Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 792753

Filing Accepted: 11/15/2024

Print Filing

Complainant

Last/Business Name *

COMPTON (AND DUNN)

First Name

DAVE (AND LAURIE)

Street Address *

9047 NW 19TH STREET

City, State Zip *

WILDWOOD, FL 34785

Email Address *

LBETHDUNN@YAHOO.COM

Complainant Type: *

Insured

Last/Business Name*		COMPTON (AND DUNN)		First Name		DAVE (AND LAURIE)
Policy # *		59CPL7285		Claim #*		59-56G4-91D

Attorney

Attorney is Applicable

Last Name*	WOODWARD First Name * HEW Initial
Street Address*		PO BOX 140312
City, State Zip*		ORLANDO , FLORIDA 32814
Email Address *		PLEADINGS@HGWLEGAL.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		STATE FARM FLORIDA INSURANCE COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 10739

Name of individual responsible for violation (if any):* JAY MERCER AND DAVD HOUK
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)(2)		Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
	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)(e)		Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
	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.
	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).
	626.9541(1)(i)(3)(j)		Altering or amending an insurance adjuster’s report without: (I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and (II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or (III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;

* 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 SUBJECT INSURANCE POLICY PROVIDES COVERAGE FOR DIRECT PHYSICAL LOSS TO DAVE COMPTON AND LAURIE DUNN’S PROPERTY. THEY SUBMITTED A CLAIM FOR FIRE, SMOKE, WATER, AND FIREFIGHTING ACTIVITY DAMAGE TO THEIR INSURED PROPERTY THAT OCCURRED DURING THE EFFECTIVE POLICY PERIOD. THE LOSS IS NOT EXCLUDED UNDER THE TERMS AND CONDITIONS OF THE POLICY. THE INSURER HAS FAILED TO ISSUE PAYMENTS PURSUANT TO THE LOSS SETTLEMENT PROVISIONS OF THE POLICY AND VALUED POLICY LAW. COVERAGE A DWELLING $954,790 COVERAGE B PERSONAL PROPERTY $716,092 COVERAGE C LOSS OF USE $286,437 FIRE DEPARTMENT SERVICE CHARGE $500 DEBRIS REMOVAL ADDITIONAL 5% AVAILABLE TREES, SHRUBS, AND LANDSCAPING 5% OF COVERAGE A AMOUNT / $750 A1 REPLACEMENTCOST - SIMILAR CONSTRUCTION B1 LIMITEDREPLACEMENTCOST - COVERAGE B BUILDING ORDINANCE OR LAW $238,698 (25% OF COVERAGE A) PERSONAL PROPERTY BUSINESS $1,500 PERSONAL PROPERTY BUSINESS ELECTRONICS $10,000 TAPESTRY, WALL HANGING ARTICLES $5,000 ANY ONE ARTICLE $10,000 AGGREGATE 6. LOSS PAYMENT. WE WILL ADJUST ALL LOSSES WITH YOU. WE WILL PAY YOU UNLESS SOME OTHER PERSON IS NAMED IN THE POLICY OR IS LEGALLY ENTITLED TO RECEIVE PAYMENT. LOSS WILL BE PAYABLE UPON THE EARLIEST OF THE FOLLOWING: a. 20 DAYS AFTER WE RECEIVE YOUR REQUESTED PROOF OF LOSS AND REACH WRITTEN AGREEMENT WITH YOU; b. 60 DAYS AFTER WE RECEIVE YOUR PROOF OF LOSS AND: 1. THERE IS AN ENTRY OF A FINAL JUDGMENT; OR 2. THERE IS A FILING OF AN APPRAISAL AWARD WITH US. IF WE DO NOT PAY OR DENY A LOSS WITHIN 90 DAYS AFTER WE RECEIVE NOTICE OF AN INITIAL, REOPENED OR SUPPLEMENTAL PROPERTY INSURANCE CLAIM FROM YOU AND NO FACTORS BEYOND OUR CONTROL WOULD REASONABLY PREVENT US FROM MAKING PAYMENT, INTEREST WILL BE PAID IN ACCORDANCE WITH SECTION 627.70131(5) OF THE FLORIDA INSURANCE CODE. SECTIONS I AND II — CONDITIONS … 3. LIBERALIZATION CLAUSE. IF WE ADOPT ANY REVISION THAT WOULD BROADEN COVERAGE UNDER THIS POLICY WITHOUT ADDITIONAL PREMIUM, WITHIN 60 DAYS PRIOR TO OR DURING THE PERIOD OF THIS POLICY IS IN EFFECT, THE BROADENED COVERAGE WILL IMMEDIATELY APPLY TO THIS POLICY. THE WORK OF ADJUSTING INSURANCE CLAIMS ENGAGES THE PUBLIC TRUST AND FLORIDA STATUTES §§ 624.307, 624.308, 626.878 AND FLA. ADMIN. CODE ANN. R. 690-220.201 ENTITLED “ETHICAL REQUIREMENTS” APPLICABLE TO ALL INSURANCE ADJUSTERS ARE ALLEGED HAVE BEEN VIOLATED AS FOLLOWS: ALL OF THE PROVISIONS IN THE SUBJECT INSURANCE POLICY ARE DICTATED BY THE FOLLOWING FLORIDA STATUTES: § 627.4025 (“RESIDENTIAL COVERAGE AND HURRICANE COVERAGE DEFINED”); § 627.404 (“INSURABLE INTEREST, PERSONAL INSURANCE”); § 627.405 (“INSURABLE INTEREST”); § 627.4091 (“SPECIFIC REASONS FOR DENIAL, CANCELLATION, OR NONRENEWAL”); § 627.40951 (“STANDARD PERSONAL LINES RESIDENTIAL INSURANCE POLICY”); § 627.410 (“FILING, APPROVAL OF FORMS”); § 627.412 (“STANDARD PROVISIONS, IN GENERAL”); § 627.413 (“CONTENTS OF POLICIES, IN GENERAL”); § IDENTIFICATION”); § 627.4131 (“TELEPHONE NUMBER REQUIRED”); § 627.4133 (“NOTICE OF CANCELLATION, NONRENEWAL, OR RENEWAL PREMIUM”); § 627.4135 (“CASUALTY INSURANCE CONTRACTS SUBJECT TO GENERAL PROVISIONS FOR INSURANCE CONTRACTS”); § 627.4143 (“OUTLINE OF COVERAGE”); § 627.4145 (“READABLE LANGUAGE IN INSURANCE POLICIES”); § 627.418 (“VALIDITY OF NONCOMPLYING CONTRACTS”); § 627.419 (“CONSTRUCTION OF POLICIES”); § 627.420 (“BINDERS”); § 627.421 (“DELIVERY OF POLICY”); § 627.425 (“FORMS FOR PROOF OF LOSS TO BE FURNISHED”); § 627.426 (“CLAIMS ADMINISTRATION”); § 627.4265 (“PAYMENT OF SETTLEMENT”); § 627.428 (“ATTORNEY'S FEE”); § 627.442 (“INSURANCE CONTRACTS”); § 627.7011 (“HOMEOWNERS' POLICIES, OFFER OF REPLACEMENT COST COVERAGE AND LAW AND ORDINANCE COVERAGE”); § 627.7015 (“ALTERNATIVE PROCEDURE FOR RESOLUTION OF DISPUTED PROPERTY INSURANCE CLAIMS”); § 627.7016 (“INSURER CONTRACTS WITH BUILDING CONTRACTORS”); § 627.7019 (“STANDARDIZATION OF REQUIREMENTS APPLICABLE TO INSURERS AFTER NATURAL DISASTERS”); § 627.702 (“VALUED POLICY LAW”); § 627.7061 (“COVERAGE INQUIRIES”); § 627.712 (“RESIDENTIAL WINDSTORM COVERAGE REQUIRED, AVAILABILITY OF EXCLUSIONS FOR WINDSTORM OR CONTENTS”).

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

STATE FARM FLORIDA INSURANCE COMPANY (“STATE FARM”) BREACHED ITS STATUTORY AND CONTRACTUAL DUTIES DURING ITS ADJUSTMENT OF THE INSURANCE CLAIM REPORTED BY DAVE COMPTON AND LAURIE DUNN (THE “INSURED” OR “INSUREDS”) IN CONNECTION WITH SEVERE DAMAGE TO A RESIDENTIAL DWELLING AND PERSONAL PROPERTY LOCATED AT 9047 NW 19TH STREET, WILDWOOD, FLORIDA, 34785 (“DWELLING” OR “INSURED PROPERTY”) CAUSED BY FIRE, SMOKE, WATER AND FIREFIGHTING ACTIVITIES ON OR ABOUT SEPTEMBER 17, 2023 (“LOSS”), RESULTING IN SUBSTANTIAL DAMAGES AND ADDITIONAL LIVING EXPENSES. DESPITE CLEAR EVIDENCE THAT THIS WAS A COVERED LOSS, STATE FARM UNDERTOOK AN EXTENDED ADJUSTMENT PROCESS IN BAD FAITH, RESULTING IN SUBSTANTIAL DAMAGE TO THE INSURED INCLUDING BUT NOT LIMITED TO SEVERE DAMAGES AND ADDITIONAL EXPENSES. AS SET FORTH IN GREATER DETAIL BELOW, STATE FARM VIOLATED THE MINIMUM STATUTORY AND CONTRACTUAL DUTIES THAT IT OWED TO THE INSURED, INCLUDING BUT NOT LIMITED TO THE FOLLOWING WAYS: FAILING TO INVESTIGATE THE CLAIMED DAMAGES TO THE INSURED PROPERTY WITH OBJECTIVE AND QUALIFIED EXPERTS AND ADJUSTERS; FAILING TO ADJUST THE CLAIMED DAMAGES AND EXPENSES IN AN OBJECTIVE AND REASONABLE MANNER; REFUSING TO PAY UNDISPUTED PORTIONS OF THE INSURANCE CLAIM; MISREPRESENTING MATERIAL FACTS; REFUSING TO ACKNOWLEDGE AND MEANINGFULLY RESPOND TO COMMUNICATIONS; REFUSING TO COMMUNICATE REASONABLE REQUESTS FOR DOCUMENTS AND INFORMATION; REFUSING TO PAY INSURANCE BENEFITS TO REPAIR ALL OF THE DAMAGED PROPERTY COVERED BY THE INSURANCE POLICY, WHEN THE OBLIGATION TO ISSUE SUCH PAYMENT WAS APPARENT. STATE FARM ISSUED AN “ALL RISK” INSURANCE POLICY TO THE INSUREDS. ACCORDINGLY, THE INSURANCE POLICY MUST BE READ TO PROVIDE COVERAGE FOR ANY AND ALL DAMAGE TO THEIR INSURED PROPERTY THAT IS NOT CLEARLY AND UNAMBIGUOUSLY EXCLUDED UNDER THE INSURANCE POLICY. MOREOVER, THE PROVISIONS OF THE “ALL RISK” POLICY PROVIDING COVERAGE ARE TO BE CONSTRUED BROADLY, WHILE THE EXCLUSIONARY LANGUAGE OF THE INSURANCE POLICY ARE TO BE READ NARROWLY AND STRICTLY. IN FACT, IT WAS STATE FARM'S OBLIGATION TO AFFIRMATIVELY POINT OUT POLICY BENEFITS TO ITS INSUREDS, DESPITE THE FACT THAT THE INSURED OR THE INSURED’S REPRESENTATIVE MAY NOT HAVE BEEN AWARE OF SUCH BENEFITS. THE INSURING AGREEMENT IS INTENDED TO PROVIDE THE INSURED WITH PEACE OF MIND AND THE INSURANCE COMPANY IS EXPECTED TO FACILITATE THAT INTENTION. STATE FARM HAS REFUSED TO PAY BENEFITS FOR DAMAGE TO THE INSURED PROPERTY CAUSED BY THE LOSS (AMONG OTHERS). RATHER THAN ATTEMPTING IN GOOD FAITH TO ADJUST THE INSURANCE CLAIM, STATE FARM WITHHELD BENEFITS AND HAS REFUSED TO MEANINGFULLY RESPOND TO THE INSURED'S CLAIM SUBMISSIONS AND ISSUE UNDISPUTED PAYMENTS ON THE LOSS. THE UNDERLYING CONCEPT OF INSURANCE IS THAT THE INSURER’S GRANTING OF TIMELY AND PROMPT INDEMNIFICATION OR SECURITY AGAINST A CONTINGENT LOSS PLACES THE INSURED BACK TO A PRE-LOSS CONDITION IN A TIMELY MANNER. HOWEVER, STATE FARM'S CLAIM REPRESENTATIVES AND ADJUSTER(S) DID NOT PERFORM AN ADEQUATE OR REASONABLE INVESTIGATION OF THE DAMAGES, AND STATE FARM HAS PROVIDED NO REASONABLE EXPLANATION AS TO WHY PAYMENT FOR ALL OF THE DAMAGED PROPERTY WAS NOT ISSUED IN A TIMELY MANNER. STATE FARM WAS TIMELY NOTIFIED OF SEVERE DAMAGE TO THE INSURED'S PROPERTY. STATE FARM’S AUTHORIZED EMPLOYEE, AGENT AND/OR REPRESENTATIVES INSPECTED THE HOME, DOCUMENTED AND PHOTOGRAPHED THE DAMAGE TO THE DWELLING AND PERSONAL PROPERTY, BUT FAILED AND/OR REFUSED TO INSPECT ALL OF THE DAMAGED PROPERTY. STATE FARM DENIED OR UNDERPAID COVERAGE FOR ALL OR PART OF THE CLAIMED DAMAGE. SPECIFICALLY, ON OR ABOUT SEPTEMBER 17, 2023, THE INSUREDS NOTIFIED STATE FARM OF THE LOSS AND SUBMITTED DOCUMENTS AND INFORMATION IN SUPPORT OF THE CLAIM, BUT STATE FARM FAILED TO PAY BENEFITS THAT WERE DUE AND OWING OR OTHERWISE ADEQUATELY RESPOND. AFTER THE INSUREDS PROVIDED IMMEDIATE NOTICE OF THE LOSS, ON OR ABOUT SEPTEMBRER 20, 2023, STATE FARM’S REPRESENTATIVE, JAY MERCER, INSPECTED THE LOSS. THEREAFTER, ON OR ABOUT OCTOBER 13, 2023, THE INSUREDS AND/OR THEIR REPRESENTATIVE SUBMITTED DOCUMENTS AND INFORMATION IN SUPPORT OF THE CLAIM, BUT STATE FARM FAILED TO PAY BENEFITS THAT WERE DUE AND OWING OR OTHERWISE ADEQUATELY RESPOND. ON OR ABOUT NOVEMBER 11, 2023, THE INSUREDS AND/OR THEIR REPRESENTATIVE SUBMITTED DOCUMENTS AND INFORMATION IN SUPPORT OF THE CLAIM, BUT STATE FARM FAILED TO PAY BENEFITS THAT WERE DUE AND OWING OR OTHERWISE ADEQUATELY RESPOND. DESPITE KNOWING THAT THE INSUREDS WERE DISPLACED FROM THEIR HOME, STATE FARM DID NOT ISSUE FULL PAYMENT ON THE CLAIM OR PROVIDE ALTERNATIVE LIVING ACCOMMODATIONS. IN LIGHT OF STATE FARM’S CONTINUED FAILURE OR REFUSAL TO ADJUST THE CLAIM, THE INSUREDS WERE FORCED TO ENGAGE A PUBLIC INSURANCE ADJUSTER. THE PUBLIC ADJUSTER SUBMITTED AN ESTIMATE, TOGETHER WITH PHOTOGRAPHS AND DOCUMENTS, SUPPORTING THEIR CLAIM. THE INSUREDS (AND LATER THEIR THE PUBLIC ADJUSTER) REPEATEDLY ASKED AND LATER PLEADED WITH STATE FARM TO PLEASE PAY CONTRACTORS’ INVOICES FOR WORK TO MITIGATE THE DAMAGE, PERFORM TEMPORARY REPAIRS, AND TO OTHERWISE SECURE THE PROPERTY. AS DISCUSSED BELOW, STATE FARM WAS CLEARLY IN POSSESSION OF SUFFICIENT DOCUMENTATION TO KNOW THAT THE INSUREDS’ LOSS EXCEEDED STATE FARM’S PAYMENTS APPROXIMATELY $478,000. HOWEVER, STATE FARM NEVER PROVIDED A COMPARATIVE/REVISED ESTIMATE, MUCH LESS ISSUE ANY FURTHER PAYMENTS FOR THE ADDITIONAL REPAIR COSTS INCURRED BY THE INSUREDS. ON OR ABOUT DECEMBER 20 AND/OR 22, 2023, THE INSUREDS (OR THEIR REPRESENTATIVES) CONTACTED STATE FARM (OR ITS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. THE INSURED REQUESTED A CERTIFIED COPY OF THE POLICY, THE CLAIMS HISTORY, CORRESPONDENCE, ESTIMATES, STATEMENTS OF LOSS, ITEL REPORTS, ENGINEERING REPORTS, CLAIM PAYMENTS, AND INSPECTION REPORTS FROM THE UNDERWRITING FILE, AND A STATEMENT OF ALL COVERAGE LIMITATIONS OR EXCLUSIONS THAT APPLY TO THE LOSS. STATE FARM FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT JANUARY 4 AND/OR 7, 2024, A JOINT INSPECTION WAS CONDUCTED, AND THE INSUREDS AND/OR THEIR REPRESENTATIVE SUBMITTED DOCUMENTS AND INFORMATION IN SUPPORT OF THE CLAIM, BUT STATE FARM FAILED TO PAY BENEFITS THAT WERE DUE AND OWING OR OTHERWISE ADEQUATELY RESPOND. ON OR ABOUT JANUARY 15 AND/OR 31, 2024, THE INSUREDS AND/OR THEIR REPRESENTATIVE SUBMITTED DOCUMENTS AND INFORMATION IN SUPPORT OF THE CLAIM, BUT STATE FARM FAILED TO PAY BENEFITS THAT WERE DUE AND OWING OR OTHERWISE ADEQUATELY RESPOND. ON OR ABOUT FEBRUARY 2 AND/OR 28, 2024, THE INSUREDS AND/OR THEIR REPRESENTATIVE SUBMITTED DOCUMENTS AND INFORMATION IN SUPPORT OF THE CLAIM, BUT STATE FARM FAILED TO PAY BENEFITS THAT WERE DUE AND OWING OR OTHERWISE ADEQUATELY RESPOND. ON OR ABOUT MARCH 4 AND/OR 21, 2024, THE INSUREDS AND/OR THEIR REPRESENTATIVE SUBMITTED DOCUMENTS AND INFORMATION IN SUPPORT OF THE CLAIM, BUT STATE FARM FAILED TO PAY BENEFITS THAT WERE DUE AND OWING OR OTHERWISE ADEQUATELY RESPOND. SPECIFICALLY, THE INSUREDS AND/OR THEIR REPRESENTATIVE SUBMITTED AN ESTIMATE SUBSTANTIATING AT LEAST $573,712.52 TO COVER THE BUILDING REPAIRS AND $187,867.68 FOR PERSONAL PROPERTY DAMAGE, BUT STATE FARM FAILED TO PAY BENEFITS THAT WERE DUE AND OWING OR OTHERWISE ADEQUATELY RESPOND. ON OR ABOUT APRIL 3 AND/OR 18, 2024, THE INSUREDS AND/OR THEIR REPRESENTATIVE SUBMITTED DOCUMENTS AND INFORMATION IN SUPPORT OF THE CLAIM, BUT STATE FARM FAILED TO PAY BENEFITS THAT WERE DUE AND OWING OR OTHERWISE ADEQUATELY RESPOND. ON OR ABOUT MAY 2 AND/OR 21, 2024, THE INSUREDS AND/OR THEIR REPRESENTATIVE SUBMITTED DOCUMENTS AND INFORMATION IN SUPPORT OF THE CLAIM, BUT STATE FARM FAILED TO PAY BENEFITS THAT WERE DUE AND OWING OR OTHERWISE ADEQUATELY RESPOND. ON OR ABOUT JUNE 3 AND/OR 5, 2024, A JOINT INSPECTION WAS CONDUCTED, AND THE INSUREDS AND/OR THEIR REPRESENTATIVE SUBMITTED DOCUMENTS AND INFORMATION IN SUPPORT OF THE CLAIM, STATE FARM DID NOT ISSUE TIMELY PAYMENT OR ADEQUATELY RESPOND TO THE INSUREDS’ CLAIM SUBMISSIONS AND REQUESTS. INSTEAD, STATE FARM TRANSFERRED THE CLAIM TO ANOTHER INSURANCE ADJUSTER, DAVID HOUK. AT THE INSPECTION, STATE FARM’S NEW ADJUSTER ADVISED THE INSUREDS AND/OR THEIR REPRESENTATIVE THAT STATE FARM WAS ISSUING PAYMENT ON THEIR CLAIM; HOWEVER, MR. HOUK DID NOT TAKE ANY PHOTOGRAPHS OR MEASUREMENTS. ON OR ABOUT JUNE 12 AND/OR 27, 2024, THE INSUREDS AND/OR THEIR REPRESENTATIVE SUBMITTED DOCUMENTS AND INFORMATION IN SUPPORT OF THE CLAIM, BUT STATE FARM FAILED TO PAY BENEFITS THAT WERE DUE AND OWING OR OTHERWISE ADEQUATELY RESPOND. THE INSUREDS AND/OR THEIR REPRESENTATIVE SUBMITTED A REVISED ESTIMATE SUBSTANTIATING AT LEAST $571,710.15 FOR THE DWELLING REPAIRS AND $52,474.69 FOR THE OUTSTANDING DAMAGES TO THE PERSONAL PROPERTY. DESPITE THE FACT THAT THE CLAIM WAS FULLY SUBMITTED AND INVESTIGATED, STATE FARM DID NOT ISSUE ANY ADDITIONAL PAYMENTS FOR DAMAGE TO THE DWELLING, MUCH LESS DID STATE FARM PRODUCE A REVISED ESTIMATE REFLECTING ITS FINDINGS DURING THE INSPECTION COMPLETED EARLIER ION JUNE 2024. ON OR ABOUT JULY 12 AND/OR 22, 2024, THE INSUREDS AND/OR THEIR REPRESENTATIVE SUBMITTED DOCUMENTS AND INFORMATION IN SUPPORT OF THE CLAIM, BUT STATE FARM FAILED TO PAY BENEFITS THAT WERE DUE AND OWING OR OTHERWISE ADEQUATELY RESPOND. ON OR ABOUT AUGUST 13 AND/OR 26, 2024, THE INSUREDS AND/OR THEIR REPRESENTATIVE SUBMITTED DOCUMENTS AND INFORMATION IN SUPPORT OF THE CLAIM, BUT STATE FARM FAILED TO PAY BENEFITS THAT WERE DUE AND OWING OR OTHERWISE ADEQUATELY RESPOND. IN LIGHT OF STATE FARM’S CONTINUED FAILURE OR REFUSAL TO ADJUST THE CLAIM, THE INSUREDS WERE FORCED TO FILE A COMPLAINT WITH THE THE FLORIDA DEPARTMENT OF FINANCIAL SERVICES. ON OR ABOUT AUGUST 30, 2024, THE INSUREDS AND/OR THEIR REPRESENTATIVE ALSO FILED A PROOF OF LOSS, AS WELL AS DOCUMENTS AND INFORMATION IN SUPPORT OF THE CLAIM, BUT STATE FARM FAILED TO PAY BENEFITS THAT WERE DUE AND OWING OR OTHERWISE ADEQUATELY RESPOND. ON OR ABOUT SEPTEMBER 3 AND/OR 20, 2024, THE INSUREDS AND/OR THEIR REPRESENTATIVE SUBMITTED DOCUMENTS AND INFORMATION IN SUPPORT OF THE CLAIM, BUT STATE FARM FAILED TO PAY BENEFITS THAT WERE DUE AND OWING OR OTHERWISE ADEQUATELY RESPOND. ON OR ABOUT SEPTEMBER 23, 2024, STATE FARM FILED ITS RESPONSE TO THE DFS COMPLAINT. IN ITS RESPONSE STATE FARM STATED, THAT “AN ADDITIONAL ESTIMATE WAS COMPLETED BY DAVID HOUK” AND THAT “THEY REVIEWED THE REVISED ESTIMATE AND UPDATED THEIR ESTIMATE FOR THE WARRANTED REPAIRS.” THESE ASSERTIONS WERE FALSE AND MISLEADING BECAUSE, STATE FARM DID NOT PRODUCE A REVISED ESTIMATE AND NO ADDITIONAL PAYMENTS WERE MADE FOR THE DWELLING DAMAGE. ON OR ABOUT OCTOBER 3 AND/OR 16, 2024, THE INSUREDS AND/OR THEIR REPRESENTATIVE SUBMITTED DOCUMENTS AND INFORMATION IN SUPPORT OF THE CLAIM, BUT STATE FARM FAILED TO PAY BENEFITS THAT WERE DUE AND OWING OR OTHERWISE ADEQUATELY RESPOND. IN LIGHT OF STATE FARM’S CONTINUED FAILURE OR REFUSAL TO ADJUST THE CLAIM, THE INSUREDS WERE FORCED TO FILE A REQUEST FOR MEDIATION WITH THE FLORIDA DEPARTMENT OF FINANCIAL SERVICES. AT THAT TIME, ON OR ABOUT OCTOBER 21, 2024, THE INSUREDS AND/OR THEIR REPRESENTATIVE ALSO SUBMITTED DOCUMENTS AND INFORMATION IN SUPPORT OF THE CLAIM, BUT STATE FARM FAILED TO PAY BENEFITS THAT WERE DUE AND OWING OR OTHERWISE ADEQUATELY RESPOND. ON OR ABOUT NOVEMBER 3, AND/OR 7, 2024, THE INSUREDS AND/OR THEIR REPRESENTATIVE SUBMITTED DOCUMENTS AND INFORMATION IN SUPPORT OF THE CLAIM, BUT STATE FARM FAILED TO PAY BENEFITS THAT WERE DUE AND OWING OR OTHERWISE ADEQUATELY RESPOND. IN SUMMARY, STATE FARM WAS IN POSSESSION OF SUFFICIENT DOCUMENTATION TO KNOW THAT THE INSUREDS’ LOSS EXCEEDED STATE FARM’S PAYMENTS APPROXIMATELY $478,000. HOWEVER, STATE FARM NEVER PROVIDED A COMPARATIVE/REVISED ESTIMATE, MUCH LESS ISSUED ANY FURTHER PAYMENTS FOR THESE ADDITIONAL REPAIR COSTS. IN ADDITION TO CAUSING THE INSUREDS TO SUFFER UNDUE STRESS AND DISTRESS, STATE FARM’S STALLING AND DELAYING TACTICS CAUSED THE INSUREDS TO INCURR SUBSTANTIAL ADDITIONAL LIVING EXPENSES. STATE FARM HAS VIOLATED THE FUNDAMENTAL RULE REQUIRING IT TO IMMEDIATELY PAY BENEFITS OWED ON A CLAIM, AND PROHIBITING IT FROM WITHHOLDING UNDISPUTED AMOUNTS OWED IN ORDER TO EFFECTUATE A BETTER SETTLEMENT OF THE REMAINDER OF THE CLAIM. STATE FARM DENIED OR UNDERPAID INSURANCE BENEFITS BASED UPON INSUFFICIENT INFORMATION, SPECULATION AND BIASED INFORMATION. THE FAILURE TO FAIRLY AND REASONABLY INVESTIGATE A CLAIM DOES NOT PERMIT STATE FARM TO DENY THE CLAIM, OR REFUSE BENEFITS, DUE TO LACK OF INFORMATION OR ONE-SIDED INFORMATION. IT CANNOT JUST FOCUS ON FACTS THAT WOULD SUPPORT DENYING A CLAIM. STATE FARM IGNORED EVIDENCE WHICH ESTABLISHES INSURANCE COVERAGE AND TRIGGERS THE PAYMENT OF INSURANCE BENEFITS. STATE FARM WAS REQUIRED TO ACKNOWLEDGE THE INSURED’S CLAIM SUBMISSIONS AND, AT A MINIMUM, ADVISE THE INSUREDS THAT IT DISAGREED WITH THEIR CLAIM SUBMISSIONS BY IDENTIFYING THE AREAS OF DISAGREEMENT AND CONDUCTING AN ADDITIONAL INVESTIGATION OF THE CLAIM. IN FACT, STATE FARM CANNOT IGNORE AN INSURED’S CLAIM SUBMISSIONS IN SUCH A MANNER. BY IGNORING THE INSURED’S CLAIM SUBMISSIONS, IT IS CLEAR THAT STATE FARM MADE A PRECONCEIVED DETERMINATION TO UNDERPAY OR DENY ALL OR PART OF THE CLAIM BASED ON SPECULATION AND CONJECTURE, AND USED PREDICTABLE OR BIASED EXPERTS AND/OR ADJUSTERS TO DEVELOP DEFENSES TO THE CLAIM, AS OPPOSED TO ADJUSTING THIS CLAIM IN GOOD FAITH AND PAYING THE INSURED INSURANCE THE BENEFITS IT OWES. STATE FARM MADE NO GOOD FAITH ATTEMPT TO ADJUST THE CLAIM PURSUANT TO THE REPLACEMENT COST VALUE COVERAGES OF THE SUBJECT INSURANCE POLICY. IN FACT, STATE FARM'S “LOW BALL” ESTIMATE FOR THE COST TO REPAIR THE DWELLING ALTOGETHER FAILED TO INCLUDE ALL OF THE DAMAGED ROOMS AND PROPERTY. MOREOVER, STATE FARM REFUSED TO ADJUST THE CLAIM BASED UPON THE SAME HIGH QUALITY MATERIALS AND LABOR THAT WAS USED TO BUILD THE DWELLING, WITH ALL OF THE ACCOUTERMENTS EXISTING AT THE TIME THE LOSS. STATE FARM ALSO FAILED AND REFUSED TO ADJUST THE INSURED'S CLAIM IN A MANNER THAT WOULD ENABLE THEM TO RESTORE THE DWELLING TO ITS PRE-LOSS CONDITION ON A REPLACEMENT COST BASIS BECAUSE ITS ESTIMATES DID NOT INCLUDE THE COST TO REPLACE THE DAMAGES TO THE BUILDING WITH NEW MATERIALS OF LIKE KIND AND QUALITY AND WITHOUT ANY DEDUCTIONS FOR DEPRECIATION. IT DID NOT INCLUDE THE COST TO REPAIR OR REPLACE ADJOINING AREAS OF THE DWELLING SO THAT BOTH THE REPLACED AREAS AND ADJOINING AREAS OF THE DWELLING REASONABLY MATCH IN QUALITY, COLOR AND SIZE. STATE FARM'S ESTIMATES DID NOT INCLUDE THE COST TO REPAIR OR REPLACE ALL PORTIONS OF THE BUILDING THAT WOULD BE DAMAGED DURING THE COURSE OF REPAIRS. SIMILARLY, STATE FARM SEEMS TO HAVE ALTOGETHER IGNORED THE INSURED'S CLAIM SUBMISSIONS FOR BENEFITS TO REPLACE THE DAMAGED PERSONAL PROPERTY AND REMEDIATE THE CONDITIONS. IN FACT, STATE FARM HAS NOT ISSUED PAYMENT FOR ANY OF THE ADDITIONAL LIVING EXPENSES SUBMITTED, MUCH LESS IDENTIFIED THE COST TO REPAIR OR REPLACE ANY ITEMS OF PERSONAL PROPERTY. STATE FARM DISPATCHED ENGINEERS, CONTRACTORS AND/OR ADJUSTERS IN AN EFFORT TO INTIMIDATE THE INSURED AND FORCE IT TO ABANDON THE INSURANCE CLAIM, OR ACCEPT A LOW BALL SETTLEMENT OFFER. DESPITE THE ESTIMATES AND SUBMISSIONS MADE BY OR ON BEHALF OF THE INSUREDS, STATE FARM FAILED AND REFUSED TO PROVIDE ANY MEANINGFUL RESPONSE TO THEIR CLAIM SUBMISSIONS. RATHER THAN REVIEWING THE ESTIMATES PROVIDED BY THEM, AND PAYING THE REQUESTED INSURANCE BENEFITS, STATE FARM EITHER COMPLETELY IGNORED OR TOTALLY DISMISSED THE CLAIM SUBMISSIONS. PURSUANT TO THE TERMS, CONDITIONS AND COVERAGES OF THE SUBJECT INSURANCE POLICY, STATE FARM WAS OBLIGATED TO INVESTIGATE AND INDEMNIFY THE INSURED IN FULL. YET, NO ADDITIONAL PAYMENTS AND NO COVERAGE DETERMINATION DELINEATING DISPUTED AND UNDISPUTED PORTIONS OF THE CLAIM WERE PROVIDED BY STATE FARM. STATE FARM WAS OBLIGATED TO CONTINUE ITS ADJUSTMENT OF THE CLAIM AND ISSUE PAYMENTS TO REPAIR THE DAMAGE TO THE BUILDING THAT STATE FARM BELIEVED TO BE CAUSED BY A COVERED LOSS. AT A MINIMUM, STATE FARM SHOULD HAVE RE-INSPECTED THE LOSS AND PREPARED AND PROVIDED ANOTHER ESTIMATE OF THE COST TO REPAIR ALL OF THE CLAIMED AREAS OF DAMAGE. STATE FARM VIOLATED THE MINIMUM STATUTORY REQUIREMENTS OF ALL INSURERS TO PROVIDE PAYMENT OF ALL UNDISPUTED AMOUNTS DUE AND OWING UNDER THE SUBJECT INSURANCE POLICY IN A TIMELY MANNER. STATE FARM KNEW AND/OR SHOULD HAVE KNOWN THAT INSURANCE MONIES WERE DUE AND OWING, HOWEVER, STATE FARM HAS NOT MADE ANY ADDITIONAL PAYMENTS TO THE INSURED. STATE FARM'S REFUSAL TO PAY INSURANCE BENEFITS IS AN INTENTIONAL ATTEMPT TO “LOW BALL” THE INSURED'S DAMAGES. STATE FARM HAS ACTED IMPROPERLY AND IN BAD FAITH BY IGNORING OR SUMMARILY DISMISSING THE INSURED'S AND THEIR CONTRACTORS’ CLAIM SUBMISSIONS AND REPAIR ESTIMATES, WITHOUT CONDUCTING A FAIR AND REASONABLE INVESTIGATION. IN SUM, STATE FARM DID NOT INVESTIGATE AND FAIRLY OR REASONABLY INTERPRET THE FACTS SURROUNDING THIS CLAIM. STATE FARM HAS FAILED TO ISSUE PAYMENT OF THE UNDISPUTED PORTION OF THE INSURED'S PROPERTY DAMAGE CLAIM WITHIN 90-DAYS, DESPITE THE FACT THAT IT HAD ALL INFORMATION NECESSARY TO CALCULATE THE ISSUE PAYMENT FOR THE UNDISPUTED PORTION OF THE CLAIM. STATE FARM FAILED TO PROMPTLY PAY THE FULL BENEFITS OWED TO THE POLICYHOLDER, THE REASONS FOR THIS MAY BE ATTRIBUTED TO IMPROPER TRAINING, SUPERVISION, AND/OR FAILURE OF ADJUSTERS AND CLAIMS SUPERVISORS TO PROMPTLY AND FAIRLY INVESTIGATE, ADJUST AND PAY FULL BENEFITS AVAILABLE TO ALL BENEFICIARIES. THE INSURER FAILED TO ADOPT PROPER STANDARDS OF INVESTIGATION AND ADJUSTMENT OF LOSSES, OR IS OTHERWISE NOT IMPLEMENTING THOSE STANDARDS BECAUSE FULL PAYMENT AND PROMPT PAYMENT FOR THE LOSS IS NOT OCCURRING. STATE FARM HAS FAILED TO CREATE AND IMPLEMENT ADEQUATE GUIDELINES FOR PROPER INVESTIGATION TO EVALUATE CLAIMS HANDLING AND FOR TRAINING AND SUPERVISION OF EMPLOYEES, RESULTING IN STATUTORY VIOLATIONS AS SET FORTH ABOVE. STATE FARM HAS FAILED AND/OR REFUSED TO THOROUGHLY, ACCURATELY, AND COMPLETELY INVESTIGATE AND EVALUATE THE INSURED'S INSURANCE CLAIM AND DAMAGES. STATE FARM HAS FAILED AND/OR REFUSED TO ACKNOWLEDGE AND ACT PROMPTLY UPON COMMUNICATION FROM ITS INSURED (OR THEIR REPRESENTATIVES) WITH RESPECT TO THE INSURANCE CLAIMS. STATE FARM HAS FAILED TO PROMPTLY SETTLE THE INSURED'S INSURANCE CLAIMS WHEN THE OBLIGATION TO SETTLE THESE CLAIMS HAD BECOME REASONABLY CLEAR, UNDER AT LEAST ONE PORTION OF THE INSURANCE POLICY’S COVERAGES, IN ORDER TO INFLUENCE THE SETTLEMENTS UNDER OTHER PORTIONS OF THE INSURANCE POLICY COVERAGE. TO DATE, NOTWITHSTANDING THE INSURED'S PLEAS OTHERWISE, STATE FARM HAS CONTINUED TO REFUSE TO ACKNOWLEDGE ITS OBLIGATION TO TENDER ALL INSURANCE MONIES DUE AND OWING THE INSURED, OR ASSIST THE INSURED IN THE MITIGATION OF THEIR DAMAGES. THE INSURED WAS THEN, AND IS STILL, FORCED TO EXPEND MONIES TO SUBMIT THE INSURANCE CLAIM, PAY FEES AND COSTS, RETAIN EXPERTS AND ADJUSTERS TO INVESTIGATE THE FULL EXTENT AND NATURE OF THE LOSS, AND TO FORCE STATE FARM TO HONOR ITS OBLIGATIONS UNDER THE INSURANCE POLICY AND PAY ALL THE INSURANCE PROCEEDS DUE AND OWING THE INSURED. THE INSURED HAS REPEATEDLY DEMANDED THAT STATE FARM ACKNOWLEDGE THEIR CLAIM SUBMISSIONS, AND ISSUE PAYMENT. STATE FARM REFUSED AND/OR FAILED TO ACKNOWLEDGE THEIR CLAIM SUBMISSIONS, TENDER ALL INSURANCE PROCEEDS OWED TO THE INSURED UPON DEMAND, AND UNREASONABLY WITHHELD PAYMENT TO THE INSURED. STATE FARM'S REFUSAL AND/OR FAILURE TO SETTLE THE INSURANCE CLAIM WHEN UNDER ALL CIRCUMSTANCES IT COULD HAVE AND SHOULD HAVE DONE SO HAD IT ACTED FAIRLY AND HONESTLY TOWARDS THE INSURED IS UNREASONABLE, WRONGFUL AND ILLEGAL CONDUCT. IN FACT, STATE FARM'S REPRESENTATIVES HAVE MADE MATERIAL MISREPRESENTATIONS TO THE INSURED CONCERNING THE STATUS OF ITS INVESTIGATION AND ADJUSTMENT OF THE CLAIM, INCLUDING BUT NOT LIMITED TO THE DATE THE INSURED. THESE REPRESENTATIONS ARE FALSE BECAUSE STATE FARM HAS NOT ADEQUATELY INVESTIGATED AND ADJUSTED THE CLAIM AND HAS NOT ISSUED ANY ADDITIONAL PAYMENTS TO THE INSURED. STATE FARM HAS DONE LITTLE MORE THAN MANUFACTURE COVERAGE DEFENSES AND PURSUE EVIDENTIARY SUPPORT FOR PRE-CONCEIVED AND ILL-CONCEIVED COVERAGE DEFENSES, ALL IN BAD FAITH ON THE PART OF STATE FARM. DESPITE HAVING EXTENSIVE KNOWLEDGE OF THE FOREGOING INFORMATION, STATE FARM HAS REFUSED TO PAY THE INSURED'S CLAIM. IT IS BELIEVED THAT FUTURE BAD FAITH DISCOVERY MAY REVEAL AN EXTENSIVE HISTORY OF DENIALS (OR UNDERPAYMENTS) OF CLAIMS SIMILAR TO THAT OF THE INSURED(S) AND OTHER INSUREDS ACROSS THE STATE OF FLORIDA, AS THIS CONDUCT MAY BE A BUSINESS PRACTICE OF THIS INSURER. IN FLORIDA THE WORK OF ADJUSTING INSURANCE CLAIMS ENGAGES THE PUBLIC TRUST. STATE FARM BREACHED ITS STATUTORY AND CONTRACTUAL DUTIES AS WELL AS THIS TRUST. TO CURE THE DEFECTS OUTLINED IN THIS CIVIL REMEDY NOTICE, STATE FARM MUST: (1) CREATE AND IMPLEMENT ADEQUATE GUIDELINES FOR PROPER INVESTIGATION AND EVALUATION AS TO CLAIMS HANDLING AND FOR THE TRAINING AND SUPERVISION OF EMPLOYEES, AGENTS AND REPRESENTATIVES WHICH WILL AVOID FUTURE STATUTORY VIOLATIONS AS SET FORTH ABOVE TO AVOID THIS FROM OCCURRING IN THE FUTURE. (2) CREATE AND IMPLEMENT ADEQUATE GUIDELINES FOR THE PROPER INVESTIGATION AND EVALUATION OF FIRE DAMAGE CLAIMS, AND FOR THE TRAINING AND SUPERVISION OF EMPLOYEES, AGENTS AND REPRESENTATIVES WITH REGARD TO THESE CLAIMS TO ENSURE THAT STATE FARM'S CLAIMS HANDLING PROCEDURES WITH REGARD TO THESE TYPES OF LOSSES ARE ADEQUATE TO STOP UNFAIR AND WRONGFUL TREATMENT OF INSUREDS. (3) ASSIST THE INSUREDS AND/OR REIMBURSE THEIR EXPENSES TO MITIGATE DAMAGES. (4) PROMPTLY AND TIMELY RESPOND TO REQUESTS FOR INFORMATION BY THE INSUREDS. (5) ACT FAIRLY AND HONESTLY TOWARDS THE INSUREDS AND WITH DUE REGARD FOR THEIR INTERESTS IN ATTEMPTING TO SETTLE THE INSURED'S CLAIM. (6) IMMEDIATELY TENDER ALL INSURANCE MONIES DUE AND OWING THE INSUREDS PURSUANT TO THE MOST RECENT ESTIMATES AND PROPERTY INVENTORIES SUBMITTED. (7) ACKNOWLEDGE IN WRITING TO THE INSURED THAT STATE FARM'S HANDLING OF THIS CLAIM IS AND WAS INSUFFICIENT TO PLACE THE INSUREDS BACK INTO THEIR PRE-LOSS CONDITION. (8) TAKE ANY OTHER REASONABLE AND NECESSARY MEASURES TO PLACE THE INSUREDS BACK INTO THEIR PRE-LOSS CONDITION. (9) ACKNOWLEDGE, IN WRITING, ITS SINCERE APOLOGY TO THE INSURED FOR ITS WRONGFUL CLAIMS HANDLING PRACTICES IN THE ADJUSTMENT OF THIS CLAIM. (10) IMMEDIATELY PAY ALL AMOUNTS NECESSARY TO REPAIR THE DAMAGE TO THE DWELLING AND PERSONAL PROPERTY, PLUS ADDITIONAL LIVING EXPENSES AND INTEREST (BUT SUBTRACT PRIOR PAYMENTS, DEDUCTIBLE AND DEPRECIATION) WHICH PAYMENTS ARE EXCLUSIVE ANY CLAIMS FOR FEES, COSTS, BAD FAITH OR EXTRA-CONTRACTUAL DAMAGES.

Comments

User Id		Date Added		Comment
sregino@kelleykronenberg.com		01-10-2025		January 10, 2024 VIA ELECTRONIC SUBMISSION Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Insured: Dave Compton and Laurie Dunn Insurance Carrier: State Farm Florida Insurance Company Claim No.: 59-56G4-91D Policy No.: 59-CP-L728-5 (effective December 4, 2022-2023) Date of Loss: September 17, 2023 CRN Filing No.: 792753 Property Location: 9047 NW 19th Street, Wildwood, FL 34785-7449 To Hew Woodward, Esq: This is State Farm Florida Insurance Company’s (“State Farm”) formal response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed on behalf of Dave Compton and Laurie Dunn by Hew Woodward, Esq., as it relates to Claim number 59-56G4-91D. The Department of Financial Services (“DFS”) accepted the CRN on November 15, 2024, and assigned it filing number 792753. The following reply has been uploaded to the Department of Financial Services. After reviewing the CRN, State Farm denies all allegations contained in the Insureds’ CRN. State Farm conducted a thorough review of its handling of the Insureds’ claim, Subject Claim No.: 59-56G4-91D. State Farm denies that it has violated any of the statutes as alleged in the CRN. At all times, State Farm acted in good faith, fairly and honestly toward its Insureds and with due regard for the Insureds’ interests. State Farm also argues that the CRN fails to adequately describe the alleged violations and fails to provide sufficient information to allow State Farm to correct the alleged violations. The Notice is deficient and fails to comply with the requirements of the Florida Statutes. Florida Statute §624.155(3)(b) requires that a Civil Remedy Notice “state with specificity” the statutory provisions allegedly violated, the facts and circumstances giving rise to the violation, the name of any individual involved in the violation, and the specific policy language relevant to the violation. Rather than include the specifics required by Statute, when asked to identify the specific policy language relevant to the alleged violations, the Notice simply lists sections of the Policy and general language regarding coverage. The Notice does not provide an explanation as to how State Farm failed to comply with the terms of the policy with specific factual support or specific language in the policy pertaining to the alleged incident. Simply listing sections of the policy and general policy language regarding coverage without providing any further analysis or discussion of how the policy was violated is in direct contradiction to Florida Statute §624.155(3)(b) and renders the Notice defective. See Julien v. United Property & Casualty Insurance Company, 2021 WL 824438 (Fla. 4th DCA 2021). The notice filed by Hew Woodward, Esq., in the above-referenced matter includes statutory provisions that could be claimed against an insurance company regardless of whether they are relevant or applicable to the alleged facts contained in the Notice. Because the CRN fails to identify the specific facts applicable to the listed statutes that were allegedly violated with respect to the subject claim, State Farm is unable to properly respond and said CRN should be rejected and returned. Specifically, the Insureds allege the following violations of Florida Statutes: • § 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 and his interests. State Farm strictly denies any violation of any section of Florida Statute § 624.155(1)(b)(1). • § 624.155(1)(b)(2): Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made. State Farm strictly denies any violation of any section of Florida Statute § 624.155(1)(b)(2). • § 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. State Farm strictly denies any violation of any section of Florida Statute § 624.155(1)(b)(3). • § 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. State Farm strictly denies any violation of Florida Statute §626.9541(1)(i)(3)(a). • § 626.9541(1)(i)(3)(b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. State Farm strictly denies any violation of Florida Statute §626.9541(1)(i)(3)(b). • § 626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims. State Farm strictly denies any violation of Florida Statute § 626.9541(1)(i)(3)(c). • § 626.9541(1)(i)(3)(d): Denying claims without conducting reasonable investigations based upon available information. State Farm strictly denies any violation of Florida Statute § 626.9541(1)(i)(3)(d). • § 626.9541(1)(i)(3)(e): Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed. State Farm strictly denies any violation of Florida Statute § 626.9541(1)(i)(3)(e). • § 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. State Farm strictly denies any violation of Florida Statute § 626.9541(1)(i)(3)(f). • § 626.9541(1)(i)(3)(g): Failing to promptly notify the insured of any additional information necessary for the processing of a claim. State Farm strictly denies any violation of Florida Statute § 626.9541(1)(i)(3)(g). • § 626.9541(1)(i)(3)(h): Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. State Farm strictly denies any violation of Florida Statute § 626.9541(1)(i)(3)(h). • § 626.9541(1)(i)(3)(j): Altering or amending an insurance adjuster’s report without: (I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and (II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or (III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change. State Farm strictly denies any violation of Florida Statute § 626.9541(1)(i)(3)(j). • § 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 §327.70131(5). State Farm strictly denies any violation of Florida Statute §626.9541(1)(i)(4). Contrary to the requirement to, “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time,” the purpose of which is “to enable the insurer to investigate and resolve [the] claim,” the CRN itself only provides unsupported, vague, ambiguous, and incorrect allegations with no basis in fact or circumstances. Aside from the fact that the allegations are devoid of any specific facts, the tenor and inferences of the allegations are wholly without merit and State Farm denies each and every one. The general allegations state, “State Farm Florida Insurance Company (“State Farm”) breached its statutory and contractual duties during its adjustment of the insurance claim reported by Dave Compton and Laurie Dunn (the “insured” or “insureds”) in connection with severe damage to a residential dwelling and personal property located at 9047 NW 19th Street, Wildwood, Florida, 34785 (“Dwelling” or “Insured Property”) caused by fire, smoke, water and firefighting activities on or about September 17, 2023 (“Loss”), resulting in substantial damages and additional living expenses. Despite clear evidence that this was a covered loss, State Farm undertook an extended adjustment process in bad faith, resulting in substantial damage to the insured including but not limited to severe damages and additional living expenses. State Farm violated the minimum statutory and contractual duties that it owed to the insured, including but not limited to the following ways: Failing to investigate the claimed damages to the insured property with objective and qualified experts and adjusters; failing to adjust the claimed damages and expenses in an objective and reasonable manner; refusing to pay undisputed portions of the insurance claim; misrepresenting material facts; refusing to acknowledge and meaningfully respond to communications; refusing to communicate reasonable requests for documents and information; refusing to pay insurance benefits to repair all of the damaged property covered by the insurance policy, when the obligation to issue such payment was apparent.” The general allegations further state, “…In Fact, it was State Farm’s obligation to affirmatively point out policy benefits to its insureds, despite the fact that the insured or the insured’s representative may not have been aware of such benefits. The insuring agreement is intended to provide the insured with peace of mind and the insurance company is expected to facilitate that intention. State Farm has refused to pay benefits for damage to the insured property caused by the loss (among others). Rather than attempting in good faith to adjust the insurance claim, State Farm withheld benefits and has refused to meaningfully respond to the insured’s claim submissions and issue undisputed payments on the loss. The underlying concept of insurance is that the insurer’s granting of timely and prompt indemnification or security against a contingent loss places the insured back to a pre-loss condition in a timely manner. However, State Farm’s claim representatives and adjuster(s) did not perform an adequate or reasonable investigation of the damage, and State Farm has provided no reasonable explanation as to why payment for all of the damaged property was not issued in a timely manner.” The general allegations go on to state, “ State Farm violated the minimum statutory requirements of all insurers to provide payment of all undisputed amounts due and owing under the subject insurance policy in a timely manner. State Farm knew and/or should have known that insurance monies were due and owing, however, State Farm has not made any additional payments to the insured. State Farm’s refusal to pay insurance benefits is an intentional attempt to “low ball” the insured’s damages. State Farm has acted improperly and in bad faith by ingnoring or summarily dismissing the insured’s and their contractors’ claim submissions and repair estimates, without conducting a fair and reasonable investigation. In sum, State Farm did not investigate and fairly or reasonably interpret the facts surrounding this claim. State Farm has failed to issue payment of the undisputed portion of the insured’s property damage claim within 90-days, despite the fact that it had all information necessary to calculate the issue payment for the undisputed portion of the claim.” The general allegations further state, “…State Farm refused and/or failed to acknowledge their claim submissions, tender all insurance proceeds owed to the insured upon demand, and unreasonably withheld payment to the insured. State Farm’s refusal and/or failure to settle the insurance claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards the insured is unreasonable, wrongful, and illegal conduct. In fact, State Farm’s representatives have made material misrepresentations to the insured concerning the status of its investigation and adjustment of the claim, including but not limited to the date the insured. These representations are false because State Farm has not adequately investigated and adjusted the claim and has not issued any additional payments to the insured. State Farm has done little more than manufacture coverage defenses and pursue evidentiary support for pre-conceived and ill-conceived coverage defenses, all in bad faith on the part of State Farm.” Setting forth the correct factual background, this claim was first reported to State Farm on September 17, 2023 which is the date of loss. On September 18, 2023, the day after the reported date of loss, the Insured agreed to use to the State Farm Premier Service Program and signed an authorization of repair contract with Servpro of Lake County for mitigation and cleaning services. On September 20, 2023, an inspection was completed by Claim Specialist Jay Mercer from State Farm and coverage was opened. Thereafter payments were made for actual cash value in the amount of $230,362.50 with recoverable depreciation in the amount of $11,473.15. State Farm kept in regular contact with the insureds at every step of the claim handling process, inspection, and investigation. At each point that the insureds provided State Farm with receipts or expenditures, they were received, reviewed and payments were made. Claim Specialist David Houk from State Farm issued State Farm’s payment letter in the amount of $230,362.50 to the Insureds for damages under Coverage A. On the same day, Claim Specialist David Houk produced a letter to the Insured advising of their additional living expense coverage, limits, and policy provisions specific to additional living expenses. On December 21, 2023, the insureds signed a contract with Stone Claims Group (Public Adjuster) for public adjusting services with Tara Lyn Stone, P.A. of Stone Claims Group. On March 4, 2024, the public adjuster sent State Farm an estimate for damages, contents list and invoices. The estimate was in the amount of $573,712.52 for repairs and $187,867.68 for personal property. On May 6, 2024, Claim Associate Celissa Williams from State Farm authored and sent a letter to the Insureds advising they were unable to contact the Insureds and requesting further information regarding ages for all damaged personal property. This request in writing from Claim Associate Celissa Williams for the ages of the Insureds’ personal property was repeated for lack of response on May 14, 2024 and May 23, 2024. On May 10, 2024, the PA contacted State Farm and stated that he is currently uploading the damaged personal property list to the State Farm portal. The email further stated that: Dave Compton & Laurie Dunn have been contacted by State Farm adjuster David Houk on February 1st, 2024 requesting "Personal Property inventory list of all unsalvageable items along with prices for like new products". This was submitted along with an estimate of damages & invoices on March 4th, 2024 to State Farm statefarmfireclaims@statefarm.com. On May 21, 2024, the public adjuster contacted State Farm and requested a re-inspection of the property. On May 28, 2024, the public adjuster contacted State Farm and advised that the Insureds’ personal property contents list was uploaded to State Farm’s portal. On June 2, 2024, Claim Specialist David Houk received a call from the PA and they agreed to meet on site with the NI and PA the following day, June 3, 2024 where PA will outline the additional items needed to close the file. On June 13, 2024, the PA submitted a revised building repair estimate on June 13, 2024, for a total of $571,710.15 for the repairs and personal property damage totaling $52,474.69. Finally, with respect to its requirement to specify how State Farm may “cure” the alleged violations, the Insured demands State Farm “(1) create and implement adequate guidelines for the proper investigation and evaluation as to claims handling and for the training and supervision of employees, agents, and representatives which will avoid future statutory violations as set forth above to avoid this from occurring in the future; (2) create and implement adequate guidelines for the proper investigation and evaluation of fire damage claims, and for the training and supervision of employees, agents, and representatives with regard to these claims to ensure that State Farm’s claims handling procedures with regard to these type of losses are adequate to stop unfair and wrongful treatment of insureds; (3) assist the insureds and/or reimburse their expenses to mitigate damages; (4) promptly and timely respond to requests for information by the insureds; (5) Act fairly and honestly towards the insureds and with due regard for their interests in attempting to settle the insureds’ claim; (6) immediately tender all insurance monies due and owing the insureds pursuant to the most recent estimates and property inventories submitted; (7) acknowledge in writing to the insured that State Farm’s handling of this claim is and was insufficient to place the insureds back into their pre-loss condition; (8) take any other reasonable and necessary measures to place the insureds back into their pre-loss condition; (9) acknowledge, in writing, its sincere apology to the insured for its wrongful claims handling practices in the adjustment of this claim; and (10) immediately pay all amounts necessary to repair the damage to the dwelling and personal property, plus additional living expenses and interest (but subtract prior payments, deductible, and depreciation) which payments are exclusive any claims for fees, costs, bad faith or extra-contractual damages.” Section 624.155 does not impose on an insurer the obligation to pay whatever the insured demands. Section 624.155(2)(d) would have no effect or purpose under such an interpretation. In Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278 (Fla. 2000), the Florida Supreme Court accepted and quoted the reasoning of the court below in its opinion which stated in relevant part, as follows: Section 624.155 does not impose on an insurer the obligation to pay whatever the insured demands. . . . Section 624.155(2)(d) would have no effect or purpose under such an interpretation. The law does not support such an expansive and illogical reading of Fla. Stat. Ann. §624.155(2)(d). . . . [t]o cure an alleged violation and to avoid a civil action, an insurer must pay the claim . . . before the sixty days expire. Talat, 753 So2d at 1282 citing Talat Enterprises Inc. v. Aetna Cas. & Sur. Co., 952 F.Supp. 773, 777-778 (M.D. Fla. 1996). The law does not support such an expansive and illogical reading of Fla. Stat. Ann. §624.155(2)(d). Talat, 753 So2d at 1282 citing Talat Enterprises Inc. v. Aetna Cas. & Sur. Co., 952 F.Supp. 773, 777-778 (M.D. Fla. 1996). For the aforementioned reasons, the Civil Remedy Notice is insufficient as a matter of law. It is important to note, that while an insurance company is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested. Florida law continually affirms the principle that an insurer has the right to investigate claims presented for payment. An insurance company is expressly afforded an opportunity to evaluate its rights and liabilities. Neither the subject policy nor does Florida law provide that a carrier must accept whatever demand for repairs it is provided by its Insured as the amount necessary to repair a loss. In the instant case, the violations alleged by the Insured all revolve around the contention that State Farm did not accept and pay the Insured’s full demand for repair. In closing, State Farm’s actions in handling the Insured’s claim were prompt, thorough, conducted in accordance with the insurance policy and Florida law, and most importantly, in good faith. Furthermore, State Farm complied with all obligations under the insurance policy and the Florida Statutes. State Farm inspected the Insured’s property, the claimed damages, and attempted to obtain all facts and circumstances of the loss through its investigation of the claim. Therefore, State Farm denies each and every allegation contained in the Notice. State Farm takes the position that the CRN should be rejected and returned by the Department of Financial Services due to its failure to comply with Florida Statute §624.155 and Florida Case law, and regardless of the rejection, State Farm denies all allegations contained in the CRN and submits there are no violations to the insured. While this response is meant to be comprehensive, State Farm’s response above is based upon the limited information provided in the CRN and the information State Farm has to date. If Insureds, or Hew Woodward, Esq., are in possession of information or facts that State Farm is not in possession of, State Farm requests all such information or facts be provided to it immediately. Please note that State Farm’s response is not necessarily exhaustive and does not preclude it from asserting any other valid reason for seeking rejection and return of the CRN. Also, this letter or any act or failure to act on the part of State Farm or any agent or representative of State Farm should not be construed as a waiver of any rights or defenses available to it by contract or at law as all such rights and defenses are hereby specifically reserved. We trust that this response addresses the allegations of insurer violation alleged in the CRN of Insurer Violations. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Respectfully submitted, /s/ Michael L. Garcia.___ Michael L. Garcia, Esq. For the Firm cc: Hew Woodward, Esq. PO Box 140312 Orlando, FL 32814 Pleadings@HGWlegal.com

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. Before submitting a Notice using this system, please verify that all text has been entered correctly and completely. Once the Notice has been submitted, the text cannot be changed or deleted.

DFS-10-363
Rev. 10/14/2008