Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 794229

Filing Accepted: 11/26/2024

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Complainant

Last/Business Name *

NGO/PHAN

First Name

NAM/HELEN

Street Address *

1613 SW 14TH STREET

City, State Zip *

CAPE CORAL, FL 33991

Email Address *

SDC@WEKLAW.COM

Complainant Type: *

Insured

Last/Business Name*		NGO/PHAN		First Name		NAM/HELEN
Policy # *		HCPC-HO3-269225-12		Claim #*		923920

Attorney

Attorney is Applicable

Last Name*	CHOKSHI First Name * SAURIN Initial
Street Address*		800 EAST BROWARD BOULEVARD, SUITE 510
City, State Zip*		FORT LAUDERDALE , FLORIDA 33301
Email Address *		SDC@WEKLAW.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		HOMEOWNERS CHOICE PROPERTY & CASUALTY INSURANCE COMPANY, INC.
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 12944

Name of individual responsible for violation (if any):* DARLINE CALIXTE
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)(2)		Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
	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)(e)		Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
	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.
	626.9541(1)(i)(3)(j)		Altering or amending an insurance adjuster’s report without: (I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and (II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or (III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The Loss Payment/Loss Settlement provision found in the homeowner's policy authorizes payment in the event of a covered loss to insured property.

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

Nam Ngo and Helen Phan (the "Insureds") purchased an insurance policy ("Policy") from Homeowners Choice Property & Casualty Insurance Company ("HCPCIC"), with effective coverage on the date of the loss, on or about September 28, 2022, and policy number HCPC-HO3-269225-12 to insure their home located at 1613 SW 14th Street, Cape Coral, Florida 33991 (the "Property"). On or about September 28, 2022, the aforementioned Property suffered severe damage as the result of water damage, which caused ensuing damages to the Property including but not limited to the interior of the property. The Insureds promptly reported their claim to HCPCIC. HCPCIC acknowledged receipt of the claim by generating claim number 923920. After considerable stalling, HCPCIC went to inspect the property, as they are required to, and generated an estimate for the damages suffered. HCPCIC initially made a low-ball coverage decision that broadly ignored the damage sustained to the Property valuing the damage at $18,608.70 after the application of the policy deductible. It was clear that HCPCIC was trying to reduce their contractual obligation by undervaluing the damage to the Insureds’ Property from the start, despite the fact that the Insureds actively provided all proofs of claim needed to have their claim evaluated fairly. Despondent, the Insureds retained ICA Public Adjusters (“ICA”) to act as their public adjuster, to assist in the evaluation and inspection of damage to the property. ICA investigated the property and generated an estimate for the damages. ICA immediately sent their estimate, which estimated the scope or damage to be $43,310.72, to HCPCIC along with a request for additional payment, but HCPCIC failed to issue any further payments to the Insureds. HCPCIC’s dramatically insufficient coverage decision has resulted in further damages to the Insureds by preventing them from returning their Property to its pre-loss condition, rather than participating in the settlement process in good faith. As a direct consequence of HCPCIC’s failure to adjust this loss in good faith and pay what it owed under the policy, the Insureds and their family are continuing to sustain considerable hardship. Upon information and belief, HCPCIC, as part of its general business practice, initially low-balls its policyholders. HCPCIC does this in a calculated and systematic scheme that begins with manipulating the software system used in estimating its property damage claims. It appears that HCPCIC issues its adjusters estimating software which contains construction pricing below the fair market value. It also appears that HCPCIC trains its claim adjusters to overlook and/or turn a blind eye to a number of routine costs that HCPCIC knows most policyholders generally would not know to request but are actually covered under the insured’s policy. Moreover, as part of this scheme, after making one initial low-ball payment, or claiming the damages are under the policy deductible, HCPCIC stalls and intentionally delays the claim, changing adjusters, all under the false pretense that it’s “investigating” the claim. HCPCIC has violated Florida Statute §624.155(1)(b)(1) by continuously not attempting in good faith to settle this claim when it should have done so if it had acted fairly and honestly towards its Insured. HCPCIC has also violated Florida Statute § 624.155(1) (b)(3) by failing to promptly settle this covered claim to influence settlement in its favor. Despite being presented all of the indisputable evidence of the amount of damage sustained by this Property, it is a disgrace that the Insureds have been treated in this manner by their insurance company after sustaining a covered loss, submitting to every demand of HCPCIC, and making a good faith effort to resolve in an attempt to amicably come to a fair resolution. HCPCIC violated Florida Statutes § 626.9541(1)(i)(2) and §626.9541(1)(i)(3)(b) by making material misrepresentations to the Insureds for the purpose and with the intent to settle the claim on less favorable terms than those provided and contemplated by the policy. HCPCIC was informed multiple times of the discrepancies and inconsistencies of the low-ball payment issued to the Insured. While HCPCIC was made aware of this information for the purpose of obtaining the money contractually owed to the Insureds under its insurance policy to attempt to return their home to its pre-loss condition in a timely fashion, HCPCIC accepted that information and has used it to play the delay game with the Insureds, knowing all too well the additional damage and hardship that was being placed on the Insureds by its actions. HCPCIC violated § 626.9541(1)(i)(3)(a) when it failed to adopt and implement standards for the proper investigations of claims. Under no circumstances is there an excuse for the lack of a proper investigation in this case. HCPCIC and their representatives are willfully blind and grossly underqualified to handle a loss such as the one sustained by the Insured. In addition, after being placed on notice as to the blatant underpayment of the Insureds’ claim, HCPCIC has yet to rectify their actions and do right by the Insured by paying the money they are contractually owed. HCPCIC violated § 626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly upon the communications with respect to the claim. There still has yet to be significant action taken by HCPCIC to this date, despite HCPCIC being presented with the flawed rationale behind their underpayment of the Insured’s claim. HCPCIC violated § 626.9541(1)(i)(3)(g) by failing to promptly notify the Insureds of any additional information necessary for processing the claim. The Insureds have more than complied with each and every request and there has still been no action by HCPCIC. In the event HCPCIC is in need of additional information, they have failed to promptly notify the Insureds in a timely manner. This pattern of behavior is perpetuated by HCPCIC and their representatives undeterred by the Ethical Requirements that are imposed by law on all Adjusters. Fla. Admin. Code Ann. R. (3) explicitly states the adjustment of insurance claims engage the trust of the public, and therefore, an adjuster has a duty of fair and honest treatment of the Insured throughout the insurance claim process. Several duties and responsibilities to the Insured were violated in the handling of this claim, which are specifically listed responsibilities of an Adjuster in the Florida Administrative Code. These breached duties and responsibilities include adjusters from HCPCIC approaching the investigation and settlement in a manner prejudicial to the Insured, failing to allow a fair settlement with the Insured, and acting with due diligence in achieving a proper disposition of the claim. In contrast to the legislative intent motivating the enumeration of an Adjuster’s responsibilities outlined in the Administrative Code, the Insureds were not afforded the professional duties entrusted on HCPCIC by the public. To date, HCPCIC has failed to adequately compensate the Insureds for the damage that occurred on September 28, 2022. As a direct result of HCPCIC’s delay, the Insureds were forced to seek the help of legal counsel to assist them. Due to the amount of time that has passed since the date of loss, this acknowledgement is evidence that HCPCIC knowingly and intentionally are delaying the claims process in order to further disadvantage the Insureds. The financial detriment caused to the Insured and their family is a direct result of HCPCIC’s reckless delay of the claim process. The Insureds are dutiful customers who made it a priority to pay their insurance premiums to ensure that in such an event as this devastating incident, their home would be covered. The Insureds timely filed their claim and fulfilled all of their post-loss obligations. All requested information and documentation has been turned over to HCPCIC and their representatives promptly by the Insureds. However, HCPCIC failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim, failed to inform the Insured how they may remedy any deficiencies in their claim, and failed to provide them with qualified representatives to ensure the claim was initially adjusted, evaluated, and estimated properly. To deny the Insureds the benefit of their bargain after they satisfied all of their obligations is morally and ethically reprehensible, and reeks of Unfair Trade Practice. Upon information and belief, the aforementioned actions complained of, among others, were made by HCPCIC so often as to constitute a general business practice, evidencing a motive to enhance HCPCIC’s profits, and designed to cause a detrimental effect to its policy holders. HCPCIC was aware that the Insureds’ damages were covered and took advantage of its Insureds in an attempt to force them into an irreparably disadvantaged position, which they hope will force the Insured to settle for less coverage than they are contractually entitled to under the policy. This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should HCPCIC 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, HCPCIC must: (1) Immediately tender all insurance proceeds due and owing to the Insureds that are fairly owed to the Insureds under the insurance policy that would reasonably place the Insured back to a pre-loss condition; (2) Agree to reimburse the Insureds’ reasonable attorneys’ fees and costs for having to become involved to resolve the claim; (3) Agree to reimburse the Insured 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; (4) Although the Insureds have made a demand herein and have previously provided HCPCIC with all the necessary estimates, invoices, receipts, etc. in support thereof, the Insured are still willing to consider and to potentially accept any reasonable counter-offer made by HCPCIC. Therefore, if HCPCIC is not in agreement with the Insureds’ reasonable demand for payment of their rightfully owed insurance benefits being submitted at this time, the Insureds hereby request that HCPCIC now make a reasonable counter-offer before the expiration of the cure period.

Comments

User Id		Date Added		Comment
Legal@hcpci.com		01-24-2025		This is Homeowners Choice Property & Casualty Insurance Company’s (“HCPCI”) response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed by attorney Saurin Chokshi on behalf of Nam Ngo and Helen Phan (“Complainants”). HCPCI reviewed this CRN and conducted a thorough review of the subject claim (“claim”) and confirmed it handled the claim properly. Regarding an aspect of the claim, HCPCI issued payments for it on the information available to HCPCI and the circumstances at the time of such payments. HCPCI handled the claim in accordance with the policy and all statutory and regulatory requirements. HCPCI denies each allegation of bad faith and improper conduct in the CRN. At all times, HCPCI acted in good faith, fairly and honestly toward the Insured and with due regard for the Insured’s interests. Otherwise, the CRN is deficient. Generally, pursuant to Florida Statutes, Section 624.155, CRNs must identify and set forth statutory provisions insurers allegedly violated in handling insureds’ insurance claims along with specific, relevant insurance contract language and facts and circumstances. The foregoing provides insurers with notice of alleged statutory violations AND the opportunity to cure such alleged violations. Instead of complying with Florida Statutes, Section 624.155, the Insured’s attorney in the CRN contained an inaccurate recitation of the facts, failed to reference specific, relevant insurance policy language; cited irrelevant statutes; failed to offer a valid cure; and relied on inaccurate and conclusory statements. The Complainants’ laundry list of inapplicable statutes is insufficient. Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). Furthermore, the Insured’s attorney filed a lawsuit based on the claim prior to the filing of this CRN. The foregoing shows abuse by the Insured and the Insured’s attorney of the CRN and legal processes. Also and generally, the CRN constitutes an abuse of the CRN process, contravenes the purpose of CRNs, which is to promote resolution of issues in insurance claims. The CRN must be rejected, and it cannot serve as the basis of any action against HCPCI. Upon request by the Florida Department of Financial Services, HCPCI will provide to the DFS detailed correspondence HCPCI provided regarding the claim.

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