Civil Remedy Notice of Insurer Violations
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Filing Number:     791299
Filing Accepted:  11/11/2024
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Complainant
Last/Business Name *  
MICHELE PAGAN AND JUAN PAGAN   First Name  
Street Address * 2718 OSPREY CREEK LANE
City, State Zip * ORLANDO, FL 32825
Email Address * CLAY@THEKRFIRM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   MICHELE PAGAN AND JUAN PAGAN   First Name  
Policy # * 42PFP263789-01 Claim #* BH01739096
Attorney
Attorney is Applicable
Last Name* KUHN First Name * CLAYTON Initial
Street Address* 2110 WEST PLATT STREET
City, State Zip* TAMPA , FLORIDA 33606
Email Address * CLAY@THEKRFIRM.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   NATIONAL FIRE & MARINE INSURANCE COMPANY
NAIC Company Code 20079
 
Name of individual responsible for violation (if any):* ANY AND ALL PERSONS ASSOCIATED WITH THE CLAIMS HANDLING FROM NATIONAL FIRE & MARINE INSURANCE COMPANY
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unfair Trade Practice
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
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)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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.

THE POLICY LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE LOSS PAYMENT AND COVERAGE PROVISIONS OF POLICY NUMBER 42PFP263789-01 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 DENIAL TO FULLY PAY THE CLAIM, INCLUDING THE DUTIES IN THE EVENT OF LOSS PROVISIONS AND THE POLICY'S EXCLUSION OF COVERAGE PROVISIONS.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Michele Pagan and Juan Pagan (hereinafter “Insureds”) are homeowners insured with an all-risks policy issued by National Fire & Marine Insurance Company (hereinafter “Carrier”). On or about September 28, 2022, Insureds’ home located at 2718 Osprey Creek Lane, Orlando, Florida 32825 sustained significant damage as a result of a windstorm event. Specifically, Hurricane Ian created multiple openings to the roof of Insureds’ property. This resulted in interior water damage to various areas of the interior of Insureds’ property including but not limited to, the living room, loft, stairs, garage, and bedroom. The Loss is covered under Insureds’ policy issued by Carrier. The Insureds mitigated damages by contacting Loss Restorations who performed mitigation services on the subject property. All of the relevant documents were provided to Carrier. Insureds promptly reported the claim and fully cooperated with all requests for inspections. Carrier assigned Claim No. BH01739096 to the loss. The Insureds have fully cooperated with Carrier’s investigation of the claim, including providing all requested documentation and complying with all post-loss policy conditions. Specifically, the Insureds, with assistance from their public adjuster, submitted an estimate for $68,705.54, which was a fair and reasonable assessment for the repair/replacement of damages. Loss Restorations LLC has an outstanding balance in the amount of $11,349.29 for their mitigation services and tarp placement. Carrier failed to retain qualified experts necessary to identify the repairs necessary to restore the property to its pre-loss condition. Despite Insureds providing Carrier with a detailed estimate, Carrier failed to pay Insureds the amount necessary to repair/replace the damaged property, less the applicable deductible. Instead, Carrier denied full coverage for the loss by not making a coverage decision within the time frame given by the State of Florida. This has become a common business practice for Carrier. Despite the Insureds submitting all of the necessary paperwork and following the guidelines set out by Carrier for these types of claims, Carrier has allowed the claim to pass the 90-day coverage decision period in violation of Section 626.9541(1)(i)(4), Florida Statutes. It has been well over 90 days since reporting the loss and Carrier continues to delay the claim. They have yet to provide any facts or explanations for its failure to properly communicate with the Insureds and refuses to act in accordance with its statutory and contractual obligations. Under the circumstances surrounding this claim, had Carrier acted fairly and honestly toward the Insureds and with due regard for the Insureds’ 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 Insureds. In doing so, Carrier violated Section 624.155(1)(b)(1), Florida Statutes. Carrier’s use of unqualified and biased adjusters, 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 biased adjusters, 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 conduct a reasonable investigation based upon available information. In denying full coverage for this claim without conducting reasonable investigations based upon available information, Carrier has violated Section 626.9541(1)(i)(3)(d), Florida Statutes. By representing to Insureds that the Policy does not afford full coverage for this loss, Carrier is misrepresenting pertinent facts and/or insurance policy provisions relating to coverages at issue, in violation of Section 626.9541(1)(i)(3)(b), Florida Statutes. 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 Insureds, was incomplete, and lacked truthful and unbiased reports of the facts. As of the date of this Notice, it has been 775 calendar days since the loss, and Carrier has yet to pay the claim in full. Carrier has more than enough information and is still refusing to accept coverage for the Insureds’ claim. This continued and repeated reckless claim delay and denial of coverage will result in a significant punitive damage award if a bad faith lawsuit is filed. Carrier can cure the defects outlined in this Civil Remedy Notice and avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy for this claim and by paying Insured’s estimate of $68,705.54, and Loss Restorations LLC in the amount of $11,349.29, less applicable deductible, which is the reasonable amount of the covered loss pursuant to the policy. A copy of this form has been submitted to the Florida Department of Financial Services who has transmitted the same to the following parties providing them notice of the filing of this Civil Remedy Notice: National Fire & Marine Insurance Company
Comments
User Id Date Added Comment
katie.tilka@phelps.com 01-08-2025 VIA ELECTRONIC SUBMISSION Florida Department of Financial Services Bureau of Consumer Assistance Civil Remedy Section Larson Building 200 East Gaines St. Tallahassee, Florida 32399-0322 Re: Civil Remedy Notice of Insurer Violations Insurer: National Fire & Marine Insurance Company Insured: Shellpoint Mortgage Servicing Policy No. on CRN: 42PFP263789-01 Policy No.: 42PFP262421-01 Date of Loss: September 28, 2022 Location: 2718 Osprey Creek Lane, Orlando, FL 32825 Claim No.: BH01739096 DFS Filing No.: 791299 Filed on behalf of: Michele Pagan and Juan Pagan Accepted by DFS: November 11, 2024 To Whom It May Concern: We represent National Fire & Marine Insurance Company (“NF&M”), the insurer for the lender-placed policy, Policy No. 42PFP262421-01 issued to Shellpoint Mortgage Servicing (the “Named Insured”), with effective dates of February 27, 2022 to February 27, 2023 (the “Policy”). We write on NF&M’s behalf regarding the Civil Remedy Notice of Insurer Violations (the “Notice”) against NF&M, submitted to the Department of Financial Services, Division of Consumer Services (the “Department”), by Clayton Kuhn, Esq. on behalf of Michele Pagan and Juan Pagan (the “Pagans” or “Borrowers”). The Notice bears filing number 791299 with an acceptance date of November 11, 2024. NF&M first contends that the Notice is defective in that it incorrectly lists Policy No. 42PFP263789-01; Policy No. 42PFP262421-01 was the policy in force and effect at the time of the subject loss. The Notice also incorrectly lists the “Insured” as the Pagans; however, the Pagans are not the Named Insureds under the Policy. Accordingly, the Pagans lack standing to bring a lawsuit or any subsequent action that may arise from this Notice. The Notice also incorrectly identifies NF&M as an “Authorized Insurer;” however, NF&M is a Surplus Lines Carrier. In the Notice, the Borrowers allege that NF&M violated various sections of the Florida Statutes with regard to the Loss, including Sections 624.155(1)(b)(1), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(g), and 626.9541(1)(i)(4). The Notice generally alleges that the “Reason(s) for Notice” are “Claim Delay” and “Unfair Trade Practice”. NF&M categorically denies that it or any of its representatives engaged in any prohibited conduct or violated any of the statutes referenced in the Notice with respect to this claim. The Notice is impermissibly vague for a failure to allege any facts that would support a determination that NF&M engaged in any prohibited conduct or violated the statutes referenced in the Notice. The Notice is further deficient for failing to provide the name of any individual involved in the alleged violations and for failing to cite to the specific policy language that is relevant to the alleged violations. Regardless of the deficiencies in the Notice, NF&M has acted and continues to act in good faith, without delay, and with due regard for the interests of the Named Insured during the investigation, handling, and adjustment of the claim in order to resolve the dispute pursuant to the terms of the Policy. NF&M categorically denies that it or any of its representatives engaged in any prohibited conduct or violated the statutes referenced in the Notice. If the Department has any questions or requires any additional information, please contact us. Regards, /s/ Katie Tilka Martinez Katie Tilka Martinez, Esq. Copy via E-mail Only: CLAY@THEKRFIRM.COM
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