Civil Remedy Notice of Insurer Violations
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Filing Number:     792035
Filing Accepted:  11/13/2024
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Complainant
Last/Business Name *  
SULLIVAN   First Name   ROBERT AND EMILY
Street Address * 4721 SLOEWOOD DRIVE
City, State Zip * MOUNT DORA, FL 32757
Email Address * WITHHELD
Complainant Type: * Insured
Insured
Last/Business Name*   SULLIVAN   First Name   ROBERT AND EMILY
Policy # * 0760412181 Claim #* 5033020008-1-1
Attorney
Attorney is Applicable
Last Name* GUTIERREZ First Name * DANIEL Initial
Street Address* 924 DELANEY AVENUE
City, State Zip* ORLANDO , FLORIDA 32806
Email Address * SERVICE@DGPALAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   TRUCK INSURANCE EXCHANGE
NAIC Company Code 21709
 
Name of individual responsible for violation (if any):* PAULANDREA CUEVAS
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Claim Denial
Unsatisfactory Settlement Offer
Unfair Trade Practice
Cancellation
* 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)(2) A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
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.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
626.9541(1)(o)(11) No insurer shall cancel or issue a non-renewal notice on any insurance policy or contract without complying with any applicable cancellation or non-renewal provision required under the Florida Insurance Code.
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 estimate attached to the coverage decision correspondence references that the policy does not provide coverage for any wear and tear, corrosion, rust, breakdown, deterioration or decay. However, there is no specific statement or explanation as to which damages claimed are being excluded based on this policy language. Additionally, they have failed to properly adjust and pay the claim pursuant to the Section I – Conditions, Loss Settlement provision and the Section I – Conditions, Loss Payment provision.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On or about October 10, 2024, the home of Robert and Emily Sullivan (hereinafter referred to the “Insureds”) was damaged by Hurricane Milton. Specifically, the roof and exterior were damaged and interior water damages ensued. The Insured reported these damages to their homeowners’ insurance company, Truck Insurance Exchange (hereinafter referred to as “Insurer”). The Insurer responded to the claim and inspected the damages. In correspondence dated October 24, 2024, the Insurer advised that they completed their assessment of the damages and had determined that the claimed damages were below the Insureds’ deductible. The estimate provided was for minimal roof repairs and totaled $5,983.84 RCV and $4,876.35 ACV. The Insured received an estimate from a contractor for storm damages that included replacement of the roof and totaled $161,920.30 RCV and $160,236.48 ACV. These damages clearly exceed the $15,660.00 hurricane deductible. Not only have the Insureds been severely lowballed, but to add insult to injury the Insurer has advised that they will be non-renewing the Insureds in January. However, Florida Statute states that the Insurer cannot cancel or non-renew the policy until 90 days after the dwelling or residential property has been repaired, if such property has been damaged as a result of a Hurricane. The property has not been repaired and cannot be repaired until proper payment is made. However, the Insurer attempting to improperly non-renew the policy puts pressure on the Insurers to try to find new insurance, which is very difficult to do with unrepaired damages and an open claim. It is clear that the carrier is not treating the Insureds with good faith claims conduct by failing to pay a claim clearly owed, not adjusting the claim and evaluating the loss properly, failing to promptly and fairly provide full and prompt indemnity to the Insureds, failing to advise of any information necessary for further processing of the claim, failing to provide a reasonable explanation in writing of the basis in the insurance policy in relation to the facts for the denial of the claim, failing to implement proper standards for the adjustment and investigation of claims by its adjusters, and improperly attempting to non-renew the policy. This Insurer is placing the company’s interests before the Insureds’ interests when a reasonable carrier in a similar position would have provided full coverage. In particular, it is a business practice of the Insurer to severely lowball storm damage claims with their initial claim adjustment with the intent of effecting settlement of such claims on less favorable terms than those provided by the policy. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the Insured’s rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $160,236.48 (after application of the deductible) 2.) Pay the statutory interest on the amount of unpaid damages from the date the loss was reported to the date payment is finally made. 3.) Rescind the non-renewal until at least 90 days after the storm damage repairs have been completed. A copy of this form has been submitted to the FDFS and has been printed out and mailed to the following parties providing them notice of the filing of the Civil Remedy Notice: Truck Insurance Exchange 6301 Owensmouth Ave., Woodlands Hills, CA 91367 Certified Return Receipt # 9589 0710 5270 1009 7572 82
Comments
User Id Date Added Comment
cheryl.perez@farmersinsurance.com 12-23-2024 December 23, 2024 Via E-Mail Daniel Gutierrez, P.A. 924 Delaney Ave Orlando, FL 32806 Delivered by email to: service@dgpalaw.com RE: Robert Sullivan and Emily Sullivan Claim No.: 5033020008-1 Dear Daniel Gutierrez: This correspondence is Truck Insurance Exchange’s (“Truck”) response to the Civil Remedy Notice of Insurer Violation No. 792035 filed on behalf of Complainant Robert and Emily Sullivan on November 13, 2024. Complainant alleges that Truck violated various subsections within Sections 624.155 and 626.9541, Florida Statutes, pertaining to Claim No. 5033020008-1 under an insurance policy issued by Truck to Complainant. Truck welcomes the opportunity to respond to the Notice’s allegations. The Notice fails to comply with the specific notice and information requirements set forth in Section 624.155, Florida Statutes, and Form DFS-10-363. Florida law requires strict compliance with the specific notice and information requirements of section 624.155, Florida Statutes. This notice is invalid for the following reasons related to the failure to include information required on Form DFS-10-363: • The notice does not provide the Complainant’s email address. This notice is also invalid due to the failure to include statutorily required information as follows: • The notice includes multiple statutory sections that are not relevant. On the merits, Truck avers it handled the Insured’s claim correctly and with due regard for their interests. On October 14, 2024, Truck received notice of the subject claim, Hurricane Milton damage to the roof. Truck conducted a prompt and thorough investigation into this claim. We enlisted the services of an independent third-party vendor, Hancock Claims Consultants, and the inspection was completed as scheduled October 23, 2024 in the presence of our insured. Based on this inspection and photographs of the roof, Truck determined that a portion of the roof on the main dwelling had covered wind damage to the roofing shingles. No damage was observed to the separate structure. We provided a letter of explanation along with our estimate for the covered repairs on October 24, 2024. This estimated cost, however, fell below the policy’s $15,660.00 deductible. As a result, pursuant to the terms of the policy, no payment was issued to Complainant for the claim. As you are aware, your office invoked appraisal on December 12, 2024. The appraisal process is ongoing, and when it is concluded we will address the outcome as per the policy language. Complainant has failed to provide any evidence to support their assertion that Truck failed to properly adjust this claim. The only facts that Complainant alleges to support their allegations that Truck violated Florida law and handled Complainant’s claim in bad faith is that Truck’s adjustment of the claim did not result in payment of Complainant’s exorbitant demand. Truck’s policy only covers accidental direct physical loss or damage to the property that is not otherwise excluded, which is further limited by the conditions and coverage limits of the policy. In accordance with these terms, Truck properly adjusted this claim. Accordingly, contrary to Complainant’s apparent contention, Truck’s coverage determination was made in good faith. Truck denies any breach of any statutory or contractual duties in the handling of Complainant’s claim. While this response is meant to be comprehensive, Truck’s response is based on the limited information provided in the Notice filed by Complainant. Also, this letter or any act or failure to act on the part of Truck or any agent or representative of Truck should not be construed as a waiver of any rights or defenses, including but not limited to proper notice and service, available to it by contract or at law as all such right and defenses are hereby specially reserved. We trust that this response addresses the allegations raised in the Notice. Please contact us if you have any questions or should you wish to discuss this matter further. Sincerely, Cheryl Perez, Company Employee Adjuster General Claims Adjuster (913) 274-0230 Truck Insurance Exchange
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