Civil Remedy Notice of Insurer Violations
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Filing Number:     792016
Filing Accepted:  11/13/2024
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Complainant
Last/Business Name *  
MARTIN   First Name   JENNIFER
Street Address * 632 ADAMS AVENUE
City, State Zip * CAPE CANAVERAL, FL 32920
Email Address * MSJENNIFERDYLAN@AOL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   MARTIN   First Name   JENNIFER
Policy # * 0171884411 Claim #* 01000114786
Attorney
Attorney is Applicable
Last Name* STRUBLE First Name * MATTHEW Initial
Street Address* 325 FIFTH AVENUE, SUITE 103
City, State Zip* INDIALANTIC , FLORIDA 32903
Email Address * SERVICE@STRUBLECOHEN.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   FIRST PROTECTIVE INSURANCE COMPANY
NAIC Company Code 10897
 
Name of individual responsible for violation (if any):* AND ALL ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY FIRST PROTECTIVE INSURANCE COMPANY RELATED TO THIS CLAIM
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

There are no policy provision specifically at issue or in dispute, the policy provides coverage resulting from Wind but First Protective Insurance Company D/B/A Frontline Insurance has failed to extend coverage for repairs needed for the insured property
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Insurer issued an insurance policy bearing policy number 0171884411 with effective dates of coverage from February 3, 2024 to February 3, 2024, which insured the property located at 632 Adams Ave., Cape Canaveral, Florida 32920. The policy was in effect when the property sustained damage on or about July 19, 2024, when damage was caused by Wind. First Protective Insurance Company D/B/A Frontline Insurance (“Insurer”) received notice of the claim for property damage resulting from Wind, and related damages on or about July 19, 2024. The damage was reported to Insurer which assigned Claim Number 01000114786 to the claim and investigated the claim. Insurer failed to retain the experts needed to perform the inspection and needed to address the damage at issue and determine the repairs needed to restore the property. Insurer has been provided with documents establishing that the claim is covered, despite this being apparent from the condition of the property alone. Insurer has failed to extend coverage for payments owed and has refused to attempt to settle the claim with its insured. Insurer’s delay in issuing payment is causing and will cause the insured to sustain extra-contractual damages not covered by the property, including loss of use and enjoyment of the property and related damages, costs associated with hiring adjusters and experts, among other damages and these uninsured damages would not have occurred but for the insurer ’s failure to timely issue payments owed. In this claim and as a business practice, insurer fails to retain experts needed to investigate claims, ignores evidence establishing coverage and avoids covered repairs to attempt to avoid issuing payments owed pursuant to the insurance policy. Insurer can cure these violations by attempting to settle the claim in good faith and issuing payment for the remaining contractual damages owed. As Insurer is aware, issuing payment for contractual damages owed will preclude recovery of extra-contractual damages already incurred, and that will be incurred, and the contractual damages should immediately be paid and be paid within 60 days from the date of this notice. Due to applicable Florida Statutes, and the insurance policy’s payment provisions, the payment issued should also include interest. If insurer contends there is somehow more information needed that was not already provided, it should immediately advise the insured’s attorney what information is needed. Insurer has been provided with information establishing that the claim is covered but has failed to extend coverage for the claim. Insurer’s denial of the claim and refusal to issue payment is a breach of the insurance policy. This notice is being given in order to perfect the right to pursue the civil remedy authorized by this section.
Comments
User Id Date Added Comment
kferry@camboferry.com 01-03-2025 January 3, 2025 Via E-Mail Only Jennifer Martin c/o Matthew Struble, Esq. 325 Fifth Avenue, Suite 103 Indialantic, FL 32903 presuit@claimappeals.com Re: Insured: Jennifer Martin Date of Loss: July 19, 2024 Claim Number: 01000114786 Policy Number: 0171884411 DFS Filing Number: 792016 Dear Mr. Struble, As you know, my firm has been retained to represent First Protective Insurance Company (“First Protective”) in the above-referenced matter. Please allow this letter to acknowledge that First Protective is in receipt of the Civil Remedy Notice of Insurer Violations bearing Filing No. 792016 (the “Notice” or the “CRN”) filed on behalf of Jennifer Martin. (the “Insured”). The Notice is void because it is legally invalid. Beyond that, the allegations in the Notice have no merit. I. The Civil Remedy Notice is legally invalid. The filing of a valid Civil Remedy Notice is a condition precedent to an action brought pursuant to section 624.155, Florida Statutes. Talat Enter., Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Because the statute is in derogation of the common law, it must be strictly construed. Id. “[A]ny statute in derogation of the common law requires strict compliance with its provisions by one seeking to avail himself of its benefits.” Florida Steel Corp. v. Adaptable Devs., Inc., 503 So. 2d 1232, 1234 (Fla. 1986). Section 624.155, Florida Statutes, requires a civil remedy notice to provide specific information to put the insurer on notice of the alleged violation. Additionally, a civil remedy notice must be “specific enough to provide insurers notice of the wrongdoing so the insurer can cure the same within sixty days.” Valenti v. Unum Life Ins. Co. of Am., 8:04CV1615T-30TGW, 2006 WL 1627276, at *2 (M.D. Fla. 2006). Here, the Notice is invalid because it does not contain all of the information required by section 624.155. Also, it is invalid because it lacks sufficient specificity to provide notice to First Protective of the alleged wrongdoing, as discussed below. First, the CRN does not provide any specific supporting facts and merely makes conclusory statements. No specific facts identifying what, if anything, First Protective did or failed to do with regard to the claim were provided. Instead, the allegations are mere self-serving and conclusory statements without substance or relation to any alleged violation. This undermines the purpose of the CRN requirement preventing First Protective from investigating and resolving any of the alleged violations. The failure to provide any specific supporting facts for the allegations renders the CRN invalid. Second, the CRN fails to relate the specific policy language to the alleged violation as required by Fla. Stat. §624.155(3)(b)4. In fact, with regard to the policy language relevant to the alleged violation, the CRN states: “There are no policy provision [sic] specifically at issue or in dispute, the policy provides coverage resulting from Wind, but First Protective Insurance Company D/B/A Frontline Insurance has failed to extend coverage for repairs needed to the insured property[.]” Pursuant to Fla. Stat. §624.155(3)(b)4, the CRN must cite to the specific policy language that is relevant to the alleged violations. However, the failure to advise of any policy provision in dispute prevents First Protective from addressing any issues regarding the policy the Complainant alleges to have been violated, which is the underlying purpose of Fla. Stat. §624.155(3)(b)4. The CRN, therefore, is statutorily deficient because it does not comply with the requirements set forth in Fla. Stat. §624.155(3)(b)4. Third, the boilerplate CRN lacks sufficient specificity to provide notice of the alleged bad-faith conduct. The CRN lists four (4) different statutes which First Protective allegedly violated. However, the CRN fails to provide any relevant facts supporting the alleged violations or relating these alleged violations to the four (4) cited statutes. Because the Civil Remedy Notice fails to relate the cited statutes to any facts explaining why the Insured believes First Protective violated the statutes, First Protective is unable to properly respond, and the CRN is invalid and should be rejected and returned. Fourth, the CRN does not identify the person or persons on behalf of First Protective who are most responsible for/knowledgeable of the facts giving rise to the Notice. Because the CRN fails to comply with the information requirements promulgated by the Department of Financial Services, it is legally invalid. See Pin-Pon Corp. v. Landmark Ins. Co., 2020 U.S. Dist. LEXIS 100072, *7 (S.D. Fla., June 5, 2020); Julien v. United Property & Casualty Insurance Company, 311 So. 3d 875 (Fla. 4th DCA 2021). Again, in serving this response, First Protective reserves all rights under Florida law to be served with a properly completed and statutorily compliant CRN. Finally, the CRN is invalid because it does not list a specific cure for the alleged violations. In Talat, the Florida Supreme Court said that to “cure” a CRN, an insurer must pay the amount owed pursuant to the express terms and conditions of the policy.” However, the CRN simply states that, “Insurer can cure these violations by attempting to settle the claim in good faith and issuing payment for the remaining contractual damages owed.” In Talat, the Florida Supreme Court said that to “cure” a Notice, an insurer must pay the amount owed pursuant to the express terms and conditions of the policy.” Further, no cure amount of any kind is provided, and First Protective is left to guess what would be required to “cure” the alleged violations. It is improper for a civil remedy notice to not contain a cure; therefore, the CRN is invalid. Talat, 753 So. 2d at 1282–83; see also Francois v. Illinois Nat. Ins. Co., 01-CV-8070, 2002 WL 33760405, at *4 (S.D. Fla. 2002) aff'd, 49 Fed. Appx. 290 (11th Cir. 2002). As the CRN fails to strictly comply with the requirements of section 624.155, Florida Statutes, it is legally insufficient and should be rejected. II. The Civil Remedy Notice Lacks Merit. The Notice also lacks merit. Frontline issued a homeowners policy to Jennifer Martin insuring the property located at 632 Adams Ave., Cape Canaveral, FL 32920-2104, bearing policy number 0171884411 for a policy period of 02/03/2024 – 02/03/2025 (the “Policy”). On July 24, 2024, the insured reported subject claim for wind damage with a claimed date of loss of July 19, 2024. Specifically, Ms. Martin reported that the alarm panel went out, so she had the alarm company, AVS, come out to the home. AVS advised Ms. Martin that there was water damage behind the wall. When Ms. Martin reported the claim, she stated she was unsure of the cause of the water damage, but that a roofer came out to inspect her home and advised her that there is no roof damage. The insured stated that she noticed the ceiling in wood beams in the living area are cracked. That same day, Frontline sent a claim acknowledgement letter, the Homeowners Bill of Rights, and the DFS mediation notice letter to the insured. On July 25, 2024, the desk adjuster called the insured to discuss the claim and left a voicemail requesting a call back. In the voicemail, the desk adjuster advised that a field adjuster had been assigned and to expect a call to schedule the inspection date. The desk adjuster assigned independent adjusting firm, Tracker Claims Service, to inspect the property. On July 26, 2024, the desk adjuster again called the insured to discuss the claim and left a voicemail requesting a call back. On July 29, 2024, the field adjuster completed the inspection of the property. The field adjuster did not observe any damage to the insured’s metal roof. The interior inspection revealed cracks in the ceiling, dray wall and ceiling studs. Moisture was observed in the ceiling and exterior wall drywall of the living room. This is the same exterior wall where the siding damage was observed. Moisture was also observed in the ceiling around the HVAC vents in the bathroom and kitchen. Water stains and moisture were also observed to the ceiling and wall drywall in the master closet. It appears the moisture in these rooms is condensation damage from the a/c. Unrelated damage was observed to the shower enclosure in the master bath. This damage appears to be damage due to improper installation of the shower enclosure and does not appear to be related to this claim. On July 30, 2024, Frontline sent a Reservation of Rights letter. Thereafter, Frontline engaged an engineering firm, Root Cause Consulting, to inspect the property to determine the cause and origin of the claimed damage. In the engineering report dated August 15, 2024, Jaime S. Gold, PE, RRC of Root Cause Consulting inspected the subject property on August 6, 2024. Based upon Mr. Gold’s inspection and review of the available data, he made the following conclusions regarding the cause and origin of the claimed damage to the property: 1) The moisture in the east elevation and ceiling along the east elevation was the result of water intrusion through the east wall during wind-driven rain events over multiple times. a. The separation of the vinyl siding was the result of improper installation combined with a failure of the fasteners because of corrosion from salt in the air on the beach. This separation of the vinyl siding exacerbated the water intrusion, as it was a direct opening for wind-driven rain to enter the building. b. Another possible source of the water intrusion was pressure washing the east elevation from the deck outside. c. The cracked ceilings were unrelated to any moisture intrusion and were reportedly in that condition for at least one year. d. The cracks, staining, and elevated moisture in the beams were possibly in that condition since before the roof was replaced in 2018, but also may have bee exacerbated by wind-driven rain from the east elevation e. No damage was observed to the roof. No evidence of a storm-created opening was observed on the roof. 2) The staining on the ceiling of the bedroom closet upstairs was the result of condensation dripping down from the air duct in the attic above this area. No staining or evidence of water intrusion was visible on the underside of the roof sheathing over this area. 3) The reported damage to the bathroom shower panel was the result of an installation issue. The large panel was glued over existing tile and the adhesive had failed. Thus, on August 23, 2024, First Protective sent the coverage determination letter. The inspection revealed multiple causes of losses. The moisture observed in the wall and ceiling drywall of the living room appears to be from long term seepage due to improper installation of the siding on the back elevation of the home. The cause of loss for the moisture in the ceiling drywall of the bathroom, kitchen and master closet appears to be condensation damage from the a/c. The engineering inspection determined that the cause of damage was found to be the vinyl siding was improperly installed, combined with a failure of the fasteners because of the corrosion from salt in the air on the beach. Moreover, the August 23, 2024 coverage letter advised that the separation of the vinyl siding exacerbated the water intrusion, and it was a direct opening for wind-driven rain to enter the building. Additionally, the cracked ceilings were unrelated to any moisture intrusion and were reportedly in that condition for at least one year. The cracks, staining, and elevated moisture in the beams were possibly in that condition since before the roof was replaced in 2018, but also may have been exacerbated by wind-driven rain from the east elevation. The staining on the ceiling of the bedroom closet upstairs was the result of condensation dripping down from the air duct in the attic above this area. No staining or evidence of water intrusion was visible on the underside of the roof sheathing over this area. No damage was observed to the roof. No evidence of a storm-created opening was observed on the roof. The policy expressly excludes and does not provide coverage for wear, tear, repeated seepage, condensation, improper installation and or maintenance. Thereafter, the insured called First Protective and was extremely upset about the coverage decision. On August 29, 2024, a letter of representation was submitted by Ask an Adjuster. On September 24, 2024, the public adjuster submitted a repair estimate for a full roof replacement and extensive interior repairs to the property, claiming that the cause of loss was wind. On October 1, 2024, after reviewing the estimate and photographs submitted by the public adjuster on September 24, 2024, Frontline wrote to the insured to advise that it would be standing on its coverage determination, based on the engineering and expert findings as to the cause and origin of the claimed damage. Thereafter, the subject CRN was received on November 14, 2024. On December 6, 2024, the undersigned sent a letter acknowledging the CRN with a Request for Information, including the completion of the Sworn Statement in Proof of Loss, which was enclosed. On December 18, 2024, the insured’s attorney responded and provided some, but not all, of the requested documentation and information. Enclosed with this document production was a Sworn Proof of Loss dated November 18, 2024 demanding $77,168.84 RCV, based on the estimate provided by Ask an Adjuster. The Sworn Statement in Proof of Loss is rejected in both form and substance, as Frontline does not agree with the price or scope of repairs. On December 27, 2024, counsel for the insured provided a supplemental document production. The supplemental production contains a pre-purchase inspection report dated January 18, 2021, which contained the following pertinent conclusions: • The soffits on the left side of the house are open or loose and need to be sealed to prevent wind damage and vermin intrusion into the attic space. • The outdoor shower was not functional at the time of inspection. • The weather seal on the main entry door is incomplete and should be replaced. • The dishwasher leaks when used and should be repaired or replaced. No information, documentation, or expert opinion was provided in the insured’s document production that rebuts our expert’s findings or that supports a claim for windstorm damage as the cause of loss to the home. In fact, based on the insured’s representations made during the claim, the roofing company she retained to inspect her roof advised her that there was no roof damage to her roof. This is consistent with the expert opinion of the engineer retained by Frontline who inspected the subject property for the claim at issue. In light of Frontline’s investigation, coverage was properly denied for the subject claim, pursuant to the terms, conditions, exclusions, limits and deductible of the subject policy. Accordingly, Frontline denies any and all allegations of bad faith in connection with the claim submitted by Jennifer Martin. If you have any questions, please do not hesitate to contact me. Sincerely, s/ Cristina P. Cambo Cristina P. Cambo, Esq.
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