Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 794272

Filing Accepted: 11/26/2024

Print Filing

Complainant

Last/Business Name *

GONCHER

First Name

MARIANNE

Street Address *

15162 ANCHORAGE WAY

City, State Zip *

FORT MYERS, FL 33908

Email Address *

JDS@WEKLAW.COM

Complainant Type: *

Insured

Last/Business Name*		GONCHER		First Name		MARIANNE
Policy # *		12-1058334-02		Claim #*		12-3011221-22

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
Insurer Name*		TYPTAP INSURANCE COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 15885

Name of individual responsible for violation (if any):* PARESH PATEL
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.

A. Coverage A – Dwelling. 1. We cover: a. The dwelling on the "residence premises" shown in the Declarations, including structures attached to the dwelling; and b. Materials and supplies located on or next to the "residence premises" used to construct, alter or repair the dwelling or other structures on the "residence premises". B. Coverage B – Other Structures. 1. We cover other structures on the "residence premises" set apart from the dwelling by clear space. This includes structures connected to the dwelling by only a fence, utility line, or similar connection. 2. We do not cover: a. Land, including land on which the other structures are located; b. Other structures rented or held for rental to any person not a tenant of the dwelling, unless used solely as a private garage; c. Other structures from which any "business" is conducted; or d. Other structures used to store "business" property. However, we do cover a structure that contains "business" property solely owned by an "insured" or a tenant of the dwelling, provided that "business" property does not include gaseous or liquid fuel, other than fuel in a permanently installed fuel tank of a vehicle or craft parked or stored in the structure. 3. The limit of liability for this coverage will not be more than 10% of the limit of liability that applies to Coverage A. Use of this coverage does not reduce the Coverage A limit of liability. C. Coverage C – Personal Property. 1. Covered Property. We cover personal property owned or used by an "insured" while it is anywhere in the world. After a loss and at your request, we will cover personal property owned by: a. Others while the property is on the part of the "residence premises" occupied by an "insured"; or b. A guest or a "residence employee", while the property is in any residence occupied by an "insured". SECTION I – PERILS INSURED AGAINST A. Coverage A – Dwelling and Coverage B – Other Structures. We insure against direct physical loss to property described in Coverages A and B. B. Coverage C – Personal Property. We insure for direct physical loss to the property described in Coverage C caused by any of the following perils unless the loss is excluded in Section I – Exclusions.

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

Marianne Goncher (“Insured”) purchased an insurance policy ("Policy") from TypTap Insurance Company (“Carrier”) with effective coverage on the date of loss, on or about September 28, 2022, and Policy number 12-1058334-02 to insure their property located at 15162 Anchorage Way, Fort Myers, FL 33908 ("Property"). On or about September 28, 2022, the Property, which is located in Fort Myers, Florida, suffered extensive damage to the roof, exterior, pool, landscaping, and interior as a result of Hurricane Ian, a category 5 storm that devastated Florida’s west coast ("Loss"). When the Insured became aware of the damage, she hired several companies, including, but not limited to LTG Builders Construction & Roofing, as well as Pinnacle Claim Services, Inc. (“Pinnacle”) to assess the condition of the Property. In addition, Pinnacle promptly communicated their involvement with the Carrier as well as the aforementioned issues with the Property. Documentation in the form of photographs, estimates, and declarations that the roof required replacement as a result of the Loss, were also provided in support of same. Upon receiving notice of the claim, the Carrier acknowledged it and assigned claim number 12-3011221-22 ("Claim") to the Loss. Thereafter, the Carrier inspected and documented the observable damages, yet only paid a small, insufficient amount for the roof, fence, and interior. Despite being provided with photographs showing numerous missing and otherwise damaged shingles in large sections of the Property’s roof, the Carrier felt a minor repair to same was sufficient. The Carrier also failed to incorporate any exterior and pool-related damage in their payments, thereby clearly underpaying the subject claim despite being provided with clear, uncontested evidence in support of same. Since the Insured became aware of the damages to the Property, she has acted promptly in reporting the claim and protecting her property from further damage. She has cooperated in all ways possible with every request of the Carrier. The Insured has 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 Insured continue to be without adequate compensation for the damages sustained at the Insured' 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 Insured 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 Insured. As a direct result of Carrier’s denial of the Claim and breach of the Florida Statutes, the Insured was 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 Insured. The financial detriment caused to the Insured are a direct result of the Carrier’s reckless treatment of the claims process. The Insured 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 Insured the benefits clearly due and owing under the Policy, for which he has time and time again been making premium payments for and after he has 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 Insured, 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 $125,985.80, minus prior payments and the Policy’s deductible, in US dollars to the Insured which is fairly owed to the Insured under the insurance policy and would reasonably compensate the Insured in order to put the Property back to its pre-loss condition; (2) Agree to reimburse the Insured 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; and (3) Agree to reimburse the Insured’ reasonable attorneys’ fees and costs for having to become involved to resolve the claim.

Comments

User Id		Date Added		Comment
claims@typtap.com		01-23-2025		This is TypTap Insurance Company’s (“TypTap”) response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed on behalf of Marianne Goncher (“Insured”). TypTap 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, TypTap issued payments for it on the information available to TypTap and the circumstances at the time of such payments. TypTap handled the claim in accordance with the policy and all statutory and regulatory requirements. TypTap denies each allegation of bad faith and improper conduct in the CRN. At all times, TypTap 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; and relied on inaccurate and conclusory statements. The Insured’s 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. Regardless of the fact there were no violations in this claim, any action by TypTap to cure violations alleged in the CRN could have been used against TypTap in the lawsuit. 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 TypTap. Upon request by the Florida Department of Financial Services, TypTap will provide to the DFS detailed correspondence TypTap 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