Civil Remedy Notice of Insurer Violations
Login

Filing Number:     793537
Filing Accepted:  11/20/2024
         Print Filing
Complainant
Last/Business Name *  
PONCIANO VALMORES AND CORA VALMORES   First Name  
Street Address * 5856 WHITLEY BAY LANE
City, State Zip * ORLANDO, FL 32829
Email Address * CLAY@THEKRFIRM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   PONCIANO VALMORES AND CORA VALMORES   First Name  
Policy # * 39104861 Claim #* 01007118256
Attorney
Attorney is Applicable
Last Name* KUHN First Name * CLAYTON Initial
Street Address* 2110 WEST PLATT STREET
City, State Zip* TAMPA , FLORIDA 33606
Email Address * CLAY@THEKRFIRM.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):* ANY AND ALL PERSONS ASSOCIATED WITH THE CLAIMS HANDLING FROM HOMESITE INSURANCE COMPANY
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unfair Trade Practice
Unsatisfactory Settlement Offer
* 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)(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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

THE POLICY LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE LOSS PAYMENT AND COVERAGE PROVISIONS OF POLICY NUMBER 39104861, INCLUDING THE DECLARATIONS PAGE AND ALL ENDORSEMENTS TO THE POLICY, WITH RESPECT TO COVERAGES A, B, C, AND D. ADDITIONALLY, ANY SECTIONS RELIED UPON BY THE INSURER IN ITS DENIAL TO FULLY PAY THE CLAIM, INCLUDING THE DUTIES IN THE EVENT OF LOSS PROVISIONS AND THE POLICY'S EXCLUSION OF COVERAGE PROVISIONS.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Ponciano Valmores and Cora Valmores (hereinafter “Insureds”) are homeowners insured with an all-risks policy issued by Homesite Insurance Company (hereinafter “Carrier”). On or about September 28, 2022, Insureds’ home located at 5856 Whitley Bay Lane, Orlando, Florida 32829 sustained significant damage as a result of a windstorm event. Specifically, Hurricane Ian created multiple openings to the roof of Insureds’ property. This resulted in interior water damage to various areas of the interior of Insured’s property including but not limited to, the entryway, dining room, living room, and master bathroom. The Loss is covered under Insured’s policy issued by Carrier. The Insureds mitigated damages by contacting Loss Restorations LLC who performed mitigation services and placed a tarp on the roof of the subject property. All of the relevant documents were provided to Carrier. Insureds promptly reported the claim and fully cooperated with all requests for inspections. Carrier assigned Claim No. 01007118256 to the loss. The Insureds has fully cooperated with Carrier’s investigation of the claim, including providing all requested documentation and complying with all post-loss policy conditions. Specifically, the Insureds, with assistance from their public adjuster, submitted an estimate for $69,597.83, which was a fair and reasonable assessment for the repair/replacement of damages. Loss Restorations LLC has an outstanding balance in the amount of $10,123.26 for their mitigation services and tarp placement. After reporting the claim, Carrier retained an unqualified and biased field adjuster, Penni Vining, to adjust the loss. This adjuster had a financial incentive to adjust the loss in a manner that would minimize Carrier’s losses. This adjuster performed a mere cursory inspection of the property. Instead of adjusting the claim fairly, honestly, in good faith, and with due regard for the Insureds’ interests, this adjuster made a conscious effort to ignore evidence of covered losses to the property. Worse still, Carrier failed to retain qualified experts necessary to identify the repairs necessary to restore the property to its pre-loss condition. Despite Insureds providing Carrier with a detailed estimate, Carrier failed to pay Insureds the amount necessary to repair/replace the damaged property, less the applicable deductible. Instead, Carrier gave Insured a lowball estimate that failed to encompass all covered damages. The carrier only offered to pay $0.00, after applicable deductible of $7,960.00, a gross underpayment for all the damage associated with this claim. Under the circumstances surrounding this claim, had Carrier acted fairly and honestly toward the Insured and with due regard for the Insured’s interests, Carrier could and should have attempted in good faith to settle this claim. Carrier did not and, instead, dishonestly, and unfairly placed its own interests well ahead of those of the Insureds. In doing so, Carrier violated Section 624.155(1)(b)(1), Florida Statutes. Carrier’s use of unqualified and biased adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to adopt and implement standards for the proper investigation of claims in violation of Section 626.9541(1)(i)(3)(a), Florida Statutes. Carrier’s use of unqualified and biased adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to conduct a reasonable investigation based upon available information. In denying full coverage for this claim without conducting reasonable investigations based upon available information, Carrier has violated Section 626.9541(1)(i)(3)(d), Florida Statutes. By representing to Insureds that the Policy does not afford full coverage for this loss, Carrier is misrepresenting pertinent facts and/or insurance policy provisions relating to coverages at issue, in violation of Section 626.9541(1)(i)(3)(b), Florida Statutes. When applying the facts present here to Florida law, it is clear that Carrier is acting in bad faith. Florida Statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit based on determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. Carrier has breached this duty by refusing to properly and timely adjust the loss. Moreover, Section 69B-220.201 of the Florida Administrative Code defines Carrier’s adjusters conduct here as an unfair claims settlement practice. Specifically, Section 69B-220.201(3) provides that “[a]n adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured” and that “[a]n adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.” As detailed above, Carrier’s investigation and adjustment of this claim was done in a manner prejudicial to Insureds, was incomplete, and lacked truthful and unbiased reports of the facts. Carrier has more than enough information and is still refusing to accept coverage for the Insureds’ claim. This continued and repeated reckless claim delay and denial of coverage will result in a significant punitive damage award if a bad faith lawsuit is filed. Carrier can cure the defects outlined in this Civil Remedy Notice and avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy for this claim and by paying Insureds’ estimate of damages $69,597.83, and Loss Restorations LLC in the amount of $10,123.26, less applicable deductible and prior payments, which is the reasonable amount of the covered loss pursuant to the policy. A copy of this form has been submitted to the Florida Department of Financial Services who has transmitted the same to the following parties providing them notice of the filing of this Civil Remedy Notice: Homesite Insurance Company
Comments
User Id Date Added Comment
tiyarollelaw@gmail.com 01-08-2025 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 8, 2025 Ponciano Valmores and Cora Valmores c/o Clayton Kuhn 2110 West Platt Street Tampa, Florida 33606 Clay@thekrfirm.com Re: Civil Remedy Notice Claim No.: 01-007-118256 Date of Loss: 9/11/2023 Insureds: Ponciano Valmores and Cora Valmores Policy No.: 39104861 Dear Clayton Kuhn, 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 793537. 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) Unfair Trade Practice, and (2) Unsatisfactory Settlement Offer. 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) Unfair Trade Practice, and (2) Unsatisfactory Settlement Offer. Homesite responds by stating that these allegations are without basis and are therefore denied. Homesite further states that the alleged 09/11/2023 loss was first reported to Homesite on January 12, 2024. The property was inspected and ultimately Homesite issued its coverage determination on or about January 26, 2024 which indicated the claimed damages did not exceed the deductible. Currently the issues between the parties are being litigated in the matter of Ponciano Valmores and Cora Valmores v. Homesite Insurance Company, pending in Orange County, Case No. 2024-CA-010883-O. 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 advised the insured of the coverage determination. §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 advised the insured of the coverage determination. §626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. 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 advised the insured of the coverage determination. §626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information. 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 advised the insured of the coverage determination. 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.

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