Civil Remedy Notice of Insurer Violations
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Filing Number:     794026
Filing Accepted:  11/25/2024
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Complainant
Last/Business Name *  
MARZON   First Name   YASMANY
Street Address * 4886 KEYSVILLE AVENUE
City, State Zip * SPRING HILL, FL 34608
Email Address * CDP@WEKLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   MARZOL   First Name   YASMANY
Policy # * FPH-3007557-00 Claim #* FPI238079
Attorney
Attorney is Applicable
Last Name* PAGAN First Name * CHRISTOPHER Initial D
Street Address* 800 EAST BROWARD BOULEVARD, SUITE 510
City, State Zip* FORT LAUDERDALE , FL 33301
Email Address * CDP@WEKLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   FLORIDA PENINSULA INSURANCE COMPANY
NAIC Company Code 10132
 
Name of individual responsible for violation (if any):* RANELL GREEN
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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Property Coverages - Coverage A Perils Insured Against Conditions - 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.

Yasmany Nico Marzol ("Insured") purchased an insurance policy ("Policy") from Florida Peninsula Insurance Company ("FPIC" or “Carrier”) with effective coverage on the date of loss, on or about September 28, 2022, and Policy number FPH-3007557-00 to insure her property located at 4886 Keysville Avenue, Spring Hill, FL 34608 (the "Property").?? On or about September 28, 2022, the Property suffered severe damage as the result of Hurricane Ian, which caused ensuing damages to the Property including but not limited to the roof and interior of the property ("Loss"). FPIC was notified of the Loss and was granted access to the property in order to complete their inspection. FPIC acknowledged the claim and assigned claim FPI238079 ("Claim") to the Loss. On June 1, 2023, Ranell Green, the claims examiner on behalf of FPIC, authored a letter to the Insured (“Coverage Letter”) stating that the damages were not covered under the policy and that no payment was forthcoming. Nowhere in the letter does FPIC state that they were unable to conduct or complete an investigation of the damages and necessary repairs to the Property, nor does it mention any reason why FPIC would have been prejudiced in its investigation. After being provided plenty of evidence (including photos, estimates, and immediate access to the property upon discovery) showing that damage from Hurricane Ian occurred at the property that will require extensive repairs, FPIC continues to refuse to provide any money in order to complete these repairs. FPIC also has the ability to determine the costs needed to fully repair this property but has not attempted to discover this information and has instead forced the Insured to pursue legal recourses for the money due and owing under the contract of insurance. FPIC is trying to avoid finding any further information that would increase the amount of coverage available on this claim despite being aware that additional costs would need to be incurred by the Insured to repair her home. The Insured has fully complied with all applicable Policy provisions requiring cooperation with the?investigation;?however, FPIC has unequivocally failed to properly adjust this Claim, as elaborated above. FPIC has not attempted, in good faith, to settle this claim when, under the circumstances, it could and should have done so had it acted fairly and honestly toward the policyholder and with due regard to the policyholder's interests.? Rather, FPIC has acted with only its own profit and shareholders in mind. As a direct consequence of FPIC’s failure to adjust this Loss in good faith and make any coverage payment, the Insured continues to be without adequate compensation for the damages sustained at the Insured’s Property more than two (2) years ago.?? By stating the above detailed?facts,?it is clear that FPIC has 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 toward its Insureds and with due regard for their interest. • 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)(i) Unfair claim settlement practices. To date, FPIC has in bad faith failed to provide sufficient coverage under the Policy to the Insureds. As a direct result of FPIC’s underpayment of the Claim and breach of the Florida Statutes, the Insured was?forced to seek the?help of licensed professionals to assist her, including legal counsel.?Due to the amount of time that has passed since the date of loss and the information discussed above, there is irrefutable evidence that FPIC knowingly and intentionally, and in bad faith delayed the settlement process in order to further disadvantage the Insured. The financial detriment caused to the Insured is a direct result of FPIC’s reckless treatment of the claims process. The Insured submitted all documents requested in a timely fashion, made the property available for inspection immediately after the discovery of the loss, submitted an estimate, and satisfied all requests. However, FPIC failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim.? To deny the Insured the benefits clearly due and owing under the Policy, for which they been making premium payments for and after they have satisfied all of his obligations is morally and ethically reprehensible and reeks of Unfair Claims Practice and Bad Faith. Upon information and belief, the aforementioned actions complained of, among others, were made by FPIC so often?as to constitute a general business practice, evidencing a motive to enhance FPIC’s profits, and designed to cause a detrimental effect to its policyholders. The above clearly depicts that FPIC adjusted this claim in bad faith, continue to act in bad faith towards its Insureds and that FPIC is in direct violation of Unfair Claims Practices.?? This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should FPIC fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, FPIC must: (1) Immediately tender all proceeds due and owing to the Insuredsthat are fairly owed under the insurance policy that would reasonably compensate them in order to put the loss property back to its pre-loss condition ($99,148.00 less any applicable deductible); (2) Immediately afford coverage for the repairs to the subject property necessary to put the property back into its pre-loss condition and reimburse for the work already performed (3) Agree to reimburse the Insured’s reasonable attorneys’ fees and costs for having to become involved to resolve the claim; and (4) Agree to reimburse the Insureds\ for interest on the amount of benefits that was found to be?due and owing to the Insured, relating back to the date of loss.
Comments
User Id Date Added Comment
vveliz@qpwblaw.com 12-23-2024 VIA POSTED ONLINE Florida Department of Financial Services Division of Insurance Regulation Bureau of Consumer Assistance/Civil Remedy Section Larson Building, 200 East Gaines Street Tallahassee, Florida 32399-0322 Insureds: Yasmany Nico Marzol Complainant: Yasmany Nico Marzol Claim No: FPI238079 (“Subject Claim”) Policy No: FPH3007557-00 (“Policy”) Loss Location: 4886 Keysville Avenue, Spring Hill, FL 34608 (“Property”) CRN Filing No: 794026 CRN Acceptance Date: 11/25/2024 RE: CIVIL REMEDY NOTICE - DFS FILING NUMBER 794026 Dear Sir or Madam: The undersigned counsel represents Florida Peninsula Insurance Company (“Florida Peninsula”) in regard to the alleged dispute as to subject claim number FPI238079 claimed to have been made as a result of Hurricane Ian under the Policy of insurance, FPH3007557-00, as listed above. This correspondence constitutes Florida Peninsula Insurance Company’s response to the Civil Remedy Notice of Insurer Violations (“Notice” or “CRN”), filed on behalf of Yasmany Nico Marzol regarding the claim listed above. Florida Peninsula believes that the Civil Remedy Notice should be rejected and returned by the Department of Financial Services as it completely misstates the facts surrounding this claim. ALLEGED STATUTORY VIOLATIONS 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. Florida Peninsula specifically denies the complainant’s allegation that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. The CRN does not include facts to support this allegation. Florida Peninsula conducted a thorough investigation in good faith pursuant to the terms, conditions, exclusions, and endorsements found in the subject policy of insurance. This allegation is without merit. 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. Florida Peninsula specifically denies the Complainant’s allegation that it has violated the above referenced statute. Florida Peninsula did not violate these provisions. The CRN does not include facts to support this allegation. Florida Peninsula conducted a thorough investigation in good faith and issued its coverage determination based on the Policy’s provisions, conditions, exclusions and endorsements. This allegation is without merit. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the property investigation of claims. Florida Peninsula specifically denies the Complainant’s allegation that it has violated the above referenced statute. The CRN does not include any facts to support this allegation. Florida Peninsula did not fail to adopt and implement standards for the proper investigation of the claim. Florida Peninsula further denies that it does not have proper standards in place for the investigation of claims. This allegation is without merit. 626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims. Florida Peninsula specifically denies the Complainant’s allegation that it has violated the above referenced statute. The CRN does not include any facts to support this allegation. Florida Peninsula conducted a thorough investigation in good faith and promptly and continually communicated with the insured regarding the Claim. This allegation is without merit. 626.9541(1)(i)(3)(i): Failing to pay personal injury protection insurance claims within he time periods required by S. 627.736(4)(b). This allegation does not apply to the subject Claim. The Claim at issue in this CRN involves a property damage claim, not a personal injury protection claim. Florida Peninsula specifically denies the Complainant’s allegation that it has violated the above referenced statute. This allegation is inapplicable and without merit. In addition to the allegations specifically denied above, Florida Peninsula generally denies all allegations presented in this CRN, as Florida Peninsula has not violated any statute, Code or Rule. SPECIFICITY REQUIREMENTS Florida Statute requires that a CRN state the facts and circumstances giving rise to the alleged violations with specificity sufficient to allow an insurer to “cure” the alleged violations within the sixty-day statutory period. See Fla. Stat. § 624. 155(3)(b)(2). See also Lane v. Westfield Ins. Co., 862 So. 2d 774, 777 (Fla. 5th DCA 2003), Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). However, here, the CRN is deficient and defective in that it fails to state with sufficient specificity the necessary facts in support of the complainant’s contentions, including but not limited to, those that would be necessary for Florida Peninsula to “cure” the alleged violations. Further, the subject CRN provides what appears to be several boilerplate and conclusory statements, which fail to describe any accurate facts constituting violations of the statutes cited therein. Thus, because the allegations in the CRN are incomplete and incorrect, they fail to provide actual notice of the specific allegations and the actions that Florida Peninsula could undertake to cure any alleged violations. 316, Inc. v. Maryland Cas. Co., 625 F. Supp. 2d 1187, 1193 (N. D. Fla. 2008). Blanket references to policy provisions and statutes without specification deems the Civil Remedy Notice deficient. Julien v. United Property and Casualty Insurance Co., (Fla. 4th DCA 2020). For the reasons set forth herein, Florida Peninsula hereby objects to the subject CRN and states it does not intend to waive, ratify or otherwise accept the deficiencies in the CRN, and reserves the right to contest the legal adequacy of the CRN hereinafter as appropriate. As to the content of the CRN here, it is important to note that said CRN is a nullity and should be rejected because the CRN fails to comply with the specific requirements mandated by Florida Statutes §624.155. Specifically, Fla. Stat. § 624.155(3)(b)(2) requires the Complainant to set forth with specificity, sufficient factual allegations to state a prima facie case of an insurer violation, so as to put the insurer on notice and be afforded the opportunity to cure the deficiency. However, complainant failed to do so in the subject CRN and instead only included conclusory statements, which lack even minimal specificity and/or lack the underlying factual basis to support them. The complainant’s failure to describe any actual facts or circumstances to support the alleged statutory violations in the CRN precludes Florida Peninsula from evaluating what error, if any, allegedly occurred during the claim process. Furthermore, contrary to the requirement to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time,” the purpose of which is “to enable the insurer to investigate and resolve [the] claim,” the CRN itself only provides unsupported and incorrect allegations with no basis in fact or circumstances. Consequently, the CRN lacks the requisite minimal specificity and Florida Peninsula is unable to determine what specifically the Complainant is claiming was done by or on behalf of Florida Peninsula that constitutes the bad faith alleged. Due to the absence of specific and accurate information regarding the alleged acts or omissions by Florida Peninsula which allegedly give rise to any violation of the Civil Remedy Statute, Florida Peninsula is limited in its ability to set forth specific facts to address and/or refute these unsubstantiated assertions. Notwithstanding, Florida Peninsula explicitly denies violations of any applicable Florida Statute in the adjustment of the Subject claim and realleges and re-asserts its specific denials to the alleged violations in the subject CRN as set forth above. Accordingly, without waiver of its objections, rights and defenses, Florida Peninsula maintains that it has acted and continues at all times to act in good faith during the investigation and adjustment of the claim. Further, Florida Peninsula wishes to dispel even the inference of any statutory violation and reiterates below the various reasons which clearly show the proper handling of the Subject claim by Florida Peninsula. Moreover, as stated in Demase v. State Farm Florida Insurance Company (Fla. 5th DCA November 14, 2022), as a condition precedent to bringing a first-party bad faith case, complainant must provide timely notice of the alleged violation to the authorized insurer and to the DFS. BACKGROUND FACTS Aside from the fact that the allegations contained in the subject CRN lack specific facts, the tenor and inferences of statutory violations are wholly without merit and Florida Peninsula denies each and every one. Below are some of the relevant facts regarding the subject claim that the complainant failed to include in the CRN. The Complainant’s representative reported this loss to Florida Peninsula on May 09, 2023, stating that on September 28, 2022, over eight (8) months earlier, the subject property was damaged as a result of Hurricane Ian. Specifically, it was reported that the property suffered damages in the form of lifted shingles on the roof, as well as water damage stains in the garage, living room and laundry room. The representative was unsure if the damages had been mitigated, but it was specified that no contents were damaged. No further information was provided at the time of reporting. On the same day, May 09, 2023, Florida Peninsula immediately sent correspondence acknowledging receipt of the claim. This correspondence included the Florida homeowner claim bill of rights and information on mediation and claims handling. On May 10, 2023, due to the late reporting of the subject claim, Florida Peninsula sent its Reservation of Rights correspondence, providing Complainant an excerpt from the subject policy form FP HO 03 07 21 which includes "Your Duties After Loss". Also on May 10, 2023, an independent field adjuster retained by Florida Peninsula contacted the insured in regards to the claim. Information was provided regarding the claims process and the field adjuster provided the Insured with his direct contact information. Inspection was thereafter scheduled for May 19, 2023. Inspection of the subject property was completed on May 19, 2023. Complainant, Yasmany Nico Marzol, and her representative were also present during inspection and provided the field adjuster with additional information relating to the loss, however, there was no information provided as to why this September 28, 2022 loss was not reported to Florida Peninsula until May 09, 2023. During inspection, the roof tarp that had been placed on the roof was lifted. The field adjuster did not observe any wind damage or hail damaged shingles. Further, the field adjuster observed the roof to have very heavy wear and tear with granule loss. Complainant did not provide a recorded statement. A coverage determination correspondence was issued on June 01, 2023 based on the inspection conducted as well as on the provisions, exclusions, policy limits and endorsements contained in the subject policy of insurance. In this coverage determination correspondence, the Complainant was specifically advised that no evidence of damage caused by the recent passage of Hurricane Ian had been observed. Instead, inspection revealed damage to the roof that was a result of age-related deterioration, wear, and tear. Inspection did not observe any wind-created openings. Along with its coverage determination correspondence, Florida Peninsula sent excerpted policy provisions explaining same. After this coverage determination correspondence was issued, Florida Peninsula received an assignment of benefits from a mold remediation company along with an invoice in the amount of $14,601 for mold testing and mold remediation. A supplement was opened to address these mold claims. Ultimately, it was concluded that the mold test and invoice were not related to a covered cause of loss so there no coverage was available. A steadfast correspondence was issued, including excerpted policy provisions explaining same. A lawsuit followed shortly thereafter. Florida Peninsula conducted a good faith investigation based on all available information at the time of inspection. Florida Peninsula categorically denies that it has acted with bad faith in connection with this claim. INACCURACY OF ALLEGATIONS IN THE SUBJECT CRN The case specific facts related to Florida Peninsula’s handling of the Subject claim provided above implicitly address many of the vague allegations contained within the CRN and further establish that Florida Peninsula undertook a thorough investigation in accordance with applicable statutory requirements and professional standards of care. It is important to note that the complainant has not provided even one shred of factual support for any of the above allegations. Instead, the facts support that Florida Peninsula promptly contacted the Insured, inspected the claim shortly after it was reported, and opened a supplemental investigation in good faith. The circumstances support that Florida Peninsula conducted a thorough, prompt investigation with the information provided. The complainant accuses Florida Peninsula of misrepresenting pertinent facts and delaying the claim without any basis. However, the Insured is alleging bad faith in a scenario where Florida Peninsula conducted a comprehensive, prompt investigation in good faith. The Insured simply disagrees with Florida Peninsula’s coverage determination. Furthermore, contrary to the requirement to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time”, the purpose of which is “to enable the insurer to investigate and resolve [the] claim”, the Civil Remedy Notice itself only provides false allegations with no basis in fact or circumstances. Furthermore, the tenor and inferences of the allegations are without merit and Florida Peninsula denies each and every one. Some of the relevant facts that counsel failed to include in the notice have been set out above. As clearly set forth above and contrary to the allegations set forth in the Notice, Florida Peninsula’s investigation and adjusting of its Insured’s claim was prompt, thorough, and complete. Furthermore, counsel has included absolutely no facts or evidence to support any claims in the Notice. The Civil Remedy Notice states that Florida Peninsula can rectify these violations in the following ways: (1) Immediately tender all proceeds due and owing to the Insureds that are fairly owed under the insurance policy that would reasonably compensate them in order to put the loss property back to its pre-loss condition ($99,148.00 less any applicable deductible); (2) Immediately afford coverage for the repairs to the subject property necessary to put the property back into its pre-loss condition and reimburse for the work already performed (3) Agree to reimburse the Insured’s reasonable attorneys’ fees and costs for having to become involved to resolve the claim; and (4) Agree to reimburse the Insureds for interest on the amount of benefits that was found to be due and owing to the Insured, relating back to the date of loss. The Civil Remedy Notice does not show how Florida Peninsula has failed to comply with the statutory provisions alleged to have been violated. Evidently, this Civil Remedy Notice was filed in bad faith. For the aforementioned reasons, Florida Peninsula categorically denies that it has acted with bad faith in connection with this claim. CONCLUSION The purpose of a CRN is to provide the insurer an opportunity to “cure” the alleged wrongdoing. Talat Enterprises, Inc. v. Aetna Casualty and Surety Co. , 753 So. 2d 1278 (Fla. 2000). However, the CRN here does not serve this purpose because it does not provide any means as to how Florida Peninsula can “cure” the alleged defects. This failure to provide a proper opportunity to cure renders the CRN improper. Longpoint Condominium Associations v. Allstate Insurance Co. , 2005 WL 131580 (N. D. Fla. June 2, 2005). Moreover, the method for curing the violations alleged in a civil remedy notice are not determined by the insured. In Talat Enterprises, Inc. v. Aetna Casualty and Surety Co. , 753 So. 2d 1278 (Fla. 2000), the Florida Supreme Court accepted and quoted the reasoning of the court below in its opinion which stated in relevant part, as follows: Section 624. 155 does not impose on an insurer the obligation to pay whatever the insured demands. . . . Section 624. 155(2)(d) would have no effect or purpose under such an interpretation. The law does not support such an expansive and illogical reading of Fla. Stat. Ann. §624. 155(2)(d). . . . To cure an alleged violation and to avoid a civil action, an insurer must pay the claim . . . before the sixty days expire. Talat, 753 So2d at 1282 citing Talat Enterprises Inc. v. Aetna Cas. & Sur. Co., 952 F. Supp. 773, 777-778 (M. D. Fla. 1996). Here, Florida Peninsula properly adjusted the Subject claim as it investigated the loss within the statutory time frame. Florida Peninsula denies all of the allegations contained in the subject CRN, which is defective and improper, as Florida Peninsula has not violated any of the subject statutes. Florida Peninsula further states that the accusations made against it in the subject CRN are patently false. In closing, Florida Peninsula first believes that the Civil Remedy Notice should be rejected and returned by the Department of Financial Services due to its failure to comply with Florida Statute §624.155 and Florida Case law. Due to the lack of any factual and circumstantial basis to support the allegations therein, Florida Peninsula respectfully requests, through this response, that the DFS return and reject the CRN for lack of specificity pursuant to Florida Statutes. Regardless of the rejection, Florida Peninsula denies all allegations contained in the Civil Remedy Notice and submits there are no violations. While this response is meant to be comprehensive, Florida Peninsula’s response above is based upon the limited information provided in the Civil Remedy Notice and the information we have to date. If the complainant feels that we are not in possession of all the facts, please inform us immediately. Please note that Florida Peninsula’s response is not necessarily exhaustive and does not preclude us from asserting any other valid reason for seeking rejection and return of the Civil Remedy Notice. Also, this letter or any act or failure to act on the part of Florida Peninsula or any agent or representative of Florida Peninsula should not be construed as a waiver of any rights or defenses available to it by contract or at law as all such rights and defenses are hereby specifically reserved. We trust that this response addresses the allegations of insurer violation alleged in the Civil Remedy Notice of Insurer Violation. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Please feel free to contact us if there are any questions or concerns that require additional information. Very truly yours, QUINTAIROS, PRIETO, WOOD & BOYER, P.A. /s/ electronically submitted Jose E. Bosch, Esq. Veronica Veliz, Esq. cc: Christopher Pagan, Esq. CDP@WEKLAW.com
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