Civil Remedy Notice of Insurer Violations
Login

Filing Number:     793419
Filing Accepted:  11/20/2024
         Print Filing
Complainant
Last/Business Name *  
SANCHEZ   First Name   LUIS
Street Address * 3840 E DANO STREET
City, State Zip * INVERNESS, FL 34453
Email Address * MANAGER@OWLBIZGROUP.COM
Complainant Type: * Insured
Insured
Last/Business Name*   SANCHEZ   First Name   LUIS
Policy # * 79-EA-C457-8 Claim #* 59-69H6-15K
Attorney
Attorney is Applicable
Last Name* LOUIS First Name * PIERRE Initial
Street Address* 290 NW 165TH STREET, SUITE M-500
City, State Zip* MIAMI , FL 33169
Email Address * SERVICE@LOUISLAWGROUP.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   STATE FARM FLORIDA INSURANCE COMPANY
NAIC Company Code 10739
 
Name of individual responsible for violation (if any):* NA
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
624.155(1)(b)(3) Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
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.

Governed by the cited authorities, the insurance policy (“Policy”) provides coverage on an “all risk” basis, which clearly, unambiguously and per well-settled Florida Supreme Court case law, requires the insurer to issue full payment for all covered losses and damages that arise during the Policy period as a consequence of a direct physical loss to property. Specifically, the Policy states, “[w]e will pay for accidental direct physical loss to the property described in Coverages A.” HW-2159 pg. 12 of 38. The only exceptions being fraud, intentional damage, and/or the determination that a Policy exclusion or limitation applies. That said, and to lawfully assert any exclusion and/or limitation, the insurer must have a good faith basis to conclude that it can prove the application of the exception or privilege by a preponderance of the evidence gathered during its reasonable and prompt investigation and adjustment of the claim. At a very minimum, the insurer is required to issue full payment for any losses or damages for which such exceptions and/or limitations cannot be promptly verified per the evidentiary considerations referenced, and for an amount that corresponds with the actual cash value of the loss, or the amount necessary to perform repairs in relation to the losses or damages.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The Complainant and Insured, Luis Sanchez, (including his authorized representative, hereinafter “Complainant”), maintained a homeowner’s insurance policy (hereinafter “Policy”) with State Farm Florida Insurance Company (hereinafter “SFFIC”), which generally and broadly provided coverage for any direct physical loss to the residential property, 3840 E Dano, Street Inverness, FL 34453, (hereinafter “Property”), that occurred during the Policy period. On or about, June 4, 2024, while the Policy was in full force and effect, Complainant suffered a covered loss; to wit: an accidental discharge of water from a plumbing system causing sudden and immediate physical damage to the insured property (hereinafter the “loss”). The interior of the Complainant’s property sustained significant damage, due to an accidental discharge of water, to which loss SFFIC assigned claim number 59-69H6-15K. To date, SFFIC has refused to remit all proceeds due and owing to the Complainant for his loss, despite Complainant’s compliance with his post loss obligations, and despite SFFIC’s receipt of an estimate contradictory to its unilateral assessment of the loss’ value. On November 20, 2024, Complainant, with the assistance of counsel, filed a lawsuit against SFFIC. Although hundreds of days have passed since the claims for losses and damages were presented for payment under the Policy, SFFIC has refused to remit all proceeds due and owing to Complainant for his loss. Despite Complainant’s compliance with his post loss obligations, despite no express language in the policy excluding damage caused to the Complainant’s property by the accidental water discharge, and despite SFFIC receipt of an estimate of damages contradictory to its unilateral assessment of the loss. The Complainant has established that the loss occurred during the policy, but SFFIC has failed to meet its burden that all of the damage is caused by a policy exclusion. SFFIC has attempted, in bad faith, to close Complainant’s claim by denying coverage for the loss. Since this loss occurred, SFFIC’s strategy has been to prolong and delay the fair adjustment of Complainant’s claim. As a result of the deficient adjustment of the loss, Complainant’s property has remained in a state of disrepair, while SFFIC has collected a premium on a policy that was designed to protect insureds like the Complainant during his hour of need. Complainant is requesting that SFFIC live up to the insurance contract in which SFFIC promised to adjust all losses with its Complainant. This promise to adjust all losses with its Complainant is one that SFFIC must undertake in good faith, which means it cannot unilaterally determine the value of its Complainant’s losses and remit payment to the Complainant that is grossly insufficient to cover the estimated damages, or, as in this instance, refuse to remit any payment Complainant under the Policy and deny coverage of the loss. Complainant placed his trust in SFFIC and has paid all premiums due and owing, and in exchange for said premiums, he is asking SFFIC to pay the damages that it agreed to cover when it issued the insurance policy. The work of adjusting insurance claims in Florida requires insurers to engage the public trust. SFFIC has clearly breached this trust with respect to its deficient handling of Complainant’s claim. SFFIC is obviously motivated by a desire to protect its own interest to the detriment of its Complainant, and has pursued a course, which is only advantageous to itself. SFFIC’s general business practice of willful, wanton, deceptive and bad faith claim handling policies, procedures, guidelines, protocol, adjusting, investigating, drawing valuations and issuing payment for the claims has caused the Complainant to suffer further harm and extra-contractual damages that have accrued, and will continue to accrue. The stated misconduct is collectively referred to as “Bad Faith,” and the specific factual and/or legal considerations in relation thereto are further outlined below for its consideration in accordance with Fla. Stat. Sec. 624.155 and the cited legal authorities associated therewith. 1. SFFIC insures hundreds of homes throughout the area where the Complainant’s residence is located. That said, it failed to institute the necessary policies, procedures, guidelines, protocol, personnel and contingencies in relation to fully, promptly and equitably indemnify its insureds who are impacted by accidental discharge of water losses. Consequently, insureds such as the Complainant were forced to fend for themselves to mitigate damages arising from SFFIC’s Bad Faith; absorb the burden, expense, inconvenience and delay associated with an insurer who was not equipped (because it didn’t want to incur the expense associated therewith) to meet their contractual obligations; risk health hazards associated with the presence of moisture and/or mold due to SFFIC’s failure to perform pursuant to the Policy; hire experts/professionals/counsel to force SFFIC to abide by its fiduciary duty and avoid the consequential damages associated with SFFIC’s failure to perform; etc. 2. SFFIC knew that accidental discharge of water losses are of a nature that a thorough, nuanced and specialized investigation/adjustment of the claim needs to be promptly performed by qualified and prepared personnel in order to protect its insureds, satisfy its fiduciary duties and otherwise not engage in the Bad Faith claim handling practices at issue. That said to the detriment of its insureds and to maximize its financial interests, SFFIC disregarded the obvious and known obligations by way of the following: a. Not developing, maintaining and/or instituting policies, procedures, protocol or guidelines to determine whether adjusters/personnel/vendors utilized to protect its insureds were qualified to duly assess the scope and/or value of the loss or damages. b. By way of the cited legal authorities and considerations, SFFIC knew that it would have to promptly hire licensed contractors, uniquely qualified adjusters and/or engineers to fully, equitably and honestly assess the scope and/or value of the loss or damages suffered by its insureds. c. By way of the cited legal authorities and considerations, SFFIC knew that it would be in its insureds’ interests and its obligation under the insurance policy to utilize personnel/vendors to perform moisture meter assessments throughout the insureds property to honestly assess the full extent of damages and losses suffered by its insureds. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting its insureds, however, SFFIC knows that it does not serve its financial interest since it will increase its financial obligations to insureds such as the Complainant. Although SFFIC will implement such methods to establish a lack of coverage as it relates to a specific claim in which it determines coverage may be in dispute, it choose to avoid such expense for self-gain when it knows that the claim is covered. d. By way of the cited legal authorities and considerations, SFFIC knew that it would be in its insureds’ interests and its obligation under the insurance policy to utilize personnel/vendors to perform thermal imaging assessments throughout the insured property to honestly assess the full extent of damages and losses suffered by its insureds. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting its insureds, however, SFFIC knows that it does not serve its financial interest since it will increase its financial obligations to insureds such as the Complainant. Once again though, and although SFFIC will implement such methods to establish a lack of coverage as it relates to a specific claim in which it determine coverage may be in dispute, it choose to avoid such expense for self-gain when it knows that the claim is covered. e. By way of the cited legal authorities and considerations, SFFIC knew that it would be in its insureds’ interests and its obligation under the insurance policy to utilize personnel/vendors to perform detailed, thorough, reliable and qualified assessments of any air conditioning component of the home in which moisture escaped. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting its insureds, however, SFFIC knows that it does not serve its financial interest since it will increase its financial obligations to insureds such as the Complainant. Once again though, and although SFFIC will implement such methods to establish a lack of coverage as it relates to a specific claim in which it determines coverage may be in dispute, it choose to avoid such expense for self-gain when it knows the claim is covered under the Policy. f. By way of the cited legal authorities and considerations, SFFIC knew that it would be in its insureds’ interests and its obligation under the insurance policy to retain a licensed mold assessor to determine whether there were concealed conditions within the home which necessitated mold remediation and the need for its insureds to take precautionary measures to preserve their physical health and property interests. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting its insureds, however, SFFIC knows that it does not serve its financial interest since it will increase its financial obligations to insureds such as the Complainant. Once again though, and although SFFIC will implement such methods to establish a lack of coverage as it relates to a specific claim in which it determines coverage may be in dispute, it choose to avoid such expense for self-gain when it knows that the claim is covered. g. By way of the cited legal authorities and considerations, SFFIC knew that it would be in its insureds’ interests and its obligation under the insurance policy to promptly issue payment for professional/qualified moisture assessments and remediation in order to, inter alia, avoid: the development of hazardous/toxic conditions within the residence; preclude the insured from suffering consequential and extra-contractual damages; the development of an uninhabitable residence and various risks that may develop; etc. Such practice is an accepted, reasonable, necessary and industry wide accepted means of protecting its insureds, however, SFFIC knows that it does not serve its financial interest since it will increase its financial obligations to insureds such as the Complainant. h. By way of the cited legal authorities and considerations, SFFIC knew that it would be in its insureds’ interests and its obligation under the insurance policy to utilize a license mold remediator to consider a license mold assessor’s assessments and protocol in order to honestly determine the true scope and value of damages and/or the loss. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting its insureds, however, SFFIC knows that it does not serve its financial interest since it will increase its financial obligations to insureds such as the Complainant. i. By way of the cited legal authorities and considerations, SFFIC knew that it would be in it insureds’ interests and its obligation under the insurance policy to carefully consider all policy terms that afford coverage for losses and damages as the obligation to pay was made reasonably clear, and thereafter utilize counsel when an adjuster is in doubt to advise them on a claim-by-claim basis whether in fact it is duly indemnifying its insureds. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting its insureds, however, SFFIC knows that it does not serve its financial interest since it will increase its financial obligations to insureds such as the Complainant. j. By way of the cited legal authorities and considerations, SFFIC knew that it would be in its insureds’ interests and its obligation under the insurance policy to carefully evaluate on a claim-by-claim basis whether any amounts appropriated for “depreciation” are based on sufficient facts and data, reliable principles and methods, and/or the application of reliable principles and methods. SFFIC knows that it is arbitrarily, capriciously, deceptively, willfully and wantonly appropriating depreciation without any claim/item specific consideration to justify same. In the aggregate, and unbeknownst to its insureds, this sham practice allows SFFIC to unjustly avoid millions of dollars in benefits owed to its insureds who are consequently placed in a position wherein they are financially coerced into choosing whether to leave their home in a state of disrepair, or alternatively, searching for a handyman and non-licensed vendors to perform makeshift repairs which create secondary risks and potential damages that SFFIC will deny coverage for when they arise. k. By way of the cited legal authorities and considerations, SFFIC knew that it would be in its insureds’ interests and its obligation under the insurance policy to carefully evaluate on a claim by claim basis, and only after equitably and fully investigating/adjusting claim, the amounts owed to the insured for: overhead and profit associated with the insured’s reasonable need to utilize a general contractor; taxes associated with the repairs; permit costs associated with the repair; costs associated with various licensed trades that will be needed to effectuate the repairs; whether benefits are owed to the insured for loss of use and/or additional living expenses; personal property that may have been affected by toxic/mold/moisture conditions that developed in the home; costs associated with maintaining the continuity of the finish/appearance for pairs or sets such as cabinets, flooring, walls, ceilings; etc. l. By way of the cited legal authorities and considerations, SFFIC knew that it had an obligation to ensure that software programs, data bases and adjusting practices utilized to estimate the scope and value of the loss were being utilized in form that: honestly and fully delineated the line item repairs or costs that needed to be performed; pricing corresponded with licensed professionals - as opposed to handyman or non-licensed professionals; accounted for consideration of actual expenditures incurred by the insureds or otherwise compensable expenses on a repair cost basis; etc. Ultimately, SFFIC knows that the adjusting practices are guided to unlawfully depriving its insureds of benefits owed under the insurance policy, which in the aggregate, serves to maximize its profits to the detriment of its insureds. m. By way of the cited legal authorities and considerations, SFFIC knew that it had an obligation to treat all insureds equally and honestly. However, and for its own financial interest, it will only start to fully consider its obligations as stated herein if the insured retains legal representation and pursues a legal action which exposes them to liabilities and costs. Even then, SFFIC will withhold monies owed in an unjust effort to limit/delay its liabilities in relation to the statutory considerations and otherwise. n. By way of the cited legal authorities and considerations, and even after litigation ensues, SFFIC knows that it has a continuous and ongoing duty to not engage in the Bad Faith conduct that is the subject of this Complaint. However, and to advance its own financial interest and avoid the liabilities pursuant to the above cited statutory authorities, SFFIC will direct and utilize non-qualified counsel to delay the equitable and prompt payment of the claim via delay tactics and otherwise not implementing policies, procedures and/or guidelines to ensure that its duties are fulfilled during the course of litigation. Moreover, SFFIC will insist upon the insureds to fulfill its own obligations by imposing upon them the burden to establish their full entitlement to benefits for which it knows, or should know, are owed. o. By way of the cited legal authorities and considerations, SFFIC knows that it has to assess the application of the policy deductible on a case-by-case basis and only after the claim is fully adjusted and investigated. This practice is necessary to protect the interests of the insured since, pursuant to binding precedent and the policy, the deductible is subject to being absorbed by losses and/or damages that exceed a limitation of coverage under a certain section of the policy. p. By way of the cited legal authorities and considerations, SFFIC knows that it has a duty to duly assess whether benefits are owed to the insured in relation to the costs associated with removing and resetting personal property in relation to repairs and/or remediation work that needs to be performed. This duty is ignored by SFFIC in order to maximize its own financial interests. q. By way of the cited legal authorities and considerations, SFFIC knows that it has duty to issue payment for interest owed in relation to payments that were untimely issued per governing authorities. With that said, and to the detriment of the insured, it foregoes and/or delays such considerations in order to maximize its financial interests. r. Although SFFIC knows that it has a duty to treat all insureds/assignees equally, it will consistently act inconsistently in relation to: the application of policy limits; the manner in which valuations and/or the scope of repair is assessed; the manner in which an insured is required to comply with policy conditions; the application and/or consideration of policy conditions and/or exclusions to bar coverage; the timing and/or circumstances upon which undisputed payments will be made pre-suit and post-suit; etc. The lack of consistency and organization ultimately serves to deprive insureds of their rights under a policy and otherwise creates an inherently dishonest, immoral, and unfair means of adjusting and investigating claim. s. SFFIC knows that once the claim is fully and fairly investigated and adjusted, it then has to determine whether certain benefits are owed to the insured for the cost of engineering fees in relation to the construction/repairs that need to be performed. These costs are avoided by SFFIC by engaging in the Bad Faith conduct described herein. t. SFFIC’s Bad Faith conduct as described places the insured in a position of being forced into incurring expert fees to secure judicial relief by way of a legal action. Moreover, and as part of the Bad Faith practice, SFFIC will await the insured’s post-suit retention of an expert to retain a designated/pre-disposed (due to financial biases) experts to further delay its obligations to its insureds and the consequential liabilities that the legislature has imposed to deter SFFIC from engaging in the Bad Faith practice. 3. SFFIC’s “toolbox” of Bad Faith claims handling practices as described above leaves insureds, the insured’s counsel, the SFFIC’s counsel and even the judiciary guessing as to when and how SFFIC will duly perform. The continuously vacillating positions and cherry picking of the described Bad Faith conduct not only serves to maximize SFFIC’s prospective financial gains by being able to avoid paying benefits, it also serves to minimize SFFIC’s lost adjusting expense as it see fit and to the invariable detriment of its insureds, the Complainant, and ultimately the tax paying citizens of this State that bear the expense of the judicial system which needs to unravel the tangled web created by SFFIC. 4. To cure the above stated immoral, deceptive, unlawful and collectively defined general business practice of Bad Faith claims handling practices that are knowingly, willfully, wantonly and/or with a reckless disregard for the Complainant’s interests being implemented, SFFIC must perform as follows within 60 days of receiving this Complaint. a. Take corrective action in association with the Bad Faith claims handling practices by way of rectifying same and thereafter duly adjusting, investigating and issuing payment for all benefits owed to the Complainant in the amount of $31,216.00, for indemnity; b. Take corrective action in association with the Bad Faith claims handling practices by way of rectifying same and thereafter duly adjusting, investigating and issuing payment for all benefits owed to the Complainant; c. To the extent verified after duly performing under the policy pursuant to cited authorities and considerations, issuing any and all payments owed to the Complaint for interest on benefits that were untimely paid; d. To the extent verified after duly performing under the policy pursuant to cited authorities and considerations, confess judgment in relation to the pending breach of contract action brought forth by the Complainant; e. After exercising good faith efforts to resolve the claim, issuing payment to the Complainant’s for any attorney’s fees and/or costs that it cannot dispute are due and owing; f. As it relates to any claims/benefits that may remain in dispute or undetermined, fairly, honestly, specifically, meaningfully and substantively disclosing to the Complainant’s counsel the basis therefor and the means to promptly reach resolution; and/or g. Otherwise fulfilling any and all obligations under the policy that it knows, or should know, remain to be performed.
Comments
User Id Date Added Comment
GLWright@MDWCG.com 01-08-2025 January 8, 2024 VIA EMAIL to pierre@louislawgroup.com Luis Sanchez c/o Pierre A Louis, Esq. 290 NW 165th Street, Suite M-500 Miami, FL 33169 RE: DFS #: 793419 DFS Acceptance Date: November 20, 2024 Complainant: Luis Sanchez Insured: Luis Sanchez Insurer: State Farm Florida Insurance Company Policy No.: 79-EA-C457-8 Date of Loss: June 4, 2024 Claim No.: 59-69H6-15K Our File No.: 40977.01163 Dear Mr. Louis: We have been retained by State Farm Florida Insurance Company (State Farm) to respond to the above-referenced Civil Remedy Notice of Insurer Violation (CRN) filed by you on behalf of Luis Sanchez (Sanchez). While State Farm welcomes the opportunity to respond to this CRN and specifically denies each and every allegation contained in the CRN filed in relation to this claim, State Farm asserts that the CRN should be rejected as it fails to comply with several of the requirements of the Civil Remedy Notice of Insurer Violation document provisions, as set forth in Florida Statute §624.155 and Florida case law. THE CRN ALLEGATIONS The CRN asserts the following reasons for the notice: • Claim Denial • Claim Delay • Unsatisfactory Settlement Offer • Unfair Trade Practice Further, the CRN alleges State Farm 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 towards 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)(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 compromised settlement. DISCUSSION For a number of reasons, the CRN fails to comply with the requirements of Florida Statutes. First, the CRN should be rejected because the CRN fails to "identify the person or persons representing the insurer who are most responsible for/knowledgeable of the facts giving rise to the allegations." No specific person or persons are identified in the CRN at all, as the CRN merely states "N/A" in this regard. Further the CRN fails to ascribe any specific act of impropriety or statutory violation to any specific State Farm employee, representative or agent. Without the identification of the appropriate individuals, State Farm cannot adequately address the alleged violations, or properly respond to the allegations. It is this failure to ascribe any specific act of impropriety or statutory violation to specific individuals which prohibits State Farm from adequately addressing the issues raised in the CRN and is a reason why the CRN should be rejected. Next the CRN requires the Complainant "pursuant to Section 624.155, Florida Statutes, please indicate all statutory provisions alleged to have been violated." As indicated above, the CRN includes statutory provision regardless of whether they are relevant or applicable to any alleged facts contained in the CRN. In fact, based upon the facts of this matter, State Farm performed a prompt investigation of the claim required of it under Florida law and the Policy. Further, the facts of this matter evidence that, at all times, State Farm acted in accordance with Florida law and the obligations under its Policy. Therefore, State Farm denies that it violated any of the statutory provisions set forth in the CRN. It is because the CRN contains statutory provisions that are clearly inapplicable, that State Farm is unable to properly respond and the CRN should be rejected. In response to The Department's request for the "specific policy language that is relevant to the alleged violation", no "specific policy language" is referenced at all. Instead the CRN merely sets forth various sections of an insurance policy without reference to the specific language of the policy in relation to the specific statutory provisions alleged to have been violated. However, 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, 311 So. 3d 875 (Fla. 4th DCA 2021). Again, it is this failure of the Complainant to comply with the requirements of the Civil Remedy Notice of Insurer Violation document provisions, as set forth in Florida Statute §624.155 and Florida case law, which prohibits State Farm from adequately addressing the issues raised in the CRN and is a reason why the CRN should be rejected. Further, the CRN itself only provides unsupported allegations without setting forth specific facts allegedly evidencing violation of each specific Florida statutes contained in the CRN. Notwithstanding the deficiencies in the CRN, State Farm denies it committed the alleged acts or violated the statutes cited in the CRN and asserts this is another reason why the CRN should be rejected. Additionally, Sanchez includes, as a to cure the alleged violation, payment of the his attorneys’ fees and costs in violation of Fla. Stat. § 624.155. However, Sanchez has no basis for recovery of attorneys’ fees and costs as at the time of filing the CRN as there is no policy provision which requires State Farm to pay his attorneys’ fees and/or costs. Sanchez’s demand for payment of attorneys’ fees and costs as a “cure” in the CRN is considered a demand for extra-contractual damages. As such, Sanchez failed to offer a proper and valid cute by demanding payment of extra-contractual damages, contrary to Fla. Stat. § 624.155. See, Garman v. State Farm Fla. Ins. Co., 2023 WL 2599514 (Fla. 1st J. Cir. Ct. January 5, 2023); Apex Roofing & Restoration LLC A/A/O Wendel Debriz v. United Services Automobile Assoc. (Fla. 13th J. Cir. Ct. August 22, 2023). As the CRN fails to offer a proper and valid cure, the CRN does not comply with Fla. Stat. § 624.155, and must be rejected. Lastly, before addressing the allegations set forth in the CRN, the CRN is insufficient on its face. Contrary to the requirements of Section 624.155, Florida Statutes, the CRN does not specifically describe the facts or circumstances giving rise to each statutory violation alleged against State Farm, and as indicated above, many of the alleged statutory violations are clearly inapplicable in light of the allegations contained in the CRN. The CRN simply sets forth the provisions of various statutes and fails to allege any fact or circumstances whereby State Farm's actions may have violated those statute. Therefore, the CRN is inadequate under Florida law and must be rejected. Based upon the foregoing, the CRN is insufficient on its face. See, Talat Enterprises Inc., vs. Aetna Cas. & Sur. Company., 753 So. 2d 1278 (Fla. 2000); Lane v. Westfield Ins. Company, 862 So. 2d 744 (Fla. 5th DCA 2003); Valenti v. Unum Life Insurance Company of America, 2006 WL 1627276, 2 (MD Fla. June 6, 2006); Longpointe Condominium Association v. Allstate Ins. Company, 2005 WL 1315810 (MD Fla. June 2, 2005); Julien v. United Property & Casualty Insurance Company, 311 So. 3d 875 (Fla. 4th DCA 2021). Setting forth the factual background, State Farm issued insurance policy number 79-EA-C457-8, with effective dates of April 27, 2024 through April 27, 2025, (the “Policy”), to Sanchez, for the property located at 3840 E Dano Street, Inverness, FL 3443 (the “Property”). The Policy is a Homeowners Policy that includes Coverage A – Dwelling limits of $273,600 and an applicable deductible of $1,000. On or about June 14, 2024, the present claim was reported to State Farm by Easy Claims (the “Public Adjuster”). At that time it was reported that the Property sustained damage to the kitchen baseboards and cabinets as a result of a p-trap leak. On June 15, 2024, correspondence was sent to Sanchez acknowledging receipt of the claim. On June 19, 2024, after a previous attempt to contact the Public Adjuster, State Farm was able to discuss the claim with the Public Adjuster and schedule an inspection. The same day, State Farm set correspondence to Sanchez requiring cooperation in the investigation and further protection of the damaged property. Additionally, the Homeowners Bill of Rights correspondence was also sent to Sanchez. State Farm inspected the Property on July 3, 2024. While at the inspection, State Farm spoke Sanchez who advised he has been living at the Property for about a year and believes the P-Trap has been leaking the entire time. Further, pursuant to Sanchez, water was leaking at a very slow pace. As a result of its investigation, State Farm issued its coverage determination letter on the same day, which advised Sanchez “the water damage to the kitchen was caused by repeated and/or intermittent water leakage over a period of time from your kitchen plumbing system. We noted you described the leak as being very slow and that it had been leaking for approximately a year since you moved into the home. Damage resulting from this cause(s) of loss is not covered by your policy.” The coverage determination letter included applicable policy language related to its decision to deny the claim. Thereafter, State farm advised the Public Adjuster of its denial and issued correspondence regarding Florida Department of Financial Services’ Mediation Program. Thereafter, State Farm received a Letter of Representation from Louis Law Group (“Sanchez’s attorney”), which State Farm timely acknowledged. Sanchez’s attorney also requested a certified copy of the Policy, which State Farm timely provided. On August 20, 2024, State Farm received Sanchez’s Signed Sworn Proof of Loss alleging the damage caused to the Property totals $26,462.60. State Farm then responded to the SPOL advising it received the document but cannot accept it as it was not provided within the required timeframe pursuant to the Policy, and it disagrees with the amount claimed. Additionally, thereafter, State Farm received a Notice of Intent to Initiate Litigation filed on behalf of Sanchez. State Farm timely responded standing on its decision to deny the claim. Lastly, Sanchez requested State Farm engage in mediation on September 20, 2024. State Farm agreed to do so. Mediation occurred on October 15, 2024, and resulted in an impasse. State Farm completed a full investigation of Sanchez’s claim, including working collaboratively with Sanchez, his Public Adjuster, and his attorney, speaking with Sanchez and his Public Adjuster regarding the loss, conducting an internal investigation, inspecting the Property, and maintaining open lines of communication with Sanchez and his representatives. After conducting a full investigation, State Farm denied thee claim pursuant to the Policy. Sanchez’s Policy states: SECTION I – LOSES INSURED COVERAGE A – DWELLING We will pay for accidential direct physical loss to the property described in Coverage A, unless the loss is excluded or limited in SECTION I – LOSSES NOT INSURED or otherwise excluded or limited in this policy. However, loss does not include and we will not pay for any diminution in value. SECTION I – LOSSES NOT INSURED 1. We will not pay for any loss to the property described in Coverage A that consists of or is directly and immediately caused by, one or more of the perils listed in items a. through m. below, regardless of whether the loss occurs abruptly or gradually, involves isolated or widespread damage, arises from natural or external forces, or occurs as a result of any combination of these: ***** f. seepage or leakage of water, steam, or sewage that occurs or develops over a period of time: (1) and is: (a) continuous; (b) repeating; (c) gradual; (d) intermittent; (e) slow; or (f) trickling; and (2) from a: (a) hating, air conditioning, or automatic fire protective sprinkler system; (b) household appliance; or (c) plumbing system, including from, within or around any shower stall, shower bath, tub installation, or other plumbing fixture, including walls, ceilings, or floors. We also will not pay for losses arising from condensation or the presence of humidity, moisture, or vapor that occurs or develops over a period of time. g. wear, tear, decay, marring, scratching, deterioration, inherent vice, latent defect, or mechanical breakdown; h. corrosion, electrolysis or rust; i. wet or dry rot ***** However, we will pay for any resulting loss from items a. through l. unless the resulting loss is itself a Loss Not Insured as described in this Section. 2. We will not pay for, under any part of this policy, any loss that would not have occurred in the absence of one or more of the following excluded events. We will not pay for such loss regardless of: (a) the cause of the excluded event; or (b) other causes of the loss; or (c) whether other causes acted concurrently or in any sequence with the excluded event to produce the loss; or (d) whether the event occurs abruptly or gradually, involves isolated or widespread damage, occurs on or off the residence premises, arises from ant natural or external forces, or occurs as a result of any combination of these: ***** g. Fungus, including: (1) any loss or use o delay in rebuilding, repairing, or replacing covered property, including any associated cost or expense, due to interference at the residence premises or location of the rebuilding, repairing, or replacement by fungus; (2) any remediation of fungus including the cost to: (a) remove the fungus from covered property or to repair, restore, or replace the property; or (b) tear out and replace any part of the building structure or other property as needed to gain access to the fungus; or (3) the cost of any testing or monitoring of air or property to confirm the type, absence, presence, or level of fungus, whether performed prior to, during, or after removal, repair, restoration, or replacement of covered property ***** 3. We will not pay for, under any part of this policy, any loss consisting of one or more of the items below. Further, we will not pay for any loss described in paragraphs 1. and 2. immediately above regardless of whether one or more of the following: (a) directly or indirectly cause, contribute to, or aggravate the loss; or (b) occur before, at the same time, or after the loss or any other cause of loss: a. conduct, act, failure to act, or decision or any person, group, organization, or governmental body whether intentional, wrongful, negligent, or without fault; b. defect, weakness, inadequacy, fault, or unsoundness in: (1) planning, zoning, development, surveying, or siting; (2) design, specifications, workmanship, repair, construction, renovation, remodeling, grading or compaction; (3) materials used in repair, construction, renovation, remodeling, grading, or compaction; or (4) maintenance of any property (including land, structures, or improvements of any kind) whether on or off the residence premises; or c. weather conditions However, we will pay for resulting loss from items .a., 3.b., and 3.c., unless the resulting loss is itself a Loss Not Insured as described in this Section. Therefore, State Farm denies it failed to perform a proper, prompt investigation and evaluation of the claim and takes exception with the allegations in the CRN which suggests the contrary. Accordingly, as reflected above, State Farm has acted within the terms of its Policy and Florida Statutes. State Farm asserts there is no basis for the claims made by Sanchez in the CRN that State Farm has failed to act in good faith in the handling of the claim. Likewise there is no basis or factual support for the claims made in the CRN that State Farm improperly denied the claim; failed to conduct a full and fair investigation of the claim; failed to implement proper standards for the adjustment and investigation of insurance claims; failed to train, supervise, or manage adjusters and independent contractors properly so that prompt and full payments are made; placed the company's interests before the policyholders' interests by attempting to deny or minimize payments owed; and ignored submitted documentation from Sanchez; or that its actions were willful, wanton and malicious in nature. Based upon the factual background of this matter, State Farm denies each and every allegation in the CRN. State Farm specifically denies it violated Florida Statute § 624.155(1)(b)(1). The CRN is void of any allegations identifying how State Farm did not attempt in good faith to settle the claim. Rather, the CRN generally alleges State Farm “refused to remit all proceeds due and owing to Complainant for his loss”. However, not once does the CRN mention State Farm concluded, after conducting its investigation, the loss was excluded pursuant to the Policy. As such, State Farm has no duty to indemnify the Sanchez for the loss. The CRN lacks any factual support to corroborate the alleged violation of Fla. Stat. § 624.155(1)(b)(1). State Farm denies the alleged violation of Florida Statute § 624.155(1)(b)(3). Again, State Farm denied the claim pursuant to the Policy based on its investigation of the claim, which included speaking to Sanchez and his Public Adjuster, in addition to inspecting the Property. As such, the alleged violation is baseless and lacks any factual support. Sate Farm denies the alleged violation of Florida Statute § 626.9541(1)(i)(3)(a). As evidenced above, Sate Farm completed a full investigation of this claim which included, speaking to Sanchez and his Public Adjuster, maintaining open lines of communication, conducting an inspection of the Property, responding to all correspondence and documents received from Sanchez and his representatives, and additional internal investigations. All of which occurred in timely manner. Sanchez cannot and did not provide any factual support to corroborate their allegations that Sate Farm failed to adopt and implement standards for a proper investigation of this claim. As such, Sate Farm denies the alleged violation of Florida Statute § 626.9541(1)(i)(3)(a). State Farm denies the alleged violation of Florida Statute § 626.9541(1)(i)(3)(d). As evidenced above, State Farm denied the claim after completing a full investigation of this claim which included, speaking to Sanchez and his Public Adjuster, maintaining open lines of communication, conducting an inspection of the Property, responding to all correspondence and documents received from Sanchez and his representatives, and additional internal investigations. State Farm’s investigation of the claim was more than reasonable. As such, State Farm denies the alleged violation. Lastly, State Farm denies the alleged violation of Florida Statute § 626.9541(1)(i)(3)(f). Aside from including the baseless alleged violation, the CRN is void of any facts to support the contention that State Farm failed to promptly provide a reasonable explanation in writing of the denial. Contrary to the assertion, State Farm issued a coverage determination letter on July 3, 2024, only nineteen (19) days after receiving notice of the alleged claim. To allege State Farm was not prompt is to ignore the facts as they are. As such, State Farm denies the alleged violation of Fla. Stat. § 626.9541(1)(i)(3)(f). In closing, State Farm first requests the CRN be rejected due to its failure to comply with Florida Statute §624.155 and Florida case law. Regardless of the rejection, as demonstrated above, State Farm has, at all times, acted in good faith, with due diligence, and in accordance with the terms of its insurance policy and Florida Statutes with respect to the handling of the Johnston claim. State Farm denies the allegations contained in the CRN. We trust this response adequately addresses the allegations of violation alleged in the CRN. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Very truly yours, Gabrielle L. Wright Gabrielle L. Wright GLW:GLW
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