Civil Remedy Notice of Insurer Violations
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Filing Number:     792286
Filing Accepted:  11/14/2024
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Complainant
Last/Business Name *  
VEST   First Name   GARY R AND BARBARA
Street Address * 349 SEMINOLE WOODS BLVD.
City, State Zip * GENEVA, FL 32732
Email Address * WITHHELD
Complainant Type: * Insured
Insured
Last/Business Name*   VEST   First Name   GARY R AND BARBARA
Policy # * 80G498963 Claim #* 59-63Q8-00L
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*   STATE FARM FLORIDA INSURANCE COMPANY
NAIC Company Code 10739
 
Name of individual responsible for violation (if any):* CHARLES HAYES
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Claim Denial
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)(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)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
* 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 coverage decision correspondence incorrectly relies and references all of the following policy language for its denial of the claimed damages to the roof: SECTION I – LOSSES NOT INSURED 1. We will not pay for any loss to the property described in Coverage A that consists of, or is directly and immediately caused by, one or more of the perils listed in items a. through m. below, regardless of whether the loss occurs abruptly or gradually, involves isolated or widespread damage, arises from natural or external forces, or occurs as a result of any combination of these: g. wear, tear, decay, marring, scratching, deterioration, inherent vice, latent defect, or mechanical breakdown; i. wet or dry rot; k. settling, cracking, shrinking, bulging, or expansion of pavements, patios, foundations (including slabs, basement walls, crawl space walls, and footings), walls, floors, roofs, or ceilings; l. all animals, birds, or insects. (1) This includes: (a) nesting, infestation, gnawing, feeding, breeding, or discharge or release of waste products or secretions by animals, birds, or insects; (b) costs to remove animals, birds, or insects from the covered property; and (c) costs to prevent the animals, birds, or insects from returning to the property; (2) However, we will pay for: (a) losses caused by wild bears or deer; and (b) the breakage of glass or safety glazing material that is a part of a building structure, when caused by animals, birds, or insects; or However, we will pay for any resulting loss from items a. through l. unless the resulting loss is itself a Loss Not Insured as described in this Section. 3. We will not pay for, under any part of this policy, any loss consisting of one or more of the items below. Further, we will not pay for any loss described in paragraphs 1. and 2. immediately above regardless of whether one or more of the following: (a) directly or indirectly cause, contribute to, or aggravate the loss; or (b) occur before, at the same time, or after the loss or any other cause of the loss: a. conduct, act, failure to act, or decision of any person, group, organization, or governmental body whether intentional, wrongful, negligent, or without fault; b. defect, weakness, inadequacy, fault, or unsoundness in: (1) planning, zoning, development, surveying, or siting; (2) design, specifications, workmanship, repair, construction, renovation, remodeling, grading, or compaction; (3) materials used in repair, construction, renovation, remodeling, grading, or compaction; or (4) maintenance; of any property (including land, structures, or improvements of any kind) whether on or off the residence premises; or c. weather conditions. However, we will pay for any resulting loss from items 3.a., 3.b., and 3.c. unless the resulting loss is itself a Loss Not Insured as described in this Section. 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 February 4, 2024, the home of Gary R Vest and Barbara Vest (hereinafter referred to the “Insureds”) was damaged by a storm. Specifically, the roof and exterior were damaged. The Insureds reported these damages to their homeowners’ insurance company, State Farm Florida Insurance Company on February 23, 2024. (hereinafter referred to as “Insurer”). The Insurer responded to the claim and inspected the damages on March 19, 2024. In correspondence dated March 20, 2024, the Insurer advised that they had determined that it was determined there is no covered damage to the roof or exterior of your residence premises. The letter further noted that the inspection found normal wear, tear, and deterioration to your roof and exterior elevations. However, at no point did the letter provide any explanation as to what damages they had determined were from the above mentioned causes of loss and how they were able to make this determination. Therefore, they failed to provide the basis in the insurance policy, in relation to the facts, for denial of the claim. The Insured received an estimate from a contractor for storm damages that included replacement of the roof and totaled $30,748.58. If any additional information or documentation is needed for the Insurer to further consider the claim, then the Insurer failed to advise of what information is necessary for the processing of the claim and why it is necessary. 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, and failing to implement proper standards for the adjustment and investigation of claims by its adjusters. 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 deny coverage for roof repairs or replacement in the 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 $30,748.58 (after application of the deductible); and 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. 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: State Farm Florida Insurance Company 3903 Northdale Blvd., Ste 112W Tampa, Florida 33624 Certified Return Receipt # 9589 0710 5270 1009 7573 05
Comments
User Id Date Added Comment
dg@dgpalaw.com 05-26-2026 This matter has been resolved. Therefore, the Insureds' withdraw this Civil Remedy Notice.
mklein@dmkleinpa.com 01-06-2025 January 6, 2026 Sent Via Email Only: service@dgpalaw.com Gary R Vest and Barbara Vest c/o Daniel Gutierrez, Esq. Daniel Gutierrez, P.A. 924 Delaney Avenue Orlando, Florida 32806 DOI FILE# : 792286 INSURER : State Farm Florida Insurance Company INSUREDS : Gary R Vest and Barbara Vest INSURED ADDRESS : 349 Seminole Woods Boulevard, Geneva, Florida 32732 CLAIM# : 59-63Q8-00L POLICY# : 80-G4-9896-3 DOL : February 4, 2024 FILING DATE : November 14, 2024 Dear Mr. and Mrs. Vest: We represent State Farm Florida Insurance Company (“State Farm®”) in this matter. Kindly accept this letter as State Farm’s response to the Civil Remedy Notice of Insurer Violation (Civil Remedy Notice or CRN) filed with the Department by Daniel Gutierrez, Esq., Daniel Gutierrez, P.A, or on behalf of, Gary R Vest and Barbara Vest (herein after the “Insureds”) on November 14, 2024; DFS/DOI File No.: 792286. State Farm contends that the subject Civil Remedy Notice is deficient or defective in that the notice fails to state, or fails to state with sufficient specificity, the necessary facts in support of the Insureds’ contentions, including but not limited to those that would be necessary for State Farm to “cure” or “remedy” the alleged violations noted in the subject Civil Remedy Notices. See, §624.155. See also, Macola v. Government Employees Insurance Co., 953 so.2d 451 (Fla. 2007); Talat Enterprises v. Aetna Casualty and Surety Co., 753 so2d 1278 (Fla. 2000); Vest v. Travelers Insurance Co., 753 so.2d 1270 (Fla. 2000). Further, see Junior Julien v. United Property & Casualty Insurance Company, 311 So. 3d 875, 878-879 (Fla. 4th DCA 2021) (in affirming the trial court's granting of a motion to dismiss, the appeals court held that the insured's CRN failed to include specific information required to allege circumstances given rise to a bad faith claim.) Additionally, State Farm denies the accusations made in the subject Civil Remedy Notice. Nevertheless, without waiving that the CRN is legally deficient, to the extent State Farm can identify that which needs to be “cured” and/or “remedied,” through the course of this response such matters are “cured” or “remedied.” Contrary to what is alleged in the CRN, State Farm has at all times performed its obligations under the policy of insurance in a prompt and diligent manner with due regard to the Insureds’ interests. None of the alleged violations have occurred, and State Farm categorically denies any violation of §624.155(1)(b)(1), & (3); §626.9541(1)(i)(2); §626.9541(1)(i)(3)(a), (b), (c), (d) , (f), (g) & (h) of the Florida Administrative Code, the policy, as alleged in the Notices of Insurer Violation, or otherwise and denies any violation of the applicable Florida Statutes, Florida Administrative Code and applicable law. Additionally, State Farm denies that: it failed to promptly investigate the claim; failed to act with due diligence and good faith to resolve the claim; that it placed its financial interest before the Insureds; it failed to properly train, evaluate and manage its adjusters; it improperly denied the claim; that it engaged in unfair trade practices and that its adjusters violated any ethical requirements. Moreover, State Farm denies that it violated any Policy provisions, including but not limited to, any policy provisions identified in the CRN. Furthermore, State Farm categorically denies the existence of any improper supervision, motivations, adoption, or application of improper standards. Furthermore, State Farm denies making misrepresentations of any pertinent facts or regarding the applicable policy. Without waiving any arguments as to the legal sufficiency of the Civil Remedy Notice, a recap of facts of this claim shows there are no grounds for, and the Civil Remedy Notice lacks merit. Claim Number: 59-63Q8-00L The Insureds contend that on or about February 4, 2024, the subject property sustained damage as a result of a wind/hailstorm. State Farm was belatedly notified of the loss on February 22, 2024, by the Insureds’ roofing contractor, Roofing Pro USA, LLC. Immediately upon the reporting of the loss, State Farm sent correspondence to the Insureds acknowledging receipt of the reported loss and providing initial claim information including, but not limited to, the building settlement claim process guidelines and other claim process guidelines and instructions explaining the claim adjusting process and the Insureds’ duties after loss. Immediately upon the reporting of the loss, State Farm initiated its attempt to contact the Insureds to discuss their claim and appliable policy coverage. As a result of its failure to reach the Insureds, State Farm sent correspondence via email to the Insureds on February 26, 2024, advising them that despite their efforts they had been unable to reach them over the phone and therefore, were requesting that they contact State Farm to discuss their claim and policy coverage. State Farm received an email correspondence form Roofing Pro USA LLC on February 29, 2024, enclosing their W9 and a Contractor's Performance & Communication Agreement with a direction to pay. State Farm responded via email correspondence by acknowledging receipt of the documents and by advising Roofing Pro USA LLC that they were attempting to contact the Insureds to schedule an inspection of the property. State Farm advised the Insureds of their Homeowner Claims Bill of Rights pursuant to Florida Statute Section 627.7142, via correspondence on March 9, 2024, and of their duty to protect the property further damage or loss, make reasonable and necessary temporary repairs required to protect the property and other duties after loss, via separate correspondence on March 9, 2024. Thereafter, the Insureds’ son, David Seagle, contacted State Farm over the phone and advised that he was assisting his parents with the claim. Mr. Seagle advised that the property had sustained hail damage to the roof. He stated he had been visiting his parents and that their neighbors advised him that there had been a storm and that he should have his parents’ roof inspected. He then advised that Roofing Pro USA LLC had assessed the roof and that he had himself personally inspected the roof and saw what he thought might be damage. Thereafter, the parties agreed to schedule State Farm’s inspection of the subject property for March 19, 2024. Thereupon, State Farm conducted its initial inspection of the subject property at the mutually agreeable date of March 19, 2024. During its inspection State Farm found no wind/hail storm related damages on the exterior elevations or on the roof of the property. Torn screens on the patio enclosure were identified, but said damage was claimed as part of the Insureds’ prior 2022 claim. The inspection of the 20 plus year old roof revealed faded matting and brittle roof shingles. No spatter or evidence of hail was found. Test squares yielded 0 hits on all directional slopes and no wind damage on the roof was identified. Animal bite marks in the framing were also found. The Insureds’ son, David Seagle reported no interior damage. The foregoing findings of the inspection were reviewed and discussed with Mr. Seagle following the inspection and he was advised of the deteriorated condition of the roof and roof age. He was also informed that no hail or wind damage to the roof was found. Thus, as a result, the loss was not a covered loss under the policy. State Farm further requested from Mr. Seagle to have his contractor submit photographs of any items they believed that State Farm may have missed or failed to consider for State Farm’s review. However, no additional supporting documentation was submitted by or on behalf of the Insureds. Hence, following its investigation, State Farm issued its coverage determination letter on March 20, 2024, and forwarded the same to the Insureds’ son via email correspondence. In said correspondence, State Farm stated that the Homeowners policy provided coverage for accidental direct physical loss unless the loss was excluded or limited in SECTION I – LOSSES NOT INSURED or otherwise excluded or limited by the policy. State Farm advised that based upon the results of its investigation there was no evidence of a covered accidental direct physical loss having been sustained to the subject property, specifically there was no covered damage to the roof or exterior of the residence premises. In said correspondence, State Farm further advised the Insureds that it had not inspected the interior of the residence, despite offering said inspection, since Mr. Seagle had advised that there was no new damage to the interior of the home, and therefore, no need for an interior inspection. State Farm further advised that the inspection revealed normal wear, tear, and deterioration to the roof and exterior elevations, pre-existing damage to the patio enclosure from a prior claim, and damage to the roof caused by animals. State Farm stated that damage from these causes of loss was not covered by the policy and specifically cited to the various applicable policy provisions and exclusions. The Insureds were further once again advised to contact State Farm if any additional developments such as additional costs for loss or damage prompted the resubmission of the claim. However, no additional documentation was provided by the Insureds supporting that the alleged damage was the result of a one-time accidental wind/or hailstorm occurring on February 4, 2024. State Farm informed the Insureds of their right to participate in the State of Florida Department of Financial Services’ mediation program in a separate letter dated March 21, 2024, and there after closed its investigation. The claim remained closed for approximately over three and half months and thereafter, on or about July 10, 2024, State Farm received a letter of representation from the Insureds’ Attorney with a request for a copy of the policy and documentation supporting or explaining State Farm’s coverage decision, including a copy of coverage determination letters. State Farm subsequently provided the Insureds’ Attorney with a copy of the applicable policy, State Farm’s coverage determination decision letter dated March 20, 2024, and State Farm's correspondence informing the Insureds of their right to participate in the State of Florida Department of Financial Services’ mediation program. Subsequently, the instant CRN was filed on behalf of the Insureds on November 14, 2024. Therefore, the foregoing facts clearly show that State Farm acted in good faith and expeditiously handled the adjusting of the Insureds’ belatedly reported claim. It should be noted that the CRN incorrectly, disingenuously, and contradictorily states that State Farm violated §624.155(1)(b)(1), & (3); §626.9541(1)(i)(2); §626.9541(1)(i)(3)(a), (b), (c), (d) , (f), (g) & (h) of the Florida Administrative Code, the policy, as alleged in the Notices of Insurer Violation, or otherwise and other applicable Florida Statutes, Florida Administrative Code and the applicable law. Furthermore, the foregoing supports that State Farm promptly investigated the claim; that it acted with due diligence and in good faith to resolve the claim. The facts also fail to support that State Farm improperly denied the claim, delayed the adjusting of the claim and it engaged in unfair trade practices and unethical conduct. Moreover, State Farm provided the Insureds with an explanation on the damages identified during its investigation that were excluded under the policy and specifically cited to the applicable policy provisions supporting its coverage determination. Furthermore, the Insureds were advised to submit additional documentation in support of their claim, including supporting documentation and photographs. However, no additional documentation, including but not limited to photographs, reports, weather records, etc., were provided by the Insureds supporting that the alleged damage was the result of a one-time accidental wind/or hailstorm occurring on February 4, 2024. Therefore, State Farm has complied with the policy and the applicable Florida Statutes, including but not limited to §624.155(1)(b)(1), & (3); §626.9541(1)(i)(2); §626.9541(1)(i)(3)(a), (b), (c), (d) , (f), (g) & (h)of the Florida Administrative Code, as alleged in the Notices of Insurer Violation, or otherwise and denies any violation of the applicable Florida Statutes, Florida Administrative Code and applicable law. The allegations raised in the CRN are boiler plate and lack any factual basis or support as noted above. Furthermore, the filing of the instant CRN asserting false allegations against State Farm constitutes a falsity and misrepresentation, as noted above. State Farm believes that, without waiving its rights to contest the validity of the subject defective and improper Civil Remedy Notice, as the facts demonstrate it has not violated any of the referenced statutes and the policy and that the accusations made against it in the subject Civil Remedy Notice are not well grounded in fact or law. If you need further information concerning this matter, please do not hesitate to contact the undersigned. Thank you for attention to this matter. Sincerely, Maria Klein, Esq. C: State Farm Florida 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