Civil Remedy Notice of Insurer Violations
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Filing Number:     794131
Filing Accepted:  11/26/2024
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Complainant
Last/Business Name *  
TOMAS A. GONZALES AND KATRINA C. GONZALES   First Name  
Street Address * 324 CURACAO WAY
City, State Zip * NICEVILLE, FL 32578
Email Address * GNZLS_TMS@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   TOMAS A. GONZALES AND KATRINA C. GONZALES   First Name  
Policy # * 59-CT-D241-3 Claim #* 59-66W9-00F
Attorney
Attorney is Applicable
Last Name* FOSKY First Name * JORDON Initial
Street Address* 925 S. FEDERAL HWY
City, State Zip* BOCA RATON , FL 33432
Email Address * JFOSKY@KPATTORNEY.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   STATE FARM FLORIDA INSURANCE COMPANY
NAIC Company Code 10739
 
Name of individual responsible for violation (if any):* PAUL HENRICHS
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unfair Trade Practice
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)(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.

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.

The carrier was immediately put on notice of the insureds’ windstorm claim. Subsequently, the insureds prepared a loss package in the amount of $97,263.09 needed to restore the property back to its pre-loss condition. This was submitted to State Farm prior to the filing of this CRN. Whereas, the carrier has failed to prudently inspect the insureds’ property, come to a fair coverage determination and promptly pay the claim. The carrier improperly determined that the loss was not covered under the policy and wrongfully denied the claim. In turn, the insureds have complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insureds. About three hundred twenty-five days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of the damage sustained by the insured’s property and has not taken any meaningful ensuing action. It is clear that the carrier is not treating the insureds with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insureds; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insureds’ interests; refusing to pay the full amount owed to the insureds despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insureds, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The carrier’s actions are in violation of Florida Statutes §§ 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) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $97,263.09, less any prior payments and less any applicable policy deductible; and 2.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier. Please do not hesitate to contact the undersigned or Devin Pruitt at (239) 488-6829 if you have any questions or concerns. Sincerely, Jordon Fosky Attorney at Law
Comments
User Id Date Added Comment
Amanda@whsf-law.com 01-20-2025 WILSON, HARRELL, FARRINGTON, FORD, WILSON, SPAIN & PARSONS, P.A. ATTORNEYS AT LAW 307 SOUTH PALAFOX STREET PENSACOLA, FLORIDA 32502-5929 JAMES M. WILSON POST OFFICE DRAWER 13430 WILLIAM E. FARRINGTON II PENSACOLA, FLORIDA 32502-3430 J. STEVEN FORD TELEPHONE: (850) 438-1111 JOSEPH A. WILSON FAX: (850) 432-8500 ADRIANNA M. SPAIN ELIZABETH A. PARSONS BOARD CERTIFIED CIVIL TRIAL LAWYER (Certified by the Florida Bar) MEGAN M. HALL C. MINER HARRELL (OF COUNSEL) ANNA L. UNIACKE January 20, 2025 via U.S. Mail and electronic mail to jfoskey@kpattorney.com Mr. and Mrs. Tomas Gonzales c/o Jordan Fosky, Esquire Kanner & Pintaluga, P.A. 925 S. Federal Highway Boca Raton, FL 33432 RE: Insureds: Tomas Gonzales and Katrina C. Gonzales CRN Filing No: 794131 Claim No.: 59-66W9-00F Subject Property: 324 Curacao Way, Niceville, Florida 32578 Dear Mr. and Mrs. Gonzales: Please accept this correspondence as the response of State Farm Florida Insurance Company (“State Farm”) to the Civil Remedies Notice (“CRN”) of Insurer Violation which your attorney filed on your behalf on November 26, 2024. The CRN suggests that there has been a disagreement regarding State Farm’s investigation, handling, and evaluation of your claim. In Florida, statute § 624.155 governs CRNs. Since this statute is in derogation of the common law, it must be strictly construed. Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). The substantive allegations in the your CRN fail to comply with § 624.155(3)(b)(1). This section requires the CRN to specify the statutory provision, including the specific language of the statute, which the insurer allegedly violated. Rather than identify the specific statute relevant to the insurer’s alleged violation, you listed many statutory sections which have little relevance to the facts of this claim. For example, you cite § 624.155(1)(b)(3), Florida Statutes, which provides that an insurer should not fail to settle one portion of the insurance policy in order to influence settlement under other portions of the insurance policy. Nothing in your allegations suggests that State Farm failed to settle one portion of the insurance policy in order to influence settlement under another portion of the policy. As a second example, you cite § 626.9541(1)(i)(3)(a), Florida Statutes, which requires an insurer to adopt and implement standards for the proper investigation of claims. You never suggest or propose standards which State Farm should have adopted which would have made a difference in your claim. In addition, you cite §626.954(1)(i)(3)(b), Florida Statutes, which applies if an insurer misrepresents pertinent facts or insurance policy provisions relating to coverages at issue. In this case, you do not allege that State Farm made any misrepresentations regarding pertinent facts or insurance policy provisions relating to coverage. Furthermore, you cite § 626.9541(1)(i)(3)(c), Florida Statutes, which applies if an insurer fails to acknowledge and act promptly upon claim communications. However, you never allege that State Farm failed to acknowledge or act promptly in its communications with you. Finally, you cite § 626.9541(1(i)(3)(f), Florida Statutes, which applies if the insurer fails to provide a reasonable explanation for denial of a claim or the offer of a settlement. Again, your never allege that State Farm failed to explain its denial. In summary, it appears that you listed random statutes which govern general claim practices instead of citing statutes that relate to any of your allegations. Such a listing lacks the specificity required by the statute and invalidates the CRN. See Demase v. State Farm Florida Ins. Co., 351 So. 3d 136, 138 (Fla. 5th DCA 2022) and Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). Furthermore, your CRN does not specify how the insurer violated the statutes listed. Florida courts have denounced CRNs that are “shotgun” in nature and lack the specific notice required by the statute. See Heritage Corp. of S. Florida v. Nat'l Union Fire Ins. Co. of Pittsburgh, PA, 580 F. Supp. 2d 1294, 1300 (S.D. Fla. 2008), aff'd, 361 Fed. Appx. 986 (11th Cir. 2010). Such CRNs “reflects a shotgun-blast effort to hit a lot of targets with a single salvo. This approach is contrary to the purpose of the statute.” Rousso v. Liberty Surplus Ins. Corp., 10-CV-20554, 2010 WL 7367059, at *5 (S.D. Fla. 2010). In addition, your CRN fails to comply with § 624.155(3)(b)(2), Florida Statutes, which requires the CRN to specify the facts and circumstances giving rise to the alleged violations. Your CRN contains generic and vague allegations without alleging specific facts in support of those generic and vague allegations. The CRN fails to explain how State Farm’s investigation and adjustment of the claim was allegedly deficient, beyond implying that you and your attorney disagree with State Farm’s evaluation of the claim. In other words, you and your attorney want additional policy proceeds without identifying any sufficient supporting basis. The CRN’s vague accusations and lack of specificity deprives State Farm of any meaningful notice and ability to respond, and is contrary to the statute. See Heritage Corp. of S. Florida, 580 F. Supp. 2d at 1299 and Marques v. Heritage Property & Cas. Ins. Co., 2021 WL 3473940, at *2 (Fla. 19th Cir. Ct. August 2, 2021). Furthermore, your CRN fails to comply with § 624.155(3)(b)(4), Florida Statutes, which requires the CRN to reference the specific policy language that is relevant to the violation. In the section of the form designated to list the specific policy language relevant to the violation, you merely wrote “Loss settlement provision.” Beside this vague assertion, the CRN does not reference specific policy language from the policy. Accordingly, this section of the CRN is not in compliance with Florida Statutes. See Fox v. Starr Indem. & Liab. Co., No. 8:16-CV-3254-T-23MAP, 2017 WL 1541294 (M.D. Fla. 2017) and Julien, 311 So. 3d at 879. Finally, the CRN fails to offer a proper and valid cure because it demands the payment of extra-contractual damages. In support of your claim, you have submitted your contractor’s estimate for $97,263.09 in replacement cost value (RCV) and $93,939.82 in actual cash value (ACV). In your CRN, you demand the RCV amount of $97,263.09, when in fact your policy and Florida law provide that at most, you are only entitled to the ACV amount. See § 627.7011(3)(a), Florida Statutes, and Citizens Prop. Ins. Corp. v. Salazar, 388 So. 3d 115, 118 (Fla. 3d DCA 2023). By demanding RCV rather than ACV, you are demanding extra-contractual damages, which renders the CRN defective and invalid. See Garman v. State Farm Fla. Ins. Co., 2023 WL 2599514, at *1 (Fla. 1st Cir. Ct. January 5, 2023); Brister v. State Farm Fla. Ins. Co., 2023 WL 5016671, at *3 (Fla. 4th Cir. Ct. July 17, 2023); and Apex Roofing & Restoration LLC v. United Services Auto. Ass'n, 2023 WL 5334035, at *2 (Fla. 13th Cir. Ct. August 15, 2023). State Farm has fully and fairly investigated and responded to this claim. On May 2, 2024, you reported this claim to State Farm and advised that the date of loss was January 9, 2024. On June 24, 2024, State Farm Claim Specialist Paul Henrichs met with Mrs. Gonzales and learned for the first time that the alleged windstorm at issue caused a tree to fall and damage the deck and a window. Mrs. Gonzales did not provide any explanation of why you waited nearly four months to report the loss and why you did not take any photographs of the tree on the house, on the deck, or on the window. Furthermore, Mrs. Gonzales advised that she did not keep any records, receipts, or invoices from the company who removed the tree. During Mr. Henrichs’ inspection, he observed no accidental direct physical loss to your home, but he did observe damage caused by wear, tear, deterioration, rust, poor maintenance, and faulty workmanship. On June 28, 2024, State Farm sent a letter to you to explain the basis of its denial due to late reporting, prejudice to its investigation, and damage caused by excluded causes. Months later, Mrs. Gonzalez sent State Farm a sworn proof of loss which merely incorporated by reference your contractor’s estimate. State Farm rejected the sworn proof of loss because it was untimely and not in the correct form. State Farm has in the past and will continue in the future to make all efforts to resolve this claim in a fair and reasonable fashion and in full accord with the State Farm insurance policy and Florida law. State Farm has acted fairly and honestly toward you, with due regard for your interests. State Farm has acted in good faith in an attempt to investigate and evaluate this claim. It has acknowledged and acted promptly on all communications with you, and it has provided reasonable explanations in writing as to its decisions. If you or your attorney would like for State Farm to consider any information or evidence otherwise unknown to it, please provide the information or evidence to me and I will be happy to forward it to State Farm. Thank you for your attention in this regard. Sincerely, ADRIANNA M. SPAIN AMS:ans
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