Policy provisions, The insurance policy’s definition sections, The insurance policy’s exclusion of coverage provisions” of the Policy and further states, “Please advise if there are other applicable policy provisions that are not cited above but would provide coverage to the Insured for the January 9, 2024, wind loss”. This is clearly improper, nonspecific, over generalized, and noncompliant with the CRN requirements. The failure to comply with this requirement or to provide factual support as to what and how Florida Peninsula purportedly violated the policy prevents Florida Peninsula from engaging in any meaningful review of the policy terms and conditions or actions that the Complainant takes issue with and addressing any issues regarding the policy. Florida Peninsula cannot hit a moving target by attempting to determine what provisions of the policy are actually at issue. As for public policy, this appears to be the exact purpose for the statutory requirements referenced above, which you have violated by failing to accurately provide the policy provisions at issue. Moreover, to the extent the Complainant subsequently intends to rely on specific additional policy provisions, he is precluded from doing so as he failed to properly include those provisions in the CRN. Notwithstanding, Florida Peninsula denies violating any provision or duty set forth in the policy. Alleged Factual and Circumstantial Support for the CRN A review of the facts and circumstances surrounding the investigation and claim decisions on the subject claim reveals Florida Peninsula acted in good faith and diligently investigated, handled, and adjusted the claim at issue in this dispute. Florida Peninsula acted fairly, honestly, and in good faith, acknowledged and acted promptly upon receipt of the claim, attempted in good faith to adjust the claim pursuant to the terms of the policy, took reasonable steps to investigate the claim, communicated reasonably and honestly with the Insured and the Insured’s representatives about the claim, and provided the Insured reasonable explanations for its actions. The subject claim involves alleged windstorm damage with a reported date of loss of January 9, 2024 to the property located at 2012 Imperial Way, Clearwater, FL 33764 (the “Property”) first reported to Florida Peninsula on February 21, 2024 in relation to a Citizens policy assumed by Florida Peninsula. Florida Peninsula promptly responded with acknowledgement of the claim and the Homeowner Claims Bill of Rights and initiated its investigation of the claim, which included an inspection of the Property by a qualified independent adjuster. Florida Peninsula made a determination of coverage on this claim based on the totality of its diligent, reasonable, and good faith investigation and the terms and conditions of the subject policy and Florida law. Based on the investigation, Florida Peninsula issued its coverage determination letter on April 4, 2024 providing a detailed explanation along with the applicable policy language advising the claimed damage was not covered pursuant to the Policy. Specifically, Florida Peninsula explained, “During our inspection of the property 2/29/2024, we found no damage to roofing materials or exterior elevations caused by wind, hail or any other sudden impact damage that would be covered by the policy. Our inspection of your home revealed evidence of previous repair attempts and cracked roof tiles throughout the roofing surface. The roof tiles have been painted white in the past and white paint shows within some of the cracks. We observed no evidence of any openings or damage on the roof surface, or any other area on the exterior of your home that might have been caused by wind or any other peril for which coverage is afforded under the terms of your insurance policy. Based upon or investigation it is apparent that the rain intrusion to the interior of the dwelling was due to deterioration of roofing system components. The policy does not provide coverage for rain unless an opening for fair to leak through was created by a peril covered by the policy. Wear and tear and deterioration, inadequate maintenance and materials, expansion and shrinkage resulting in cracking, and inherent vice (such as corner cracks) are not covered by the policy. Damage existing prior to the time of loss are not covered by the policy. According to the policy, prompt notice of the loss was to have been given to us or your insurance agent.” As made clear, Florida Peninsula has continued to promptly and fairly adjust the claim as information is made available to it. Florida Peninsula promptly and honestly made all coverage determinations based on its reasonable investigation of the claim. Moreover, contrary to the Complainant’s claims, Florida Peninsula has and continues to promptly respond to all communications, communicate honestly with the Insured and his representatives, and conduct a fair and good faith ongoing investigation of the claim. There is no indication in the CRN nor anywhere within the record evidence to suggest that Florida Peninsula handled the subject claim in bad faith or incongruent with the applicable Florida Statutes. Rather, the record evidence establishes the opposite, and shows that Florida Peninsula properly handled and adjusted the subject claim and has continued to do so from the time it was first received through the present. Furthermore, under the circumstances, and upon information and belief, the filing of the CRN appears to be an effort to strong-arm Florida Peninsula into payment for repairs and excessive benefits for which the Complainant is not entitled under the policy. The disagreement with the claim decision does not in any way constitute bad faith on the part of Florida Peninsula. Under the circumstances presented, Florida Peninsula cannot in good faith issue a payment for damages that are claimed and demanded by the Complainant as doing so would, in essence, breach Florida Peninsula’s duty of good faith and fair dealing owed toward each and every one of its other policyholders. Accordingly, there is no evidence that Florida Peninsula has acted in any way, whatsoever, contrary to the terms of the policy or in violation of the statutes listed in the CRN. III. Demands to Cure Defects. Moreover, the CRN does not specify a cure for the alleged violations that comports with the provisions of the subject Policy. Further, the CRN requests “cures” that are improper according to Florida law and Fla. Stat. §624.155. See Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So. 2d 1278, 1281 (Fla. 2000). The Talat decision provides that a “cure” must be limited to contract damages. Additionally, Section 624.155, Florida Statutes, does not impose on an insurer the obligation to pay whatever its insured demands. Talat, 753 So. 2d at 1282. On 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. See Talat, 753 So. 2d at 1281. The subject Notice is deficient as it does not provide an opportunity to “cure” the alleged violations without imposing obligations on Florida Peninsula not owed or contemplated by the Policy. To the extent the CRN requests anything other than contract proceeds, the CRN is defective and should be rejected. The offer to cure in the CRN, rather, is illusory and even a reading of the CRN in a light most favorable to the Complainant requires that it be invalidated and rejected. Notably, the CRN requests that in order to cure the alleged violations, Florida Peninsula must: 1) agree to acknowledge its duties and obligations under the law in adjusting its insured’s claim; and 2) pay the Insured $117,604.54 (less prior payments, depreciation, excess policy limits, and the deductible). First and foremost, Florida Peninsula has acknowledged and complied with its duties and obligations under the law in adjusting its insured’s claim. Additionally, based on its thorough investigation, the information received at this time, and the terms and conditions of the Policy, Florida Peninsula properly determined the claimed damages are not covered under the Policy. Moreover, the Complainant requests actions by Florida Peninsula to “cure” the CRN which he is not entitled to and which go beyond that which is entitled under the Policy and Florida law. IV. Conclusion. In closing, Florida Peninsula first believes that the CRN does not comply with section 624.155, Florida Statutes, and should therefore be rejected and returned by DFS due to its failure to comply with § 624.155, Florida Statutes, and Florida case law. Regardless of the rejection and lack of compliance, Florida Peninsula denies all allegations contained in the CRN and submits there are no violations. While this Response is meant to be comprehensive, Florida Peninsula’s Response above is based upon the limited information provided in the CRN and the information we have to date. If the Complainant feels that we are not in possession of all the facts, please inform us immediately. Please note that Florida Peninsula’s Response is not necessarily exhaustive and does not preclude us from asserting any other valid reason for the lack of compliance with Florida Statute § 624.155. 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. We trust that this Response addresses the allegations of insurer violation alleged in the CRN filed on November 8, 2024. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned.
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