Civil Remedy Notice of Insurer Violations
Login

Filing Number:     794024
Filing Accepted:  11/25/2024
         Print Filing
Complainant
Last/Business Name *  
BEJAMIN   First Name   RICHARDSON
Street Address * 158 WG H WASHINGTON ST
City, State Zip * APOPKA, FL 32703
Email Address * NFRAVIEN@HOTMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   BEJAMIN   First Name   RICHARDSON
Policy # * SFLH3000491-05 Claim #* 63451
Attorney
Attorney is Applicable
Last Name* ALTMAN First Name * ALEXIS Initial
Street Address* 925 SOUTH FEDERAL HIGHWAY, 7TH FLOOR
City, State Zip* BOCA RATON , FL - FLORIDA 33432
Email Address * AALTMAN@KPATTORNEY.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   SAFEPOINT INSURANCE COMPANY
NAIC Company Code 15341
 
Name of individual responsible for violation (if any):* COREY OSBOURNE
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unfair Trade Practice
Claim Delay
Claim Denial
* 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)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

loss settlement provision
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

State Farm Florida Insurance Company (carrier) has not attempted in good faith to settle the insured’s 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 their interests. The carrier has done everything possible to delay the claim and refuses to pay the complete covered loss amount due under the policy. Furthermore, the carrier is required to properly investigate and adjust claims and cannot place that burden upon the insured. This was made clear by the appellate court and the Florida Supreme Court in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005)(“The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insureds…”). The carrier was put on notice of the insured’s water loss claim. The carrier sent an inspector to go out and inspect the leak and stated that the water damage was a result of the p-trap. Rather than paying for the claim the carrier wrongfully denied it. An estimate was provided in the amount of $47,121.61. Despite a myriad of requests to pay the amount that is due and owed to the insureds, they are left with no other option but to seek legal advice and representation to enforce his rights under the policy and Florida law. Under all attendant circumstances described above, the carrier has not engaged in good faith claims conduct. The adjusters handling the claim did not properly evaluate or adjust this loss, specifically related to their failure to tender all sums due and owing for the loss. It is clear that the carrier intentionally sent out its field adjuster with the instructions to deny the claim hoping they will get away with taking advantage of their insured. The carrier has intentionally downplayed the extent of damages and wrongfully denied the claim. Further its estimate fails to comply with Florida business code and Florida statute. Its failure to pay violates the loss payment provision constitutes an unsatisfactory settlement offer, and its refusal to tender all sums due and owing constitute claim delay and unfair trade practices. The carrier’s actions are in violation of the Loss Settlement provision of the policy as well as the following Florida Statutes: 624.155(1)(b)(1): Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its 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)(b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. 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 notify the insured of any additional information necessary for the processing of a claim. This notice is provided in order to perfect a right to pursue the civil remedy authorized by Florida Statute §624.155. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1) Pay all amounts due and owing to the insured in the amount of $47,121.61 minus any applicable deductible; 2) Pay any emergency services; 3) Pay the statutory interest on the amount of unpaid damages from the date of the loss to the date payment is finally made; and Should you have any questions, please do not hesitate to contact me at 561-892-9988. Thank you for your attention to this matter. Sincerely, Alexis Altman
Comments
User Id Date Added Comment
jbrookings@safepointins.com 01-24-2025 January 24, 2025 VIA EMAIL: AALTMAN@KPATTORNEY.COM Alexis Altman, Esq. 925 South Federal Highway, 7th Floor Boca Raton, FL - Florida 33432 RE: Insured: Richardson Bejamin Claim Number: 63451 Policy: SFLH3000491-05 Date of Loss: 5/18/2024 CRN Filing Number: 794024 Dear Sir/Madam: This is the formal response of SafePoint Insurance Company (“SafePoint”) to the purported Civil Remedy Notice of Insurer Violations (“Purported Notice”) that was filed on behalf of Richardson Bejamin (“Complainant” / “Insured”). The Florida Department of Financial Services accepted the Purported Notice, in form only, on November 25, 2024. The Purported Notice was filed in connection with Complainant’s insurance claim for property damage. The Purported Notice names SafePoint and alleges “Unfair Trade Practice,” “Claim Delay,” and “Claim Denial” supposedly in violation of Sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(d) and 626.9541(1)(i)(3)(g) Florida Statutes. The Purported Notice is a legal nullity for the reasons discussed below. SafePoint reserves all (and waives none) of its rights or defenses, including its right to assert additional deficiencies in the Purported Notice. SafePoint specifically denies each and every allegation contained in the Purported Notice. Additionally, SafePoint denies that it violated these or any statutes, Florida law or policy provisions regarding the claim adjustment of this matter. Under Section 624.155(3), Florida Statutes, a claimant must file a notice with the Florida Department of Financial Services (“the Department”) at least 60 days before filing a Statutory “bad faith” lawsuit. This notice is commonly referred to as a “civil remedy notice” (“CRN”). Section 624.155(3), Florida Statutes sets out five pieces of information which must be included in a CRN: 1. The statutory provision, including the specific language of the statute, which the authorized insurer allegedly violated; 2. The facts and circumstances giving rise to the violation; 3. The name of any individual involved in the violation; 4. Reference to specific policy language that is relevant to the violation, if any. If the person bringing the civil action is a third party claimant, she or he shall not be required to reference the specific policy language if the authorized insurer has not provided a copy of the policy to the third party claimant pursuant to written request; and 5. A statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. The statute also provides that, in addition to these five requirements, the CRN shall be “on a form provided by the [Department] and shall state with specificity . . . such other information as the department may require.” (emphasis added); The Florida Supreme Court has held that Section 624.155, Florida Statutes “must be strictly construed.” Talat Enterprises, Inc. v. Aetna Cas. and Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Strict construction is appropriate as “this statute is in derogation of the common law.” Id. When interpreting a statute in derogation of the common law, “[a] court will presume that such a statute was not intended to alter the common law other than as clearly and plainly specified in the statute.” Time Ins. Co., Inc. v. Burger, 712 So. 2d 389, 393 (Fla. 1998). Accordingly, such an interpretation would mean that statutory bad faith cases cannot proceed unless the claimant has specifically complied will all statutory requirements. After the promulgation of this statute, the Department created a CRN form: Form DFS-10-363. Form DFS-10-363 lays out 15 requirements: 1. Complainants Name; 2. Complainants Address; 3. Complainants E-mail address; 4. Complainant type (Insured or otherwise); 5. Insured’s Name; 6. Insurance Policy Number; 7. Insurance Claim Number; 8. Attorney’s Name; 9. Attorney’s Address; 10. Attorney’s E-mail Address; 11. Type of Insurer (authorized or otherwise); 12. Name of Insurer; 13. Address of Insurer; 14. Type of Insurance (Commercial Property & Casualty or otherwise); and 15. Reason for Notice. As these requirements are all information required by the Department, according to Section 624.155, Florida Statutes, they each must be stated with specificity. The Notice fails to meet the requirements of Fla. Stat. § 624.155 on the following grounds: Deficiency #1 Section 624.155(3)(b)(4), Florida Statutes, requires the CRN to reference specific policy language that is relevant to the violation, if any. If the person bringing the civil action is a third- party claimant, she or he shall not be required to reference the specific policy language if the authorized insurer has not provided a copy of the policy to the third-party claimant pursuant to written request. The Complainant is the Insured and not a third-party claimant; therefore, the Purported Notice must include specific language from the subject policy that is relevant to the alleged violations. It does not. Rather, the Purported Notice lists a vague heading from an unknown insurance policy, “Loss settlement provision.” Thus, the Purported Notice is invalid for noncompliance with Section 624.155(3)(b)(4), Florida Statutes. This deficiency applies to all allegations in the Purported Notice, including but not limited to “Unfair Trade Practice,” “Claim Delay,” and “Claim Denial” supposedly in violation of Sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(d) and 626.9541(1)(i)(3)(g) Florida Statutes. On March 3, 2021, the Fourth District Court of Appeal issued a relevant opinion in Junior Julien v. United Property and Casualty Insurance Company, No. 4D19-2763. In Julien, the insured appealed the circuit court’s dismissal of his lawsuit against his insurer, finding that the insured’s Civil Remedy Notice (“CRN”) failed to satisfy the statutory requirement that an insured “state with specificity” the policy language and the statutory provisions at issue. In his CRN, the insured cited numerous statutory provisions and listed nearly every provision in the insurance policy. On appeal, the Fourth District affirmed the dismissal and agreed with the circuit court that the CRN failed to specify the statutory and policy provisions at issue. Like the CRN in Julien, the Purported Notice fails to “state with specificity” the policy language at issue. Deficiency # 2 Section 624.155(3)(b)(2), Florida Statutes, requires that the CRN state with specificity the facts and circumstances giving rise to the violation. The Purported Notice does not supply specific facts or circumstances that explain the allegations. Rather, the Purported Notice contains incorrect facts and fails to explain how the purported facts constitute violations of Florida law. The Purported Notice asserts general allegations consisting of conclusory and inaccurate statements rather than specific allegations of fact regarding any alleged misconduct or statutory violations. For example, the Purported Notice states, “Rather than paying for the claim the carrier wrongfully denied it.” However, these statements are conclusory, inaccurate and without factual basis. This is a claim for interior water damage that was late reported on May 20, 2024, two (2) days after the alleged date of loss, May 18, 2024. On May 21, 2024, SafePoint retained ‘Leak Doctor’ to timely inspect the subject property and document any visible damage. It was noted, there was no evidence indicating a single or sudden discharge event in the kitchen. The observed damage and staining inside the kitchen cabinet was consistent with long-term water infiltration through the gaps between the sink and counter. This infiltration likely occurred over several months prior to the date of loss. Further, the technician used state-of-the-art electronic equipment to inspect the plumbing system and found no leaks. The electronic leak detection confirmed there were no active leaks in the plumbing supply system. The technician noted water damage likely due to long-term leakage through the sink/countertop gap and possibly a previous leak from the old P-trap, although this couldn't be confirmed. They found discoloration in the cabinet below the sink but no moisture at the time of inspection. The technician also observed some old P-trap parts under the sink, and the current P-trap showed no signs of leakage. A gap between the sink and the marble countertop was identified as the likely source of water entering the cabinet below. The Policy does not provide coverage for pre-existing damages and loss caused by wear and tear, deterioration, age-related damage, faulty or inadequate repairs, maintenance of the water supply system, or long-term constant and repeated seepage and or leakages of water. As such, on August 6, 2024, contrary to the Purported Notice erroneous assertion, “The carrier has done everything possible to delay the claim and refuses to pay the complete covered loss amount due under the policy[.]” the Complainant was notified in writing and provided a detailed explanation as to why there was not a covered peril under the Policy in accordance with the investigation and the Policy terms and conditions. Finally, the Notice makes boilerplate recitations of statutes and conclusory statement without the requisite specificity. Specificity is of particular importance for this Notice as Complainant generally alleges that SafePoint “[m]isrepresent[ed] pertinent facts or insurance policy provisions relating to the coverages at issue.” However, the Notice does not set forth any facts regarding any misrepresentations made by SafePoint and does not identify the person or persons who made such misrepresentations. It is evident that the statement of facts falls short of the specificity required by Fla. Stat. §624.155. The above noted deficiencies apply to all allegations in the Purported Notice, including but not limited to “Unfair Trade Practice,” “Claim Delay,” and “Claim Denial” supposedly in violation of Sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(d) and 626.9541(1)(i)(3)(g) Florida Statutes. Deficiency # 3 The Purported Notice does not supply necessary information that would allow SafePoint to “cure” the alleged violations without paying benefits which are not due and owing to the Complainant, as required by Florida law. The purpose of a Civil Remedy Notice is to provide the insurer an opportunity to “cure” the alleged wrongdoing. Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278 (Fla. 2000). However, Section 624.155, Florida Statute, does not impose on an insurer the obligation to pay whatever an insured demand. Talat, 753 So. 2d at 1282. To the contrary, the Florida Supreme Court holds that the scope of what can be “cured” in responding to a Civil Remedy Notice, is limited to contractual amounts due to the insured. See Talat, 753 So. 2d at 1281. Here the Complainant seeks extracontractual damages, specifically requesting the payment of statutory interest on the unpaid damages from the “date of loss” until the date of final payment. However, pursuant to Fla. Stat. § 627.70131, interest begins to accrue from the date the insurer “receives notice” of the claim (not the date of loss). Further, Complainant is seeking $47,121.61 as payment due and owing which is above the maximum amount allotted under the Policy for water related covered damages. Per the Policy, the limit of liability for all damages to the covered property due to water loss is $10,000.00 per loss. Consequently, the Purported Notice is deficient as it fails to afford SafePoint the opportunity to cure the alleged violations without incurring extracontractual damages. SafePoint is only obligated to pay contractual amounts owed to cure a civil remedy. See id. at 1278. This deficiency applies to all allegations in the Purported Notice, including but not limited to “Unfair Trade Practice,” “Claim Delay,” and “Claim Denial” supposedly in violation of Sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(d) and 626.9541(1)(i)(3)(g) Florida Statutes. STATUTORY ALLEGATIONS 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. SAFEPOINT denies the allegation that it violated the above referenced statute. 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. SAFEPOINT denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. SAFEPOINT denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. SAFEPOINT denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims. SAFEPOINT denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(d): Denying claims without conducting reasonable investigations based upon available information. SAFEPOINT denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(g): Failing to notify the insured of any additional information necessary for the processing of a claim. SAFEPOINT denies the allegation that it violated the above referenced statute. The allegations set forth in the Purported Notice are denied as they are mere conclusory allegations unsupported by facts, devoid of logic and intended solely to tarnish SafePoint’s name and reputation. SafePoint has at all times, acted fairly, honestly and in good faith in its dealings with the Complainant. While an insurance carrier is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested. SafePoint unequivocally denies each and every allegation asserted in the Purported Notice. At no time has SafePoint breached any duty to the Complainant. AN INSURER IS NOT REQUIRED TO PAY WHATEVER AMOUNT THE INSURED DEMANDS. SafePoint retained a field adjuster and leak detection specialist and conducted an inspection of the subject property to investigate the Insured’s claim. Thereafter, Safepoint made a coverage decision pursuant to all applicable policy language and statutes. Please be advised, by this letter, SafePoint neither waives, nor is estopped, from asserting any and all rights it may have in law, or, under the terms of the Policy. In fact, SafePoint hereby again, expressly, and specifically, reserves all of its rights, without exception or limitation. If you have any questions or concerns with this response, or, regarding any other matter, please contact me in writing. Sincerely, /s/ Ari A. Zeltzer Ari A. Zeltzer, Esq. Staff Counsel SafePoint Insurance Cc: Florida Department of Financial Services
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