Civil Remedy Notice of Insurer Violations
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Filing Number:     791701
Filing Accepted:  11/12/2024
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Complainant
Last/Business Name *  
RIOS   First Name   ARIEL
Street Address * 3805 BERRYHILL ROAD
City, State Zip * MILTON, FL 32571
Email Address * N/A
Complainant Type: * Insured
Insured
Last/Business Name*   RIOS   First Name   ARIEL
Policy # * 07143716-2 Claim #* CH0524424337
Attorney
Attorney is Applicable
Last Name* ELIMELECH First Name * REBECCA Initial R
Street Address* 1500 N.E. 162ND ST.
City, State Zip* MIAMI , FLORIDA 33162
Email Address * RELIMELECH@ILGPA.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   MONARCH NATIONAL INSURANCE COMPANY
NAIC Company Code 15715
 
Name of individual responsible for violation (if any):* N/A
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
624.155(1)(b)(3) Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
* 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 dwelling on the "residence premises" shown in the Declarations, including structures attached to the dwelling; and b. Materials and supplies located on or next to the "residence premises" used to construct, alter or repair the dwelling or other structures on the "residence premises". SECTION I – PERILS INSURED AGAINST A. Coverage A – Dwelling and Coverage B – Other Structures 1. We insure against direct loss to the covered property described in Coverages A and B only if that loss is a physical loss to property.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Ariel Rios (hereinafter the “Insured”), paid for a policy of insurance with Monarch National Insurance Company (hereinafter, “Insurer”) bearing policy number 07143716-2 (the “Policy”). The Policy provides coverage for damage to the Insured’s property located at 3805 Berryhill Rd, Milton, FL 32571 (the “Property”), including the significant damage that occurred as a result of a sudden and accidental water leak from a broken shower pan on or about January 8, 2024 (the “loss”). Specifically, the Insured’s Property sustained substantial damage to the master bath due to a shower pan leak. The Insured promptly reported their claim to the Insurer. On April 12, 2024, the Insurer issued a letter to the Insured denying the claim based on the wear and tear and deferred maintenance policy exclusions. In this letter, the Insurer alleges that their inspection found the damage in the master bathroom is the result of water leaking around the shower frame during use that is the result of wear and tear and deferred maintenance. The Insurer also alleges that they found separation and gaps at the shower wall interface that is the result of accelerated deterioration of the wood framing due to the long-term water damage from the shower use. The Insured contacted the Claims Resolution Services, Inc. (hereafter, CRS Adjusters), who conducted a thorough inspection of the property and compiled an estimate of damages. CRS Adjusters, on behalf of the Insured, forwarded said estimate which fully detailed the Insured’s damages and total $24,117.00. However, the Insurer refuses to resolve the Insured’s claim and pay for all damages to the Property. The Insurer’s conduct is in bad faith and violates Florida’s statutes concerning the adjustment of insurance claims. First, Florida Statute § 624.155(1)(B)(1) requires good faith in the settlement of claims. The Insurer is in violation of this Statute for failing to provide a reasonable repair estimate. What is more, the Insurer violated Florida Statute § 624.155(1)(b)(3) by failing to promptly settle the claim, when the obligation to settle the claim became reasonably clear. Again, the Insurer failed to make a good faith offer to settle this claim and failed to account for the full scope of the damages. They failed to respond to the estimate provided by CRS Adjusters, on the Insured’s behalf, in a timely manner. They are obligated to provide coverage for all damages to the Insured’s Property, and not attempt to resolve this claim with lowball offers. Additionally, the Insurer’s conduct violates Florida Statute § 626.9541, which prohibits unfair settlement practices. More specifically, the Insurer has violated Florida Statute § 626.9541(1)(i)(3)(a) by failing to adopt and implement standards for the proper investigation of claims. Moreover, the Insurer has violated Florida Statute § 626.9541(1)(i)(3)(b) by misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. The Insurer has demonstrated bad faith by concealing critical information in the underlying adjustment of the claim. The Insurer used a fraudulent engineer report to support their underpayment of the Insured’s claim. As such, the Insured is being provided misinformation. Further, the Insurer has violated Florida Statute § 626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly with the Insured and its counsel. As mentioned above, the Insurer failed to account for the full scope of the damages and has additionally failed to respond to the estimate provided by CRS Adjusters, on behalf of the Insured, in a timely manner, delaying the resolution of this claim. Had the Insurer done so, it would have immediately settled this claim on a fair and reasonable basis and provided full coverage to its Insured. Therefore, to cure the defects outlined in this Civil Remedy Notice, the Insurer must: (1) create and implement adequate guidelines for the proper investigation and evaluation of claims and for the training and supervision of employees, which will avoid future statutory violations and avoid this from occurring in the future; (2) immediately tender all insurance proceeds due and owing its Insured under the Policy in the amount of $24,117.00 (less the deductible and any prior payments), plus all statutory interest; (3) act fairly and honestly towards its Insured and with due regard for their interests in attempting to settle their Insured’s claim; (4) hold the claim open in the event that its errors and delay does or may cause the Insured to suffer either further loss and/or damage; and, (5) stipulate to the Insured’s entitlement to attorney’s fees and court costs pursuant to Florida Statutes §§ 627.428 and 626.9373. Acknowledgment This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statutes section 624.155, should Monarch National Insurance Company fail to cure the violations set forth in this Civil Remedy Notice within the given cure period.
Comments
User Id Date Added Comment
kwhite@roiglawyers.com 12-14-2024 December 14, 2024 Department of Insurance CIVIL REMEDY SECTION Larson Building 200 E. Gaines Street Tallahassee, Florida 32399-0300 Re: Policy No.: 07143716-2 Claim No.: CH0524424337 Date of Loss: 1/8/2024 Insured: Ariel Rios Complainant: Ariel Rios Filing No.: 791701 Filing Accepted: 11/12/2024 Dear Sir/Madam: Please allow this to serve as Monarch National Insurance Company’s response to the Civil Remedy notice filed by Ariel Rios and their attorney, Rebecca Elimelech, Esq. Contrary to the allegations in the Civil Remedy Notice, Monarch National Insurance Company (“Monarch”) has acted in good faith and with due regard for the insureds’ interests and denies each and every allegation contained in the Civil Remedy Notice. First, the Civil Remedy Notice filed by the Ariel Rios is defective in that it is overly broad in scope. Ariel Rios has listed five (5) statutes in their Civil Remedy Notice. This does not satisfy the statute’s “specificity” requirement. Please see Julien v. United Prop. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021); Demase v. State Farm Fla. Ins. Co., 351 So. 3d 136 (Fla. 5th DCA 2022); Cassella v. Travelers Home & Marine Ins. Co., 352 So. 3d 1290 (Fla. 2d DCA 2023); and Boone v. Stat Farm Ins. Co., 2023 WL 2800296 (Fla. 6th DCA 2023). Accordingly, the subject civil remedy notice is defective, and Monarch cannot cure or remedy this demand. Monarch respectfully denies any wrongdoing in the adjustment and handling of the above-referenced claim and denies any and all allegations that it committed any acts or violated any Florida statutes or law. Quite plainly, Monarch has acted quickly and responsibly, in good faith and in accordance with the terms and provisions of the applicable policy of insurance as well as with Florida Statutes 624.155, 626.9541 and their sub-parts. Moreover, Monarch has and will always continue to act fairly and honestly toward Ariel Rios, and all insureds, as well as with due regard for their interests when attempting to settle claims. As such, Monarch cannot “cure” or “remedy” this demand. Monarch has followed all proper procedures and is bound by the subject insurance policy. Among other sections, the Insured alleges that Monarch has not complied with Florida Statute 624.155(1)(b)(1). Said statute states, “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 towards its insured and with due regard to her or his interests.” It is a longstanding principle of Florida law that a claim for bad faith pursuant to section 624.155(1)(b)(1) is founded upon the obligation of the insurer to pay when all conditions under the policy would require an insurer exercising good faith and fair dealing toward its insured to pay. See Vest v. Travelers Insurance Company, 753 So.2d 1270 (Fla. 2000). Here, based on the good faith investigation of this claim, Monarch denied coverage for the damages claimed by Ariel Rios in accordance with the contract. Monarch is not required to indemnify an insured for damages that are not due under the insurance contract. Additionally, Ariel Rios alleges that Monarch violated Florida Statute 626.954 by failing to adopt and implement standards for the proper investigation of claims. Again, based on the good faith investigation of this claim, Monarch denied coverage for the damages claimed by Ariel Rios in accordance with the contract. Monarch is not required to indemnify an insured for damages that are not due under the insurance contract. Monarch respectfully disagrees with the allegations set forth in the Civil Remedy Notice. The assertions in the Civil Remedy Notice are not supported by the facts or documentation in this matter. Contrary to the allegations in this Civil Remedy Notice, and as explained above, Monarch has acted in good faith, with due regard for the insureds’ interest and denies each and every allegation contained in the Civil Remedy Notice. Monarch continues to stand firm on the coverage determination. Please contact the undersigned if you would like to discuss this matter further or would like clarification of any of the above information. Very truly yours, KRISTEN L. WHITE, ESQ. KLW/klw
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