Civil Remedy Notice of Insurer Violations
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Filing Number:     794183
Filing Accepted:  11/26/2024
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Complainant
Last/Business Name *  
ILCHISHIN   First Name   SERGEY AND SVETLANA
Street Address * 3886 MUIRFIELD BOULEVARD EAST
City, State Zip * JACKSONVILLE, FL 32225
Email Address * JDS@WEKLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   ILCHISHIN   First Name   SERGEY AND SVETLANA
Policy # * FL07937579 Claim #* 608884
Attorney
Attorney is Applicable
Last Name* SPILLER First Name * JASON Initial
Street Address* 800 EAST BROWARD BLVD., SUITE 510
City, State Zip* FORT LAUDERDALE , FLORIDA 33301
Email Address * JDS@WEKLAW.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):* DAVID FLITMAN
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.
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.

SECTION I – PROPERTY COVERAGES A. Coverage A – Dwelling 1. We cover: a. The dwelling on the "residence premises" shown in the Declarations, including structures attached to the dwelling... SECTION I – PERILS INSURED AGAINST A. Coverage A – Dwelling And Coverage B – Other Structures 1. We insure against direct loss to the covered property described in Coverages A and B only if that loss is a physical loss to property. This includes the peril of “catastrophic ground cover collapse” as provided in Part A. below.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Sergey and Svetlana Ilchishin (“Insureds”) purchased an insurance policy ("Policy") from Citizens Property Insurance Corporation, of which said policy was taken over by SafePoint Insurance Corporation (“Carrier”) with effective coverage on the date of loss, on or about December 16, 2023, and Policy number FL07937579 to insure their property located at 3886 Muirfield Boulevard East, Jacksonville, FL 32225 ("Property"). On or about December 16, 2023, the Property suffered damage to the roof and interior of the Property ("Loss") as a result of a significant weather event. When the Insureds became aware of what appeared to be water damage entering the Property, the Insureds hired a roofing company, Trinity Restoration & Roofing, to assess the condition of the roof and interior. After confirming the presence of damage to the Property, the Insureds promptly reported the subject claim to the Carrier. Upon receiving notice of the claim, the Carrier acknowledged it and assigned claim number 608884 ("Claim") to the Loss. Thereafter, the Carrier inspected and documented the observable damages, but denied coverage to its Insureds for the subject loss despite the Insureds providing uncontroverted evidence of the existence of wind-related damage to the Property. This is further supported by the fact that a 4 Point Inspection was completed for the Property on June 27, 2022, which documented no observable damage to the Property’s interior or roofing system, as well as opining that said roofing system had approximately six (6) remaining years of useful life. Since the Insureds became aware of the damages to the Property, they have acted promptly in reporting the claim. They have cooperated in all ways possible with every request of the Carrier. The Insureds have fully complied with all applicable Policy provisions requiring cooperation with the investigation; however, the Carrier has unequivocally failed to properly adjust this Claim, as further elaborated above. Rather than paying the actual damages and/or trying to settle with the Insured, the Carrier has failed to act in good faith, delaying any prompt resolution of the claim. The Carrier 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 policyholders and with due regard to the policyholders' interests. As a result of this incident, the Insured has suffered damage to the building on the subject Property and loss of use of the Property and possessions therein. As a direct consequence of the Carrier’s failure to adjust this Loss in good faith and make any payment, the Insureds continue to be without adequate compensation for the damages sustained at the Insureds' Property. By stating the above detailed facts, it is clear that the Carrier 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; • 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. To date, the Carrier has acted in bad faith and failed to provide coverage under the Policy to the Insureds. As a direct result of Carrier’s denial of the Claim and breach of the Florida Statutes, the Insureds were forced to seek the help of licensed professionals to assist them, including a public adjuster and 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 Carrier knowingly and intentionally, and in bad faith delays the settlement process in order to further disadvantage the Insureds. The financial detriment caused to the Insureds are a direct result of the Carrier’s reckless treatment of the claims process. The Insureds submitted all documents requested in a timely fashion, made their property available for inspection, submitted estimates and requests. However, the Carrier failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim. To deny the Insureds the benefit clearly due and owing under the Policy, for which they have time and time again been making premium payments for and after they have satisfied all of their 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 the Carrier so often as to constitute a general business practice, evidencing a motive to enhance the Carrier’s profits, and designed to cause a detrimental effect to its policyholders. The above clearly depicts that the Carrier adjusted this claim in bad faith, continue to act in bad faith towards its Insureds, and that the Carrier 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 the Carrier 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, the Carrier must: (1) Immediately tender $74,307.37 in US dollars to the Insureds which is fairly owed to the Insureds under the insurance policy and would reasonably compensate the Insureds in order to put the Property back to its pre-loss condition; (2) Agree to reimburse the Insureds for interest on the amount of benefits that was found to be due and owing to the Insureds, relating back to the date of loss; and (3) Agree to reimburse the Insureds’ reasonable attorneys’ fees and costs for having to become involved to resolve the claim.
Comments
User Id Date Added Comment
jbrookings@safepointins.com 01-24-2025 January 24, 2025 VIA EMAIL: JDS@WEKLAW.COM Jason Spiller, Esq. 800 East Broward Blvd., Suite 510 Fort Lauderdale, Florida 33301 RE: Insured: Sergey And Svetlana Ilchishin Claim Number: 60884 Policy: FL07937579 Date of Loss: 12/16/2023 CRN Filing Number: 794183 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 Sergey And Svetlana Ilchishin (“Complainant” / “Insured”). The Florida Department of Financial Services accepted the Purported Notice, in form only, on November 26, 2024. The Purported Notice was filed in connection with Complainant’s insurance claim for property damage. The Purported Notice names SafePoint and alleges “Claim Denial,” “Claim Delay,” “Unsatisfactory Settlement Offer,” and “Unfair Trade Practice” supposedly in violation of Sections 624.155(1)(b)(1), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b) and 626.9541(1)(i)(3)(d), 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 Purported Notice fails to meet the requirements of Fla. Stat. § 624.155 on several 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 vague and overbroad language from an unknown insurance policy: “SECTION I - PROPERTY COVERAGES A. Coverage A - Dwelling 1. We cover: a. The dwelling on the "residence premises" shown in the Declarations, including structures attached to the dwelling... – SECTION I - PERILS INSURED AGAINST A. Coverage A - Dwelling And Coverage B Other Structures 1. We insure against direct loss to the covered property described in Coverages A and B only if that loss is a physical loss to property. This includes the peril of “catastrophic ground Cover collapse” as provided in Part A. below.” General, vague and overbroad references to policy provisions does not satisfy the specificity required by § 624.155(3)(b)(4), Fla. Stat. As such, the Purported Notice is deficient as a matter of law. This deficiency applies to all allegations in the Purported Notice, including but not limited to “Claim Denial,” “Claim Delay,” “Unsatisfactory Settlement Offer,” and “Unfair Trade Practice” supposedly in violation of Sections 624.155(1)(b)(1), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b) and 626.9541(1)(i)(3)(d), 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 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, “Thereafter, the Carrier inspected and documented the observable damages, but denied coverage to its Insureds for the subject loss despite the Insureds providing uncontroverted evidence of the existence of wind-related damage to the Property.” However, these statements are conclusory, inaccurate and without factual basis. This is a claim for roof and interior damage to the property that was late reported on January 9, 2024, twenty-four (24) days after the alleged date of loss, December 16, 2023. On January 19, 2023, SafePoint retained MD Claims to promptly inspect the subject property and document any visible damage. When MD Claims was unable to determine causation, SafePoint engaged Precision Claims Solutions for a reinspection on January 31, 2024. The inspection report noted, there was no evidence of storm-related damage (e.g. wind, hail, etc.) to the roof correlating with the reported date of loss. Further, weather data showed a maximum estimated wind speed of 45 mph at the property on the reported date of loss, which is below design wind speed for laminated shingles. Leaks in the home were not the result of storm-created openings to the roof and were consistent with thermal cracking and installation errors resulting in cracking of the chimney mortar. The Policy does not provide coverage for damage due to wear and tear, improper installation, and/or deferred maintenance, nor does it cover interior water damage from rain in the absence of an opening in the exterior caused by a covered peril and the rain enters the house through this opening. As such, on February 8, 2024, contrary to the Purported Notice erroneous assertion, “Denying claims without conducting reasonable investigations based upon available information[.]” 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. In the coverage determination letter, SafePoint advised Complainant, if there was additional information to consider, to provide that information in writing. To date, nothing was provided to support a reconsideration of the claim determination. Further, it is SafePoint’s position that Insured failed to comply with their post-loss duties as required under the Policy including but not limited to the failure to provide failure to show the damaged property, failure to protect the property and late reporting the claim as previously noted above. Finally, the Notice makes boilerplate recitations of statutes and conclusory statements 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 “Claim Denial,” “Claim Delay,” “Unsatisfactory Settlement Offer,” and “Unfair Trade Practice” supposedly in violation of Sections 624.155(1)(b)(1), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b) and 626.9541(1)(i)(3)(d), 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 including but not limited to, “Agree to reimburse the Insureds’ attorneys’ reasonable fees and costs...” and improperly demanding payment of statutory interest from the “date of loss”. 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). 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. Deficiency #4 Finally, the Complainant failed to respond to each of the fields set forth on the DFS Form with the requisite specificity and as outlined herein as well as including but not limited to, the use of the attorney’s firm’s email address, “JDS@WEKLAW.COM” for that of the Complainant. Therefore, the Purported Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. See Pin Pon, 2020 WL 6588379; 2021 WL 824438. 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. 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)(d): Denying claims without conducting reasonable investigations based upon available information. 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. Finally, SafePoint retained a field adjuster 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.

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DFS-10-363
Rev. 10/14/2008