Civil Remedy Notice of Insurer Violations
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Filing Number:     793169
Filing Accepted:  11/19/2024
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Complainant
Last/Business Name *  
DIRLING   First Name   ROBERT
Street Address * 7061 68TH STREET NORTH
City, State Zip * PINELLAS PARK, FL 33781
Email Address * RRDDIRLING@MSN.COM
Complainant Type: * Insured
Insured
Last/Business Name*   DIRLING   First Name   ROBERT
Policy # * PFL327876-08 Claim #* CFL24604218
Attorney
Attorney is Applicable
Last Name* KRAPF First Name * GRANT Initial W
Street Address* 2790 SUNSET POINT RD
City, State Zip* CLEARWATER , FL 33759
Email Address * GRANT@KRAPFLEGAL.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   PEOPLE'S TRUST INSURANCE COMPANY
NAIC Company Code 13125
 
Name of individual responsible for violation (if any):* SYDNEY LYON, KEITH KILLINGSWORTH, TREVOR STEWART, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, PEOPLE'S TRUST INSURANCE COMPANY, WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unfair Trade Practice
Other : Misrepresenting the terms of the insurance policy
Other : Not treating the Insured with good faith claims conduct
Other : Looking for ways to deny full recovery to the Insured
Other : Looking for ways to delay full recovery to the Insured
Other : Failing to properly investigate the Insured's loss
Other : Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made,
Other : Not adjusting claims and evaluating loss properly
Other : Shifting the burden of insuring the loss to the Insured
Other : Intentionally misstating the terms, conditions, and benefits of the insurance policy to the insured
Other : Failing to implement proper standards for the adjustment and investigation of claims
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
626.9541(1)(i)(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.

Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language. "It is an accepted principle of law that when parties contract upon a matter which is the subject of statutory regulation, the parties are presumed to have entered into their agreement with reference to such statute, which becomes a part of the contract, unless the contract discloses a contrary intention." Westside EKG Assocs. v. Found. Health, 932 So. 2d 214, 216 (Fla. 4th DCA 2005), aff'd, 944 So. 2d 188 (Fla. 2006).
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

People's Trust Insurance Company (the "Insurer") has committed the following in handling the Insured's claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the policyholder and the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; 9) failing to provide an estimate that complies with the Florida Building Codes; and 10) 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. On or about September 26, 2024, while the subject policy was in full force and effect, the Insured's property was severely damaged by Hurricane Helene. The areas impacted include but are not limited to the roofing system, fence, shed, and exterior. The Insured timely submitted a claim on October 3, 2024, to the Insurer for hurricane damage and the ensuing damage therefrom. Thereafter, the Insurer assigned claim number CFL24604218 to the loss and sent a field adjuster to inspect the property on October 14, 2024. Then in a letter dated October 28, 2024, the Insurer notified the Insured that it was extending partial coverage for the loss. However, the Insurer wrongfully determined that it would only require $12,220.08 to restore the insured property to its pre-loss condition. The Insurer's lowball estimate is that of a classic under scope and under value of the claim. The Insurer erroneously denied coverage for the damage to the Insured's shed, siding, and downspout. The claims determination letter failed to comply with Fla. Stat. 626.9541(1)(i)(3)(f) as it did not include a reasonable explanation of the basis in the insurance policy, in relation to the facts, for the denial. The letter simply states the damage resulted from wear and tear. Given the partial denial, the Insured's disagreement with the coverage decision, and the scope and nature of the damage resulting from Hurricane Helene, the Insured retained a roofing contractor. After assessing the damage and the true scope of repairs, the roofing contractor produced an estimate identifying $18,413 for just a roof replacement. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. However, when the Insurer conducted its inspection of the insured property, the Insurer's adjuster failed to conduct a thorough and adequate investigation, or the adjuster intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss. The Insurer misrepresented the loss and wrongfully denied coverage for the damage sustained to the Insured's property. According to the claims determination letter, the Insurer's field adjuster observed damage to the shed, siding, and downspout, but attributed the cause of this damage to wear and tear. However, the Insurer never retained a professional engineer to determine the cause of this damage. The Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697. The Insurer intentionally ignored covered damage to deny the reported loss and wrongfully fail to pay the Insured. This is an underhanded attempt to place the financial interests of the Insurer over those of the Insured and to delay and frustrate the Insured's ability to have his claim adjusted promptly to begin restoring his property. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer's claim file and standards and procedures for the adjustment and investigation of claims. In short, the Insurer is not acting with due regard for the Insured's interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully denied coverage for the shed, siding, and downspout as well as wrongfully determining that it would only require $12,220.08 to restore the insured property to its pre-loss condition. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer's actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer's actions amount to but are not limited to the following: 1. Claim denial 2. Claim delay 3. Not treating the Insured with good faith claims conduct 4. Looking for way to reduce recovery to the Insured 5. Looking for ways to deny recovery to the Insured 6. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 7. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's interests 8. Placing the financial interest of the Insurer over that of the health and safety of the Insured 9. Shifting the burden of investigating onto the Insured 10. Conducting inadequate investigations 11. Making material misrepresentations Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1). Admit full coverage for the Insured's loss. (2). Tender full benefits owed to the Insured under the insurance contract. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. Via E-mail: PEOPLE'S TRUST INSURANCE COMPANY 18 People's Trust Way Deerfield Beach, FL 33441 claimsadmin@pti.insure
Comments
User Id Date Added Comment
bfrankel@gmail.com 12-30-2024 The Legal Department has been requested by People’s Trust Insurance Company (“PTI”) to assist it in responding to a Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of its Insured, Robert Dirling (“Insured”). In direct response to the CRN filing, PTI maintains that it has not been in any violation of the law and that the CRN is defective on its face and fails to comply with the specificity requirements under Florida Statute 624.155. As such, PTI objects to the Department’s acceptance of the above-referenced CRN. To be more specific, the CRN requirements set forth by Section 624.155 are that the notice be filed on a form provided by the department stating with specificity the following information, and such other information the department may require: (1) The statutory provision, including the specific language of the statute, which the authorized insurer allegedly violated. (2) The facts and circumstances giving rise to the violation. (3) The name of any individual involved in the violation. (4) Reference to specific policy language that is relevant to the violation, if any. If the person bringing the civil action is a third party claimant, she or he shall not be required to reference the specific policy language if the authorized insurer has not provided a copy of the policy to the third party claimant pursuant to written request. (5) A statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. In light of the instant CRN, PTI will provide a simple review of the facts and claims handling in support of its position there was no “bad faith” in the handling of this claim and detail how and why PTI acted property and within the letter of the law while handling the subject insurance claim. Following the claims summary, PTI will then address each respective statutory violation alleged in the Insureds’ CRN and respond accordingly in order to highlight why the CRN fails to perfect the Claimant’s right to pursue civil remedies under Florida Statutes. ? 1) On 10/3/2024, the Insured, Lisa Dirling, called to report shingles blown off her roof. Per the Insured, there were no other damages, no repairs had been performed, and the roof was 15 years old. Subsequently, on 10/14/2024, PTI’s Field Adjuster inspected the home in order to determine the cause of loss and scope of damages. At the time of the inspection, the Insured’s mother was present and stated that the wood fencing was blown over by the wind, and that shingles were missing on the roofing system. There was no inspection of the interior due to PTI’s Field Adjuster being informed there was no interior damage and therefore no need to inspect. As it relates to the roof, the inspection revealed wind damage, but no loss related damage was observed to the rear flat patio roof. 2) On 10/28/2024, a Coverage Determination letter was issued to the Insured acknowledging coverage for damages related to the roofing system, and excluding damage to the right elevation downspout, siding and shed as it was determined that those damages resulted from wear, tear, deterioration and mechanical damage. As for the exterior fence, the letter explained that while it did have wind damage it is excluded under the hurricane exclusion portion of the policy. The letter further explained that PTI was issuing payment for the covered damages measured at Actual Cash Value but the Insured could submit documentation of incurred costs to receive an additional payment for withheld depreciation, bringing the payment to Replacement Cost Value. 3) A few weeks later, on 11/8/2024, PTI received a Letter of Representation from Krapf Legal (“Insureds’ Attorney”), which was acknowledged on 11/12/2024 at which time PTI requested all estimates, invoices, documents, and photographs related to the claim for damages, as well as submission of a Sworn proof of Loss and supporting estimate. Thereafter, a certified copy of the policy was sent to Insureds’ Attorney on 12/2/2024. As shown, PTI has not acted in bad faith but has observed the terms and conditions of the Policy and Florida law, and has not engaged in any actions listed under “reasons for notice,” which include claim denial, claim delay, misrepresenting terms of the policy, inadequate/improper investigation, and unfair trade practice. Specifically, the CRN references no specific policy language relevant to the alleged violations and admittedly states that the violations alleged are statutorily based and do not rely on any specific policy language. In response thereto, PTI advises that coverage was acknowledged in this matter, PTI paid the full amount of damages as assessed by its Field Adjuster as covered under the policy, and that said payment was issued in accordance with the Loss Settlement provision of the policy. Moreover, the loss settlement provision states that the initial payment is measured at actual cash value and upon receipt of expenses incurred PTI will issue additional payment for withheld depreciation. To date, the Insured has not submitted proof of any incurred expenses that would warrant additional payment under the policy. As it relates to claim delay, PTI specifically denies this allegation as the timeline of events details how PTI promptly and timely investigated the subject claim and responded to correspondence and documents submitted by and on behalf of the Insured. As it relates to allegations concerning the Insureds disagreement with the coverage decision, PTI advises that it issued full payment in accordance with the assessment by its Field Adjuster and in line with the policy, and no proof of incurred expenses has been submitted that would warrant additional payment. While the CRN mentions an estimate prepared by a roofing contractor on the Insureds behalf, PTI has no documentation relating to this valuation. As it relates to unfair trade practice, the CRN does not provide any information in support of this and therefore PTI denies said allegations. PTI further maintains that its practices and/or guidelines for response to claims are adequate to provide for the proper investigation and resolution of all claims. Turning to the statutory sections alleged to be violated, PTI responds as follows: GENERAL DENIAL PTI denies of all the statutory violations alleged in the Insured’s CRN. 1) ALLEGED VIOLATION §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. RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. PTI accepted coverage and provided the Insured with PTI’s estimate and scope of repairs supporting the ACV undisputed payment issued on 10/28/2024. 2) ALLEGED VIOLATION §626.9541(1)(i)(2) – A material misrepresentation made to an insured or any other 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 contact or policy on less favorable terms than those provided in, and contemplated by, such contract or policy. RESPONSE The Insured does not indicate what facts and/or policy provisions were misrepresented. In fact, the CRN states the following: “the violations alleged are statutorily based and do not rely on any specific policy language…”. Hence, PTI denies this alleged statutory violation. 3) ALLEGED VIOLATION §626.9541 (1)(i)(3)(a) – Failing to adopt and implement standards for the proper investigation of claims. RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. PTI advises that this allegation requires specific facts regarding the method of the investigation; the reasons the investigation was improper or otherwise inadequate; the reasons why this alleged inadequacy is due to the failure to adopt and implement standards for the proper investigation of claims, and the facts supporting these conclusions. To allege an inadequate investigation, the Notice must include specific facts regarding the method, rather than merely the results. Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006) As mentioned above, PTI issued a coverage determination letter on 10/28/2024. Within the letter, the Insured was advised that coverage was being afforded for the claim and that a payment of $6,332.08 under Coverage A and would be issued. This payment reflected the Actual Cash Value of the damages to the dwelling. As the Insureds have not advised PTI as to how it failed to investigate the claim and/or what standards were not adopted or implemented, this alleged violation is emphatically denied. 4) ALLEGED VIOLATION §626.9541 (1)(i)(3)(b) – Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. RESPONSE The Insured does not indicate what facts and/or policy provisions were misrepresented. In fact, the CRN states the following: “the violations alleged are statutorily based and do not rely on any specific policy language…”. Hence, PTI denies this alleged statutory violation. 5) ALLEGED VIOLATION §626.9541 (1)(i)(3)(d) – Denying claims without conducting reasonable investigations based upon available information. RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. As mentioned above, the Insureds have not advised PTI as to how it failed to investigate the claim and/or what standards were not adopted or implemented. Furthermore, PTI promptly investigated the claim, and a favorable coverage decision was made within 14 days after the post-loss property inspection. 6) ALLEGED VIOLATION §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. RESPONSE PTI denies this alleged statutory violation and advises that Claimants have not provided any facts to sustain such an allegation. PTI issued a coverage determination letter on 10/28/2024. Within the letter, the Insured was advised that coverage was being afforded for the claim and PTI was issuing loss payment in accordance with the itemized estimate describing the work needed to return the home to pre-loss condition and that said payment was measured at actual cash value in accordance with the policy at issue. The letter also cited to the relevant portion of the applicable policy and advised the Insured to submit documentation showing incurred expenses in order to obtain additional payment for the withheld depreciation and bring the payment to replacement cost value. CONCLUSION /SUMMATION In sum, PTI timely accepted coverage under Florida law and maintains that all alleged violations of Florida Statutes in this CRN are baseless, and the CRN offers no facts in support of the statutory violations alleged. In fact, the CRN broadly, vaguely and without a scintilla of evidence, alleges boilerplate, unsupported false allegations of statutory violations and tracks, in generalities and conclusions only, the language of numerous sections of Florida’s Civil Remedy Statutes without connecting the purported statutory violations to the facts of the claim and the history of the claims investigation. Moreover, the CRN also fails to include specific policy language relevant to the violation(s). In response to these very general allegations, and to comply with its statutory obligations, PTI responds by denying each and every allegation of misconduct asserted in the CRN, whether expressed and or implied, and by categorically denying each and every alleged statutory violation.?? PTI further maintains that the CRN, as filed, is defective on its face as it fails to meet the specificity requirements of Florida Statute 624.155. As always, PTI is willing to consider any additional information the Insureds can provide in support of their claim. We trust the foregoing fully explains the facts and circumstances of the claim and addresses any concerns raised. If we can provide other information or clarification of information in the claim, please do not hesitate to contact the undersigned. Thank you for your attention to this matter. Very truly yours, /S/ Cosima Ortiz Cosima Ortiz, Esq. Corporate Counsel People’s Trust Insurance Company Cc: Grant Krapf, Esq. 2790 Sunset Point Rd. Clearwater, FL 33759 E-mail: grant@krapflegal.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.

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