Civil Remedy Notice of Insurer Violations
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Filing Number:     793829
Filing Accepted:  11/22/2024
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Complainant
Last/Business Name *  
MICHAEL S RAMER DDS PA   First Name  
Street Address * 7672 N NOB HILL ROAD
City, State Zip * TAMARAC, FL 33321
Email Address * WITHHELD
Complainant Type: * Insured
Insured
Last/Business Name*   MICHAEL S RAMER DDS PA   First Name  
Policy # * BPG8794W Claim #* 001-006-134246
Attorney
Attorney is Applicable
Last Name* DANIELS First Name * MONICA Initial
Street Address* 560 VILLAGE BOULEVARD, SUITE 110
City, State Zip* WEST PALM BEACH , FLORIDA 33409
Email Address * MDANIELS@THEDANIELS-LAWGROUP.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):* KATE SHOULTZ, KEVIN BYERS, MATTHEW PRATT, AND ANY AND ALL OTHER ADJUSTERS, MANAGERS, SUPERVISORS, AND INDIVIDUALS ASSOCIATED WITH THE CLAIM
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Claim Denial
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)(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.

A. Coverage We will pay for direct physical loss of or damage to Covered Property at the premises described in the Declarations caused by or resulting from any Covered Cause of Loss. e. Water Damage, Other Liquids, Powder Or Molten Material Damage If loss or damage caused by or resulting from covered water or other liquid, powder or molten material occurs, we will also pay the cost to tear out and replace any part of the building or structure to repair damage to the system or appliance from which the water or other substance escapes. We will not pay the cost to repair any defect that caused the loss or damage; but we will pay the cost to repair or replace damaged parts of fire extinguishing equipment if the damage: (1) Results in discharge of any substance from an automatic fire protection system; or (2) Is directly caused by freezing..
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Michael S. Ramer DDS PA (the “Insured”) purchased an insurance policy from Main Street America (the “Insurer”), subscribing to policy number BPG8794W (the “Policy”), to cover property located at 7672 N Nob hill road, Tamarac, Florida 33321 (the “Property”). On or about April 29, 2023, the Insured’s property suffered damages as the result of a sudden and accidental air conditioner loss which caused physical damages to the walls, ceilings, and floors throughout the office. The Insured promptly contacted a an A/C repairman and the insurance company, and complied with all applicable post-loss obligations. The Insured also retained a public adjuster to assist with the handling of the damages and the claim. The Insurer acknowledged the loss and assigned claim number 001-006-134246 (the “Claim”) and assigned claims examiners Kate Shoultz to assist in adjusting the Claim. The Insurer also enlisted engineer Field Adjuster Matthew Pratt and Engineer Kevin Byers to inspect the Property. The Insured’s public adjuster promptly provided the Insurer a true and accurate estimate of the damages, extensive photographs relating to the Claim, documents related to A/C repair services performed in connection with the Claim, opened the Property for inspection, and complied with all of the Insurer’s requests for information and documentation. It is clear that the Insured has done everything in his power to comply with the Insurer’s requests and all applicable post-loss obligations. Despite all the above and the Insured promptly filing this claim and mitigating all damages in compliance with the Policy, the Insurer unreasonably denied the Claim citing lack of a peril created opening to the roof and repeated leakage and seepage. This finding is in contrast to the clear evidence that this was a covered, sudden A/C Leak that caused extensive damage to the Insured’s Property. Understandably the Insured has become extremely frustrated by the Insurer’s clear delay tactics and failure to adjust the Claim in good-faith. The Insured was forced to retain legal counsel to move this Claim forward. The insured’s denial is nonsensical because this is not a roof claim or a wind claim- it is an A/C claim. The carrier is merely trying to use a windstorm exclusion to deny coverage for an otherwise covered claim simply because the A/C unit is on the property’s roof. The Insurer’s refusal to properly investigate, adjust and fully compensate the Insured for this Claim undoubtedly evidences the Insurer’s violation of Section 626.9541(1)(i)(3)(a), Florida Statutes, which requires the Insurer to “adopt and implement standards for the proper investigation of claims.” All available information leads to one conclusion – the Property was damaged by a covered cause of loss for which the Insured is entitled to full and complete compensation. The Insurer’s obligation to promptly settle the Insured’s Claim is undeniable, and therefore, the Insurer has also violated Fla. Stat. Section 624.155(1)(b)(1) and 624.155(1)(b)(3). The Insurer’s conduct continues to be egregious because the Insurer retained biased and inexperienced individuals who approached the loss with an eye towards underpayment and has repeatedly attempted to take advantage of its Insured by unilaterally applying illogical policy interpretations regarding the Policy deductible. The actions taken by the Insurer in the handling and adjustment of the Claim are willful, wanton, and in disregard for the rights of the Insured, and have occurred with such frequency as to indicate a general business practice in violation of the law. This practice includes the Insurer hiring biased and inexperienced adjusters and experts and failing to properly and timely pay for obvious damages owed to its Insureds. The Insurer’s actions amount to, but are not limited to: A. “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 the insured and with due regard for her or his interests;” B. “Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear;” C. “Failing to adopt and implement standards for the proper investigation of claims;” D. Claim Delay; E. Unsatisfactory Settlement Offers; and F. Unfair Trade Practices In addition to the above statutory violations, the Insurer’s adjuster violated the following ethical requirements of the Florida Administrative Code 69B-220.201: (3) Code of Ethics . . . An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance. The following are standards of conduct that define ethical behavior, and shall constitute a code of ethics that shall be binding on all adjusters: (b) An adjuster shall treat all claimants equally. 2. An adjuster shall adjust all claims strictly in accordance with the insurance contract. (c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured. (d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. (e) An adjuster shall handle every adjustment and settlement with honesty and integrity, and allow a fair adjustment or settlement to all parties without any remuneration to himself except that to which he is legally entitled. (f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim. (o) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise. The Insured is a dutiful customer who made it a priority to pay insurance premiums to ensure that in such an event as the one here, the Property would be covered. The Insured timely filed the Claim and fulfilled all post-loss obligations. The Insurer acknowledged the loss, assigned a claim number, inspected the property, and then ultimately unjustifiably denied the Claim. It is abundantly clear that the Insurer has failed to provide the Insured with qualified representatives to ensure the Claim was initially adjusted, evaluated, and paid properly. To deny the Insured the benefit of the bargain after he has satisfied all his obligations is morally and ethically reprehensible, and reeks of Unfair Trade Practice. Insurer is putting its profits ahead of its contractual and statutory obligations. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has failed to create and implement adequate guidelines for the proper investigation to evaluate claims handling, and for training and supervision of employees. The Insurer has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance Claim and damages. Therefore, the Insurer breached its statutory and ethical duties, and has put profits ahead of the duties it owed to its Insured when he most needed the insurance coverage he paid for. Florida Statute § 624.02 defines “insurance” as a contract where one undertakes to indemnify another or pay or allow specified amounts, or determinable benefit, upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly. This timely and prompt payment allows the insured to mitigate their damages and place them back to the position they were in prior to the loss, as quickly as possible. The Insurer breached this duty. The Insurer has refused and failed to tender all insurance proceeds to the Insureds upon demand. The Insurer’s refusal and/or failure to settle the insurance Claim when it, under all circumstances, should have done so, is wrongful conduct. The Insurer is failing to timely settle the Insured’s claim as it is required to do so by contract and Florida law. To cure the defects outlined in this civil remedy notice, the Insurer must (1) immediately, and under no circumstances no later than sixty days from the date of this civil remedy notice, tender all insurance monies due and owing to the Insured; (2) immediately, and under no circumstances no later than sixty days from the date of this civil remedy notice, tender all insurance monies due and owing for any mitigation services rendered in connection with this claim; (3) ensure that payment made would be adequate to place the Insured back in his pre-loss condition; and (4) reimburse the Insured’s attorneys’ fees and costs, since the Insured was forced to hire legal counsel in order to receive adequate payment. Should the Insurer fail to comply with the demands set forth in this civil remedy notice, the Insurer must prepare to pay the full cost of its failure to rightfully indemnify the Insureds, including all future damages and legal expenses that come about as a result of the Insurer’s failure to comply with the demands set forth in this civil remedy notice. This Notice is giving in order to perfect the right to pursue the civil remedy authorized by section 624.155(3)(b), Florida Statutes.
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.: (305) 763-7321 EMAIL: tiya.rolle@amfam.com December 17, 2024 Michael S Ramer DDS PA c/o Monica Daniels, Esq. 560 Village Boulevard, Suite 110 West Palm Beach, Florida 33409 mdaniels@thedaniels-lawgroup.com Re: Civil Remedy Notice Claim No.: 01-006-134246 Date of Loss: 4/29/2023 Insureds: Michael S Ramer DDS PA Policy No.: BPG8794W Dear Monica Daniels, We are in receipt of your Civil Remedy Notice of Insurer Violations (hereinafter “Notice”). Main Street America Protection Insurance Company responds to the substance of your Civil Remedy Notice of Insurer Violations as follows: This correspondence will serve as the response of Main Street America Protection (hereinafter “MSA”) to the Notice, DFS number 793829. 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 Denial, (2) Claim Delay, and (3) 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 Denial, (2) Claim Delay, and (3) Unfair Trade Practice. MSA responds by stating that these allegations are without basis and are therefore denied. MSA further states that the alleged loss was reported on May 12, 2023. The claim was investigated and an engineer, Kevin Byers, from Envista Forensics, inspected the property and alleged loss. Ultimately, the claim was denied by MSA in light of the engineering report from Kevin Byers. The issues between the parties are currently being litigated in the matter of Michael S. Ramer, DDS P.A. v. Main Street America Protection Insurance Company, pending in Broward County Circuit Court, case no. CACE-23-022154. 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 an inspection, evaluated the claim accordingly, and advised the insured of the coverage determination. §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 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. 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 an inspection, evaluated the claim accordingly, and advised the insured of the coverage determination. §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 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. 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 an inspection, evaluated the claim accordingly, and advised the insured of the coverage determination. §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. 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 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 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.
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