Civil Remedy Notice of Insurer Violations
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Filing Number:     792142
Filing Accepted:  11/13/2024
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Complainant
Last/Business Name *  
GADDY   First Name   ELIZABETH AND PARKER
Street Address * 2326 MCCLELLAN PARKWAY
City, State Zip * SARASOTA, FL 34239
Email Address * BAILEY@LOWTHERLAWLLC.COM
Complainant Type: * Insured
Insured
Last/Business Name*   GADDY   First Name   ELIZABETH AND PARKER
Policy # * GH-0000162210-00 Claim #* HO0524426540
Attorney
Attorney is Applicable
Last Name* LOWTHER First Name * BAILEY Initial
Street Address* P.O. BOX 15414
City, State Zip* SARASOTA , FL 34277
Email Address * BAILEY@LOWTHERLAWLLC.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):* JAMIE DOUGLAS AND ALL OTHER PERSONS ASSOCIATED WITH HANDLING OF THE REFERENCED CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Other : Refusal to provide Insureds with copy of engineering report
* 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)(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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES We insure against risk of direct loss to property described in Coverages A and B only if that loss is a physical loss to property. This includes the peril of “catastrophic ground cover collapse” as provided in Part A. below. We do not insure, however, for loss: 2. Caused by: e. Any of the following: (1) Wear and tear, “marring”, deterioration; (2) Inherent vice, latent defect, defect, mechanical breakdown; 2. We do not insure for loss to property described in Coverages A and B caused by any of the following. However, any ensuing loss to property described in Coverages A and B not excluded or excepted in this policy is covered. c. Faulty, inadequate or defective: (1) Planning, zoning, development, surveying, siting; (2) Design, specifications, workmanship, repair, construction, renovation, remodeling, grading, compaction; (3) Materials used in repair, construction, renovation or remodeling; or (4) Maintenance; of part or all of any propert
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Following extremely heavy rains on or about June 11, 2024, the Insureds noticed water damage to drywall around and, in particular, under various windows throughout their home. The Insureds notified Monarch of the damage on or about June 15, 2024. Monarch subsequently sent an engineer to inspect the damages. Following the inspection, the Insureds waited over 3 months to receive a decision from Monarch as to coverage. Finally, on October 1, 2024, Monarch sent the Insureds a letter stating: "The inspection revealed poor caulking around the windows due to poor installation with no storm related damage to the upstairs window. The damage present was not caused by a peril insured against." (For reasons that are unclear, the letter is erroneously dated Sept. 26, 2024; the letter contains the wrong claim number and the wrong date of loss.) Additionally, despite repeated requests by and on behalf of the Insureds, Monarch refuses to provide a copy of the engineering report on which it bases its denial of coverage. Monarch's analysis concluding that the policy does not provide coverage for the Insureds' loss is also replete with error. Monarch relies on policy language stating that: We do not insure, however, for loss caused by "wear and tear, "marring," deterioration, inherent vice, latent defect, defect, mechanical breakdown." But, in this case, the loss was not caused by "wear and tear, "marring," etc. etc. Rather, the loss was caused by extremely heavy rains entering the Insureds' home. Monarch also relied on policy language stating that: We do not insure for loss caused by "Rain . . . to the interior of a building unless a covered peril first damages the building causing an opening . . . and the rain . . . enters through this opening." But Monarch offers no reason why it believes that an opening was not created through which rain entered the building. And, because Monarch refuses to provide a copy of the engineering report, the Insureds have no way of knowing why the engineer concluded there was no opening created. As for Monarch's reliance on language in the policy stating that it does not insure for loss caused by: Faulty, inadequate or defective planning, zoning, development, etc etc. etc. is simply misplaced. The loss the Insureds' property was caused by the extremely heavy rains on or about June 11, 2024, not by faulty workmanship or materials. Thus, the exclusionary language on which Monarch relies is wholly inapplicable.
Comments
User Id Date Added Comment
tacham@hpmanaging.com 01-09-2025 January 9, 2025 Via E-mail & Posting on DFS Website Bailey Lowther, Esq. P.O. Box 15414 Sarasota, Florida 34277 bailey@lowtherlawllc.com RE: Complainant(s): Elizabeth and Parker Gaddy Insured(s): Elizabeth and Parker Gaddy Claim No: HO0524426540 Policy No: GH-0000162210-00 DFS Filing Number: 792142 Acceptance Date: November 13, 2024 Insurer: Monarch National Insurance Company To Whom it May Concern: Please allow this correspondence to serve as Monarch National Insurance Company’s (“Monarch”) official response to the Civil Remedy Notice of Insurer Violations (“Notice”). Monarch maintains that it has not been in any violation of the law and that the Notice is defective on its face and fails to comply with the specificity requirements under Florida Statute 624.155. As such, Monarch objects to the Department’s acceptance of the above-referenced Notice. Specifically, the Notice appears to reference an incorrect claim number and fails to reference a cure amount. Monarch has acted in good faith and with due regard for the insureds’ interests, and denies each and every allegation contained in the Notice. Monarch 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. Monarch has acted in good faith and in accordance with the terms and provisions of the applicable policy of insurance as well as with the law. Please note that nothing herein should be deemed as a waiver by Monarch. Monarch hereby expressly reserves all rights without exception or limitation. If you require additional information, please contact me. Sincerely, /s/ Tyler Acham, Esq. Tyler Acham In-House Counsel Monarch National Insurance Company
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