Civil Remedy Notice of Insurer Violations
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Filing Number:     792379
Filing Accepted:  11/14/2024
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Complainant
Last/Business Name *  
HAYNIE   First Name   TRACY DOLAN AND WILLIAM R.
Street Address * 8852 SW 204TH LN
City, State Zip * CUTLER BAY, FL 33189
Email Address * WITHHELD
Complainant Type: * Insured
Insured
Last/Business Name*   HAYNIE   First Name   TRACY DOLAN AND WILLIAM R.
Policy # * BKDW001132 Claim #* BW24076980005
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*   UNDERWRITERS AT LLOYD'S, LONDON
NAIC Company Code
 
Name of individual responsible for violation (if any):* JOHN CONTINO, TEVIAN ROSE
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)(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)(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.

The coverage decision correspondence incorrectly relies on the Existing Damage Exclusion and Mold and Fungus Exclusion Clause as it is inapplicable to the recent hurricane damages to the property. 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 September 27, 2024 the property of William R. Haynie and Tracy Dolan (hereinafter referred to the “Insureds”) was damaged by Hurricane Helene. Specifically, the property located at 50-526th Street, Saint Cloud, FL 34769 sustained roof and exterior damages and interior water damages ensued. The Insureds reported these damages to their homeowners’ insurance company, Certain Underwriters at Lloyd’s, London (hereinafter referred to as “Insurer”). The Insurer responded to the claim and sent Tevian Rose with Hausch and Company to inspect the damages. In correspondence dated October 31, 2024 signed by John Contino, the Insurer advised that they had determined that there was no wind damage to the roof (despite missing shingles throughout) and that the interior water damages observed were not caused by a storm created opening. Based on these conclusions, the Insurer declined to provide any coverage for the reported damages. The correspondence referenced observations of long term damages, however, no photographs or other information was provided. In fact, a December 2022 google image was also referenced, but not provided. The adjuster completely failed to acknowledge or address the clear and obvious recent hurricane damages to the property and dismissed everything as being long term damages or pre-existing. A contractor on behalf of the Insureds inspected the property and prepared an estimate of damages for repairs to storm related damages. The contractor’s estimate included replacement of the roof and totaled $45,372.20. 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 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 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 $45,372.20 (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. 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: Certain Underwriters at Lloyd’s, London 280 Park Avenue East Tower, 25th Floor New York, NY 10017 Certified Return Receipt # 9589 0710 5270 1009 7572 99
Comments
User Id Date Added Comment
dg@dgpalaw.com 05-15-2025 This matter has been resolved. Therefore, the Insureds withdraw this Civil Remedy Notice.
ccapeles@wshblaw.com 01-10-2025 We write on behalf of Underwriters at Lloyd’s, London Subscribing to Policy No. BKDW001132 (hereinafter referred to as "Underwriters"), in response to the Civil Remedy Notice of Insurer Violation bearing DFS File No. 792379 (the "Notice"), which was submitted to the Florida Department of Financial Services (the "Department") by William R Haynie and Tracy Dolan (the "Complainants") in connection with a property located at 50-52 6th Street, Saint Cloud, FL 34769 (the "Property"). Underwriters insured the Property under Policy No. BKDW001132, which was effective from May 10, 2024, through May 10, 2025 (the "Policy"). The Notice bears a filing acceptance date of November 14, 2024, making this response due on or before January 13, 2025. I. THE NOTICE IS LEGALLY DEFICIENT. At the outset, the Notice should be rejected because it fails to conform with many of the requirements of section 624.155, Florida Statutes. Section 624.155, Florida Statutes, requires that the insurer must "have been given 60 days’ written notice of the violation." According to Section 624.155(3), the notice “shall be on a form provided by the department and shall state with specificity . . . information as the department may require[.]” The purpose of a civil remedy notice is to be specific enough to provide the insurer notice of the wrongdoing so that the insurer can cure the same within sixty days. The Notice fails to conform with this requirement. The Notice includes allegations of seven (7) separate statutory violations; however, the Complainants fail to link the alleged statutory violations to any facts that would support the claim that Underwriters violated those statutes. Instead, the Complainants generally states that violations of these statutes occurred but provide nothing to substantiate these conclusory claims other than general allegations. The Notice also fails to set forth any specific policy language relevant to the purported violations as required by section 624.155(3)(b)(4), Fla. Stat. This failure to identify the specific language in the referenced policy provisions allegedly relevant to the purported violations prevents Underwriters from addressing any issues regarding the policy and is another reason why the Notice does not comply with section 624.155. Specifically, the Notice should be deemed deficient because it fails to state with specificity the facts and circumstances giving rise to the alleged violations, as required by section 624.155, Florida Statutes. Section 624.155 mandates that a notice "shall state with specificity . . . [t]he facts and circumstances giving rise to the violation." (Emphasis added). The Complainants alleges seven (7) statutory violations; however, the Complainants fail to link the alleged statutory violations to any facts that would support the claim that Underwriters violated those statutes. Instead, the Complainants state generally that violations of these statutes occurred but provides no specific facts to substantiate these conclusory claims. For example, the Notice makes blanket conclusory allegations of all of Underwriters' practices. The Notice alleges that Underwriters did not attempt "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 for her or his interests." The Notice also alleges Underwriters failed to promptly settle claims. In contrast, Underwriters have consistently handled claims with good faith throughout the state of Florida. Next, the Notice alleges Underwriters misrepresented facts of insurance policy provisions related to coverages at issue and denied claims without conducting reasonable investigations based upon available information. Additionally, the Notice alleges Underwriters failed to pay undisputed amounts of partial or full benefits owed and engaged in unfair claims settlement practices. However, the Complainants failed to state with specificity how Underwriters have violated the alleged statutes where the carrier has performed proper investigation and determined that the Property did not suffer damaged related to Hurricane Helene. In sum, the Notice does not provide any details as to how Underwriters allegedly violated these statutes. This accusatory language prejudices Underwriters, however, it also provides no factual allegations to confirm said statements. The Notice is wholly incorrect. Underwriters deny all allegations made by the Complainants in the Civil Remedy Notice. Underwriters further deny that they have violated any Florida Statutes, Administrative Codes, or provisions of the Policy. Underwriters deny all allegations made in the subject Civil Remedy Notice. Moreover, civil remedy notices are also required to cite to specific policy provisions and specific policy language. This Notice does not do so. Specifically, the Notice states the following: "[t]he coverage decision correspondence incorrectly relies on the Existing Damage Exclusion and Mold and Fungus Exclusion Clause as it is inapplicable to the recent hurricane damages to the property. 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." However, the Complainants failed to specify which section or subsection of these provisions is alleged to have been violated by Underwriters. Therefore, Underwriters are without specific information to aid in understanding of how they have violated this provision, or what steps need to be taken to cure the violated section or subsection. Therefore, the Notice is legally deficient in this regard as well. Instead of providing Underwriters with actual notice of the Complainants' concerns about the claim, the Notice is essentially a "shotgun-blast effort to hit a lot of targets with a single salvo." Rousso v. Liberty Surplus Insurance Corp., 2010 WL 7367059 at *5 (S.D. Fla. 2010). This type of approach is disfavored by Florida courts because it is contrary to the purposes of Section 624.155. "The civil remedy notice must reflect a good-faith effort to inform the insurer of how it has fallen short of its obligations under the policy and what it can do to fix its shortcomings. The civil remedy notice is not the place for posturing or advocacy, and an effort to overstate a claim in a civil remedy notice may end up undermining it." Id. "The civil remedy notice must reflect a good-faith effort to inform the insurer of how it has fallen short of its obligations under the policy and what it can do to fix its shortcomings." Rousso, 2010 WL 7367059. "The civil remedy notice is not the place for posturing or advocacy, and an effort to overstate a claim in a civil remedy notice may end up undermining it." Id. Instead of providing Underwriters with facts and instances of the Complainants' concerns about the claim, the Notice is essentially a "shotgun-blast effort" to assert that Underwriters are not complying with the provisions of the Policy and Florida law, though no specific evidence of this has been alleged by the Complainants. See id. at 5. This type of approach is disfavored by Florida courts because it is contrary to the purpose of section 624.155, Florida Statutes. Therefore, Underwriters reiterate that the Notice is legally deficient. As a result, Underwriters cannot respond to the litany of the alleged violations. Accordingly, the Complainants' Notice is deficient because it does not state with specificity the facts and circumstances giving rise to the alleged violations in a manner specific enough to provide Underwriters notice of the alleged wrongdoings, as required by the law. For these reasons, Underwriters respectfully request that the Notice be deemed deficient and insufficient. Additionally, the Notice should be deemed deficient because it does not provide Underwriters with a reasonable opportunity to "cure" the alleged defects. Section 624.155 mandates that "[n]o action shall lie if, within sixty days after filing notice, the damages are paid or the circumstances giving rise to the violation are corrected." (emphasis supplied). The Florida Legislature enacted the sixty-day cure window to provide "a last opportunity for insurers to comply with their claim-handling obligations." 316, Inc. v. Maryland Cas. Co., 625 F. Supp. 2d 1187, 1192 (N.D. Fla. 2008) (quoting Talat Enters., Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278 (Fla. 2000)). "[T]he purpose of the civil remedy notice is to give the insurer one last chance to settle the claim with its insured and avoid unnecessary bad faith litigation." 316, Inc., 625 F. Supp. 2d at 1192. The Notice states that to cure, the Complainants request Underwriters (1) pay the complete covered loss in the amount of $45,372.20 (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. We note the Complainants are not entitled to recover interest during a claim, and they are not considered part of the contract cure amount under Florida law. See Talat, 753 So. 2d at 1281. To the extent that any other allegations within the Notice have not been specifically addressed in this response, Underwriters deny any and all allegations contained in the Notice. Underwriters deny that they have violated any Florida Statutes, Administrative codes, Code of Ethics, or any provisions of the Policy. II. INSURERS HAVE ACTED IN GOOD FAITH. In the event that the Notice is not deemed deficient for the reasons laid out above, Underwriters deny that they have acted in bad faith or violated any of the statutes referenced in the Notice. To the contrary, Underwriters have, at all times, acted in good faith and with due consideration of their Insureds interests regarding this claim. Underwriters resolved the Insureds' claim as expeditious as possible and in accordance with the terms of coverage afforded by the Policy. The allegations of this claim establish that the Complainants' Notice is unfounded. Specifically, the Notice states that Underwriters placed "the company’s interests before the Insureds’ interests when a reasonable carrier in a similar position would have provided full coverage." However, Underwriters' coverage determination was based on Underwriters' investigation of the claim including an independent adjuster's inspection and the provisions found in the Policy of insurance. It is important to note that the Insureds reported the subject claim on September 30, 2024. In response, Hausch & Company, Inc. ("Hausch") was assigned as the third-party administrator for Underwriters and on October 3, 2024, Hausch assigned an independent adjuster to conduct an inspection of the Property. After the inspection was conducted, the independent adjuster determined that there were no wind created openings on the roof of the Property, and the exterior inspection revealed no wind damage and long-term ongoing algae and microbial growth. In addition, the independent adjuster's roof inspection also revealed that the shingles were at the end of life with heavy granular loss throughout and numerous shingles were missing and appeared to be long-term and ongoing as visible nail heads were rusted. In sum, Underwriters' independent adjuster did not observe any damages related to Hurricane Helene. As such, on or about October 31, 2024, Hausch issued a coverage determination letter stating that coverage was being denied and citing to the independent adjuster's inspection findings. The letter also cites to pertinent Policy language including the existing damage exclusion. In response, the Insureds did not submit any supporting documentation to the Insureds, but instead, filed this Notice and Notice of Intent to Initiate Litigation ("NOI"). In fact, the Insureds Notice was sent via certified mail, and included an Orange Contracting and Appraisal estimate dated November 1, 2024 totaling to $45,372.20. Before Underwriters' could investigate the Insureds' supplemental claim, the Insureds' filed a Notice of Intent to Initiate Litigation (NOI), which did not include any supporting documentation. That said, in an effort to investigate the Insureds' supplemental claim, Underwriters responded to the Insureds' NOI invoking their right to re-inspect the Property with an engineer. As such, a re-inspection will be coordinated with the Insureds' counsel. We further note the Insured's allegation on the Notice that a December 2022 Google image was referenced on Underwriters' coverage determination letter, but a not provided to the Insured. The Google image is public record, but will also be provided to the Insured via separate cover. In sum, Underwriters adjusted the claim diligently, promptly and properly. Specifically, Underwriters have not violated statutes 624.155(1)(b)(1), as alleged in the notice because Underwriters sent an adjuster to the property in order to investigate the claim and to determine the extent of the alleged damages associated with the subject claim. Moreover, Underwriters have not violated statutes 626.9541(1)(i)(3)(a) or 626.9541(1)(i)(3)(b) as Underwriters did not fail to adopt and implement standard for the proper investigation of claims nor have Underwriters mispresented any information or Policy provisions to the Insureds or any other person having an interest in the proceeds under the policy. Additionally, Underwriters have not violated Florida Statutes 626.9541(1)(i)(3)(d), 626.9541(1)(i)(3)(f), or 624.155(1)(b)(3) as alleged in the notice because Underwriters conducted a thorough investigation of the claim based upon the information provided and timely issued a denial letter based on the independent adjuster's inspection and the applicable policy’s conditions and exclusions. Further, Underwriters have not violated 626.9541(1)(i)(2) as no material misrepresentation have been made to the Insureds or any other person having an interest in the subject claim. Underwriters denies that is has violated any Florida Statutes, Administrative Codes, or any provisions of the Policy. As drafted, the Notice is essentially a contention that Underwriters acted in "bad faith" because it did not pay what the Complainants believed they were owed. This is not "bad faith," and out of step with the governing law and purpose behind the Civil Remedy Notice practice. See 316, Inc., 625 F. Supp. 2d at 1194. "An insurer that denies payment on a claim is not guilty of bad faith as a matter of law." Vest v. Travelers Ins. Co., 753 So. 2d 1270, 1275 (Fla. 2000). Instead, “[t]he insurer has a right to deny claims that it in good faith believes are not owed on a policy.” Id. A good faith denial precludes liability “[e]ven when it is later determined by a court or arbitration that the insurer . . . was mistaken.” Vaughn v. Producers Agriculture Ins. Co., 111 F. Supp. 3d 1251, 1259-60 (N.D. Fla. 2015). Underwriters specifically deny that they acted in bad faith simply because it has not paid the Insureds what the Insureds believes they are owed in this claim. To the contrary, Underwriters respectfully submit that they adjusted this claim in accordance with the applicable policy provisions and the laws of Florida and have acted in good faith throughout the entire investigation of this claim. For the reasons stated above, Underwriters assert that the Notice is legally deficient. Additionally, Underwriters respectfully emphasize that they have done nothing other than act in utmost good faith and applied the terms of coverage as clearly and unambiguously stated in the Policy. Florida law is clear that an insurer has the right to investigate claims presented for payment and is expressly afforded an opportunity to evaluate its rights and liabilities. See 316, Inc. V. Maryland Cas. Co., 625 F.Supp.2d 1187, 1192 (N.D. Fla. 2008) (quoting Talat Enters., Inc. V. Aetna Cas. & Sur. Co., 753 So.2d 1278 (Fla. 2000)). Underwriters vehemently deny that they have acted in bad faith and denies that they have violated any Florida Statutes, Florida law, Administrative Codes or any provisions of the subject Policy of insurance.
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