Civil Remedy Notice of Insurer Violations
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Filing Number:     793197
Filing Accepted:  11/19/2024
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Complainant
Last/Business Name *  
SUBHAM HEALTHCARE D/B/A STEINHATCHEE DRUGS   First Name   SCOTT
Street Address * 102 9 TH ST. E.
City, State Zip * STEINHATCHEE, FL 32359
Email Address * STEINHATCHEEDRUGS@OUTLOOK.COM
Complainant Type: * Insured
Insured
Last/Business Name*   SUBHAM HEALTHCARE D/B/A STEINHATCHEE DRUGS   First Name   SCOTT
Policy # * BPP5035T Claim #* 01-008-143803
Attorney
Attorney is Applicable
Last Name* KANDELL First Name * SCOTT Initial
Street Address* 2665 SOUTH BAYSHORE DRIVE, SUITE 500
City, State Zip* MIAMI , FLORIDA 33133
Email Address * CRNRESPONSE@KKPFIRM.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   MAIN STREET AMERICA PROTECTION INSURANCE COMPANY
NAIC Company Code 13026
 
Name of individual responsible for violation (if any):* BRIAN MATER AND REPRESENTATIVES FROM AMERICAN FAMILY INSURANCE CLAIMS SERVICES, INC. AND MAIN STREET AMERICAN PROTECTION INSURANCE CO.
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Claim Delay
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)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

E. Inspections And Surveys 1. We have the right to: a. Make inspections and surveys at any time; b. Give you reports on the conditions we find; and c. Recommend changes. 2. We are not obligated to make any inspections, surveys, reports or recommendations and any such actions we do undertake relate only to insurability and the premiums to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a. Are safe and healthful; or b. Comply with laws, regulations, codes or standards. 3. Paragraphs 1. and 2. of this condition apply not only to us, but also to any rating, advisory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations. 4. Paragraph 2. of this condition does not apply to any inspections, surveys, reports or recommendations we may make relative to certification, under state or municipal statutes, ordinances or regulations, of boilers, pressure vessels or elevators.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On or about September 26, 2024, the insured property located at 102 9th St SE Steinhatchee, FL 32359 (“Property”), owned by Chirag Patel (“Insured”) and insured under Subham Healthcare d/b/a Steinhatchee Drugs’ policy (“Policyholder”), suffered catastrophic damage due to Hurricane Helene. Hurricane Helene struck Taylor County as a powerful Category 4 storm, leaving behind extensive destruction. The hurricane generated winds near 140 mph, devastating nearly 90% of homes and infrastructure. This event marks one of the most severe impacts on Florida’s Big Bend region in recent history. This Civil Remedy Notice is filed pursuant to Section 624.155, Florida Statutes, due to the insurer’s failure to properly investigate, adjust, and resolve the claim in good faith. Upon discovering damages consistent with the cause of loss, the insured initially submitted their claim to Main Street American Protection Insurance Co. and desk adjuster Brian Mater from American Family Insurance Claims Services, Inc. was assigned to handle the claim. The insured solicited White Glove Adjusting, LLC’s expertise in navigating the claims process. An inspection date, November 7th, 2024, was agreed upon by both parties, but during a conversation confirming said date, Mr. Mater denied White Glove Adjusting, LLC’s request for photos of the subject loss and stated that the carrier already had an attorney retained. On the date of the inspection, Mr. Mater revealed that he had conducted an inspection of the property three days post-loss without the insured’s consent and in direct violation of Fla. Stat. § 626.9541(1)(i) (2023), which mandates that insurers adopt and implement proper standards for the investigation of claims; Mr. Mater claimed that while the insured could not access the property so soon post-evacuation efforts—a statement that proved to be false—he had a “pass.” Mr. Mater then disclosed to White Glove Adjusting, LLC’s Jessica Provost that he had also sent an engineer to conduct an inspection of the property without the insured’s consent or knowledge. When asked for a copy of the engineering report and inspection documents, Mr. Mater refused, citing work product privilege—a clear violation of the insured’s right to transparency and access to information under the policy. Time and time again, Mr. Mater had every opportunity to openly communicate with the insured and their representatives and vehemently refused to do so. Not only did Mr. Mater refuse to properly communicate with the insured, but he also deliberately created additional hurdles for the insured as he led them to believe that an inspection would not take place until after Hurricane Milton. This ongoing lack of transparency and cooperation has caused significant delays, preventing the insured from promptly making repairs and returning the property to its pre-loss condition. To date, Mr. Mater and Main Street American Protection Insurance Co. have not provided clear and detailed communication pertaining to the claim. Mr. Mater and Main Street American Protection Insurance Co. have made numerous material misrepresentations as to the facts of this loss with the intent of effecting settlement of this claim on less favorable terms than those provided in the policy. As a general business practice, Mr. Mater and Main Street American Protection Insurance Co. has demonstrated, both throughout this claim, and others, that it has failed to adopt and implement standards for the proper investigation of claims, frequently delaying its insureds’ claims and leaving them to retain their own adjusters and attorneys to ensure proper handling. It has not attempted in good faith to settle this claim 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 his/her interests. It has failed to promptly settle this claim when the obligation to settle has become reasonably clear. As a result of Mr. Mater and Main Street American Protection Insurance Co.’s lack of cooperation, the insured and policyholder have been forced to exercise their only remaining option: retaining counsel and filing a lawsuit, costing them money and reducing their ultimate recovery, preventing them from being fully indemnified and denying them the opportunity to return the property to pre-loss condition. To cure these violations, Mr. Mater and Main Street American Protection Insurance Co. must immediately issue a coverage determination and make an indemnity payment for all undisputed losses payable under the subject policy of insurance. Additionally, the insurer must provide a detailed explanation of any disputed issues relating to coverage and support any denial or partial payment with clear documentation.
Comments
User Id Date Added Comment
tiyarollelaw@gmail.com 01-06-2025 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.: (305) 763-7321. EMAIL: tiya.rolle@amfam.com January 6, 2025 Scott Subham Healthcare D/B/A Steinhatchee Drugs c/o Scott Kandell 2665 South Bayshore Drive, Suite 500 Miami, FL 33133 crnresponse@kkpfirm.com Re: Civil Remedy Notice Claim No.: 01-008-143803 Date of Loss: 9/28/2024 Insureds: Scott Subham Healthcare D/B/A Steinhatchee Drugs Policy No.: BPP5035T Dear Scott Kandell, We are in receipt of your Civil Remedy Notice of Insurer Violations (hereinafter “Notice”). Main Street America Protection Insurance Company (“MSA”) Insurance Company responds to the substance of your Civil Remedy Notice of Insurer Violations as follows: This correspondence will serve as the response of MSA to the Notice, DFS number 793197. MSA 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 and (2) Unfair Trade Practice. You have also cited several sections of the Florida Statutes alleging, in part, that MSA 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, MSA 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, MSA 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 and (2) Unfair Trade Practice. MSA responds by stating that these allegations are without basis and are therefore denied. MSA further states that the alleged 09/28/2024 loss was first reported to MSA on September 28, 2024. Thereafter, the claim was investigated, and ultimately MSA issued its coverage decision on or about November 28, 2024, which indicated that there was no coverage for the damages related to flood and/or storm surge. MSA however, issued payment of $11,053.61 toward the claimed wind damage. 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, MSA 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, MSA 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. MSA has both a duty and a right to fully investigate this loss, which it did. MSA responds by stating that this allegation is without basis and therefore denied. Following the notice of loss, MSA properly performed its investigation and issued its coverage decision. §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. MSA has both a duty and a right to fully investigate this loss, which it did. MSA responds by stating that this allegation is without basis and therefore denied. Following the notice of loss, MSA properly performed its investigation and issued its coverage decision. §626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims. This allegation is denied. MSA has both a duty and a right to fully investigate this loss, which it did. MSA responds by stating that this allegation is without basis and therefore denied. Following the notice of loss, MSA properly performed its investigation and issued its coverage decision. §626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims. This allegation is denied. MSA has both a duty and a right to fully investigate this loss, which it did. MSA responds by stating that this allegation is without basis and therefore denied. Following the notice of loss, MSA properly performed its investigation and issued its coverage decision. §626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim. This allegation is denied. MSA has both a duty and a right to fully investigate this loss, which it did. MSA responds by stating that this allegation is without basis and therefore denied. Following the notice of loss, MSA properly performed its investigation and issued its coverage decision. 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 MSA. A detailed and specific response to the cited policy language is impossible, given the vagueness of the allegations cited in the Notice. Notwithstanding, MSA has both a duty and a right to fully investigate this loss, which it did. MSA 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 MSA is precluded from being able to respond in any specific manner. Nevertheless, MSA 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. MSA therefore denies all allegations set forth as the “facts and circumstances giving rise to the violations” in the Notice. MSA denies it has engaged in bad faith conduct in this matter. MSA denies any undue delay in adjusting the claim. MSA 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. MSA denies any allegation that it did not adopt or implement standards for proper investigation of the claim. MSA stands by its adjustment and investigative practices generally and the adjustment and investigation of this claim specifically. MSA has acted properly, promptly and in accordance with the terms of the policy of insurance and applicable law in the investigation of this claim. MSA asserts that all actions taken have been made in good faith and for the purpose of fair, equitable and timely resolution of this matter. MSA has acted appropriately at all times regarding the handling of this claim. MSA 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 MSA promptly investigated the claim, and contrary to the allegations in the Notice, the facts show that MSA has consistently complied with all legal and professional standards for the investigation and adjustment of this claim. MSA 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, MSA denies it violated the statutes cited in the Notice. MSA 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. MSA 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, MSA has fully complied with its obligations under Florida Statutes and the policy of insurance with regard to the investigation and adjustment of this claim. MSA categorically denies all allegations contained in the Notice. In sum, MSA 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.
justin@kandelllaw.com 11-26-2024 The statutory violations outlined in this Civil Remedy Notice have now been cured.
justin@kandelllaw.com 11-19-2024 Please note that the correct email address for reaching counsel is CRNREPLY@KKPFIRM.COM and NOT CRNRESPONSE@KKPFIRM.COM. Thank you.
justin@kandelllaw.com 11-19-2024 Due to a clerical error, the complainant/insured name lists the first name "Scott." This was done in error as the result of autofill; please note that the business name for both Complainant and Insured should be: SUBHAM HEALTHCARE D/B/A STEINHATCHEE DRUGS
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