Civil Remedy Notice of Insurer Violations
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Filing Number:     793186
Filing Accepted:  11/19/2024
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Complainant
Last/Business Name *  
LUCE   First Name   JULIETA
Street Address * 920 SAVANNAS POINT DRIVE, APT. B
City, State Zip * FORT PIERCE, FL 34982
Email Address * CDP@WEKLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   LUCE   First Name   JULIETA
Policy # * 38784069 Claim #* 01-006-879758
Attorney
Attorney is Applicable
Last Name* PAGAN First Name * CHRISTOPHER Initial D
Street Address* 800 EAST BROWARD BOULEVARD, SUITE 510
City, State Zip* FORT LAUDERDALE , FL 33301
Email Address * CDP@WEKLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   HOMESITE INSURANCE COMPANY
NAIC Company Code 17221
 
Name of individual responsible for violation (if any):* PHIL PEASE
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
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)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

SECTION I – PROPERTY COVERAGES Coverage A – Dwelling. SECTION I – PERILS INSURED AGAINST SECTION I – CONDITIONS Loss Settlement.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Julieta Luce ("Insured") purchased an insurance policy ("Policy") from Homesite Insurance Company ("Homesite" or “Carrier”) with effective coverage on the date of loss, on or about September 28, 2022, and Policy number 38784069 to insure her property located at 920 Savannas Point Drive, Apt. B., Fort Pierce, FL 34982 (the "Property").?? On or about September 28, 2022, the Property suffered severe damage as the result of passage of Hurricane Ian, which caused ensuing damages to the Property ("Loss"). HOMESITE was notified of the Loss and was granted access to the property in order to complete their inspection. HOMESITE acknowledged the claim and assigned claim 01-006-879758 ("Claim") to the Loss. HOMESITE sent an adjuster to inspect the subject property. While the adjuster confirmed damage to the property as claimed, they also prepared a purported estimate that failed to account for several necessary repairs. On December 6, 2023, Phil Pease, Claim Senior Adjuster for HOMESITE, authored a letter to counsel for the Insureds (“Coverage Letter”) stating that the damages were covered under the policy and that payment was forthcoming. Nowhere in the letter does HOMESITE state that they were unable to conduct or complete an investigation of the damages and necessary repairs to the Property, nor does it mention any reason why HOMESITE would have been prejudiced in its investigation. After being provided plenty of evidence (including photos, estimates, and immediate access to the property upon discovery) showing that damage from a plumbing leak occurred at the property that will require extensive repairs, HOMESITE continues to refuse to provide additional money in order to complete these repairs. HOMESITE also has the ability to determine the costs needed to fully repair this property but has not attempted to discover this information and has instead forced the Insured to pursue legal recourses for the money due and owing under the contract of insurance. HOMESITE is trying to avoid finding any further information that would increase the amount of coverage available on this claim despite being aware that additional costs would need to be incurred by the Insured to repair her home. The Insured has fully complied with all applicable Policy provisions requiring cooperation with the?investigation;?however, HOMESITE has unequivocally failed to properly adjust this Claim, as elaborated above. HOMESITE has not attempted, in good faith, to settle this claim when, under the circumstances, it could and should have done so had it acted fairly and honestly toward the policyholder and with due regard to the policyholder's interests.? Rather, HOMESITE has acted with only its own profit and shareholders in mind. As a direct consequence of HOMESITE’s failure to adjust this Loss in good faith and make any additional supplemental payment, the Insured continues to be without adequate compensation for the damages sustained at the Insured’s Property more than two (2) years ago.?? By stating the above detailed?facts,?it is clear that HOMESITE has violated the following 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 Insureds and with due regard for their interest. • 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)(3)(a) Failing to adopt and implement standards for the?proper investigation of?claims; • 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims; • 626.9541(1)(i)(3)(i) Unfair claim settlement practices. To date, HOMESITE has in bad faith failed to provide sufficient coverage under the Policy to the Insureds. As a direct result of HOMESITE’s underpayment of the Claim and breach of the Florida Statutes, the Insured was?forced to seek the?help of licensed professionals to assist her, including legal counsel.?Due to the amount of time that has passed since the date of loss and the information discussed above, there is irrefutable evidence that HOMESITE knowingly and intentionally, and in bad faith delayed the settlement process in order to further disadvantage the Insured. The financial detriment caused to the Insured is a direct result of HOMESITE’s reckless treatment of the claims process. The Insured submitted all documents requested in a timely fashion, made the property available for inspection immediately after the discovery of the loss, submitted an estimate, and satisfied all requests. However, HOMESITE failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim.? To deny the Insured the benefits clearly due and owing under the Policy, for which they been making premium payments for and after they have satisfied all of his obligations is morally and ethically reprehensible and reeks of Unfair Claims Practice and Bad Faith. Upon information and belief, the aforementioned actions complained of, among others, were made by HOMESITE so often?as to constitute a general business practice, evidencing a motive to enhance HOMESITE’s profits, and designed to cause a detrimental effect to its policyholders. The above clearly depicts that HOMESITE adjusted this claim in bad faith, continue to act in bad faith towards its Insureds and that HOMESITE is in direct violation of Unfair Claims Practices.?? This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should HOMESITE fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, HOMESITE must: (1) Immediately tender all proceeds due and owing to the Insured that are fairly owed under the insurance policy that would reasonably compensate them in order to put the loss property back to its pre-loss condition ($19,195.41 less any applicable deductible and prior payment by HOMESITE); (2) Immediately afford coverage for the repairs to the subject property necessary to put the property back into its pre-loss condition and reimburse for the work already performed (3) Agree to reimburse the Insured’s reasonable attorneys’ fees and costs for having to become involved to resolve the claim; and (4) Agree to reimburse the Insureds\ for interest on the amount of benefits that was found to be?due and owing to the Insured, relating back to the date of loss.
Comments
User Id Date Added Comment
tiyarollelaw@gmail.com 12-17-2024 LAW OFFICE OF REBECCA WOLTJER ALL ATTORNEYS AND STAFF ARE EMPLOYEES OF AMERICAN FAMILY INSURANCE CO., S.I. NOT A LEGAL PARTNERSHIP OR PROFESSIONAL CORPORATION PO BOX 77055 MADISON, WISCONSIN 53707 TELEPHONE: 800-692-6326 FACSIMILE: (844) 556-7209 Direct Dial No.: (800) 692-6326. EMAIL: tiya.rolle@amfam.com December 17, 2024 Julieta Luce c/o Christopher D Pagan 800 East Broward Boulevard, Suite 510 Fort Lauderdale, FL 33301 cdp@weklaw.com Re: Civil Remedy Notice Claim No.: 01-006-879758 Date of Loss: 9/28/2023 Insureds: Julieta J Luce Policy No.: 38784069 Dear Christopher Pagan, We are in receipt of your Civil Remedy Notice of Insurer Violations (hereinafter “Notice”). Homesite Insurance Company responds to the substance of your Civil Remedy Notice of Insurer Violations as follows: This correspondence will serve as the response of Homesite Insurance Company (hereinafter “HOMESITE”) to the Notice, DFS number 793186. HOMESITE hereby responds to the factual assertions set forth in the Notice without waiving any rights under Florida law to object to the legal deficiencies and inadequacies of the Notice. In the Civil Remedy Notice, you have asserted the following as the reasons for filing the Notice – (1) Claim Delay, (2) Unsatisfactory Settlement Offer, and (3) Unfair Trade Practice. You have also cited several sections of the Florida Statutes alleging, in part, that HOMESITE has acted in bad faith and failed to settle the claim promptly. These allegations are broad and unspecified, to which a specific and detailed response is impossible given the vagueness of the allegations. Notwithstanding, HOMESITE categorically denies these allegations both as to any general practice and with regard to this particular claim. Without waiving any rights under Florida law regarding the deficiencies and inadequacies of the Notice, HOMESITE hereby responds to the assertions set forth in the Notice as follows: Response to Reason for Notice You state that the reasons for the Notice are due to the following: (1) Claim Delay, (2) Unsatisfactory Settlement Offer, and (3) Unfair Trade Practice. Homesite responds by stating that these allegations are without basis and are therefore denied. Homesite further states that the alleged 09/28/2023 loss was first reported to Homesite on November 2, 2023. The property was inspected on or around November 8, 2023. Ultimately, payment in excess of $4,000 was issued on the claim on or around December 5, 2023. The issues between the parties are currently being litigated in the matter of Luce v. Homesite pending in St. Lucie County, Case No. 2024CC002061. Response to Statutory Provisions Allegedly Violated The Civil Remedy Notice statute requires that a complainant “indicate all statutory provisions alleged to have been violated,” and you have listed several Florida Statutes. These allegations are overbroad and non-specific, apparently based upon conjecture or speculation to which a response is impossible given the uncertainty of the allegations. Notwithstanding, HOMESITE categorically denies each alleged violations of statutes or rules asserted by you, both as to any general practice and with regard to this specific claim, as well. With respect to the statutes cited in this section of the Notice, HOMESITE denies having violated the referenced statutes and responds to each of the alleged violations as follows. §624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have been done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests. This allegation is denied. HOMESITE has both a duty and a right to fully investigate this loss, which it did. HOMESITE responds by stating that this allegation is without basis and therefore denied. Following the notice of loss, HOMESITE properly performed an inspection, evaluated the claim accordingly, and issued payment. §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. This allegation is denied. HOMESITE has both a duty and a right to fully investigate this loss, which it did. HOMESITE responds by stating that this allegation is without basis and therefore denied. Following the notice of loss, HOMESITE properly performed an inspection, evaluated the claim accordingly, and issued payment. §626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims. This allegation is denied. HOMESITE has both a duty and a right to fully investigate this loss, which it did. HOMESITE responds by stating that this allegation is without basis and therefore denied. Following the notice of loss, HOMESITE properly performed an inspection, evaluated the claim accordingly, and issued payment. §626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims. This allegation is denied. HOMESITE has both a duty and a right to fully investigate this loss, which it did. HOMESITE responds by stating that this allegation is without basis and therefore denied. Following the notice of loss, HOMESITE properly performed an inspection, evaluated the claim accordingly, and issued payment. §626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b). This allegation is confusing as this is not a PIP matter. The Notice Fails to Reference Specific Policy Language The statutory provision governing Civil Remedy Notices requires complainants to “[b]riefly reference the specific policy language that is relevant to the violation, if any.” §624.155(3)(b)4, Fla. Stat. The Notice filed on your behalf fails to cite to a policy provision providing the specific language relevant to the violation. Essentially, you cite no policy language that supports any of the allegations made against HOMESITE. A detailed and specific response to the cited policy language is impossible, given the vagueness of the allegations cited in the Notice. Notwithstanding, HOMESITE has both a duty and a right to fully investigate this loss, which it did. HOMESITE acted immediately upon Notice of the complainant’s claim. Response to Facts/Circumstances Cited as Giving Rise to Alleged Violation The governing statute requires Civil Remedy Notices to “state with specificity . . . [t]he facts and circumstances giving rise to the violation.” Fla. Stat. §624.155(3)(b)2. The Notice contains a section requiring the following: “To enable the insurer to investigate and resolve your claim, describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time.” However, the Notice lists alleged violations that are vague, overbroad and unsubstantiated that HOMESITE is precluded from being able to respond in any specific manner. Nevertheless, HOMESITE asserts that all actions that have been taken in responding to your claim have been performed properly, in good faith and for the purpose of reaching a fair and appropriate claim decision. HOMESITE therefore denies all allegations set forth as the “facts and circumstances giving rise to the violations” in the Notice. HOMESITE denies it has engaged in bad faith conduct in this matter. HOMESITE denies any undue delay in adjusting the claim. HOMESITE promptly and timely responded to the loss Notice and report of claim, retained an adjuster to assess the damages, and promptly began its investigation of the claim. HOMESITE denies any allegation that it did not adopt or implement standards for proper investigation of the claim. HOMESITE stands by its adjustment and investigative practices generally and the adjustment and investigation of this claim specifically. HOMESITE has acted properly, promptly and in accordance with the terms of the policy of insurance and applicable law in the investigation of this claim. HOMESITE asserts that all actions taken have been made in good faith and for the purpose of fair, equitable and timely resolution of this matter. HOMESITE has acted appropriately at all times regarding the handling of this claim. HOMESITE has not violated any applicable statutory provisions in relation to this claim and expressly denies all of the allegations set forth as the “facts and circumstances giving rise to the violations.” Conclusion HOMESITE promptly investigated the claim, and contrary to the allegations in the Notice, the facts show that HOMESITE has consistently complied with all legal and professional standards for the investigation and adjustment of this claim. HOMESITE investigated and evaluated your claim pursuant to the policy of insurance and subject to the policy limitations, exclusions, forms and endorsements applicable to the policy and in accordance with Florida law. Notwithstanding the deficiencies in the Notice, HOMESITE denies it violated the statutes cited in the Notice. HOMESITE hereby denies each and every allegation contained in the Notice, either explicitly or implicitly, and denies any wrongdoing in the handling of the subject claim. HOMESITE has acted fairly and with due diligence throughout the entire investigation and handling of this claim. To the extent that this response does not fully address and respond to the allegations set forth in the Notice, such deficiency is the direct result of the lack of specificity and the overall vague nature of the allegations contained therein. Contrary to the allegations in the Notice, HOMESITE has fully complied with its obligations under Florida Statutes and the policy of insurance with regard to the investigation and adjustment of this claim. HOMESITE categorically denies all allegations contained in the Notice. In sum, HOMESITE has evaluated this claim in good faith and all allegations of violation are statutorily deficient and without merit. I trust that the foregoing, without waiver of arguments regarding the lack of validity of the Civil Remedy Notice of Insurer Violations, adequately addresses any concerns that the insureds may have regarding this matter. Please do not hesitate to contact the undersigned if you require more information. Respectfully submitted, /s/ Tiya Rolle Tiya Rolle, Esq.
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