Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 794393

Filing Accepted: 11/27/2024

Print Filing

Complainant

Last/Business Name *

BLUM

First Name

JAMIE

Street Address *

11654 HACKBERRY ST

City, State Zip *

PALM BEACH GARDENS, FL 33410

Email Address *

PF@WEKLAW.COM

Complainant Type: *

Insured

Last/Business Name*		BLUM		First Name		JAMIE
Policy # *		12-1042244-04		Claim #*		12301980223

Attorney

Attorney is Applicable

Last Name*	FERNANDEZ First Name * PATRICIA Initial
Street Address*		800 E BROWARD BLVD, SUITE 510
City, State Zip*		FORT LAUDERDALE , FL 33301
Email Address *		PF@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):* BASIL RILEY
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)(2)		A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
	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)(g)		Failing to promptly notify the insured of any additional information necessary for the processing of a claim.

* 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 – PERILS INSURED AGAINST COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES We insure against risk of direct loss to property described in Coverages A and B only if that loss is a physical loss to property. We do not insure, however, for loss: … 2. Caused by: … f. Any of the following: (1) Wear and tear, marring, deterioration; (2) Inherent vice, latent defect or mechanical breakdown; … 3. Excluded under Section I – Exclusions. Under items 1. and 2., any ensuing loss to property described in Coverages A and B not excluded or otherwise excepted in this policy is covered. SECTION I – EXCLUSIONS 2. We do not insure for loss to property described in Coverages A and B caused by any of the following. However, any ensuing loss to property described in Coverages A and B not otherwise excluded or excepted in this policy is covered. ... c. Faulty, inadequate or defecfive: ... (2) Design, specifications, workmanship, repair, construction, renovation, remodeling, grading, compaction; (3) Materials used in repair, construction, renovation or remodeling; or (4) Maintenance; of part or all of any property whether on or off the "residence premises." All other provisions of this policy apply.

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

Jamie Blum (the "Insured") purchased an insurance policy ("Policy") from TypTap Insurance Company ("TypTap"), with effective coverage on the date of the loss, on or about November 15, 2023, and policy number 12-1042244-04 to insure her home located at 11654 HACKBERRY ST , PALM BEACH GARDENS, FL 33410 (the "Property"). On or about November 15, 2023, the aforementioned Property suffered severe damage as a result of a weather event. As a result of the loss, the Property sustained immediate direct wind damage to the shingle roofing system, necessitating replacement. Ensuing water damage was sustained to the interior. The Insured promptly reported her claim to TypTap. TypTap acknowledged receipt of the claim by generating claim number 12301980223. TypTap sent its field adjuster to inspect the Property. At that time, the field adjuster was afforded an opportunity to inspect all of the sustained damage. After investigating the sustained damage, TypTap made a low-ball coverage decision that broadly ignored the damage sustained to the Property. TypTap’s December 28, 2023 correspondence stated that it was affording coverage for the ensuing interior water damage only, as its vendor, Hancock roof assessment, determined that there was no wind-related damage nor a storm created opening to the roofing system. Typtap valued the Insured’s damages at $1,836.26, less than the $2500 deductible, and thus no payment was made to the Insured. It was clear that TypTap was trying to reduce their contractual obligation by undervaluing the damage to the insured’s Property from the start, despite the fact that the Insured actively provided all proof of claim needed to have her claim evaluated fairly. The Insured retained Dynasty Adjusting (“Dynasty”) to act as her public adjuster, to assist in the evaluation and inspection of damage to the property. Dynasty investigated the property and generated an estimate for the damages. Dynasty immediately sent their estimate to TypTap, which estimated the scope of damage to be $63,168.39. TypTap’s dramatically insufficient coverage decision has resulted in further damage to the Insured by preventing her from returning her Property to its pre-loss condition, rather than participating in the settlement process in good faith. As a direct consequence of TypTap’s failure to adjust this loss in good faith and pay what it owed under the policy, the Insured is continuing to sustain considerable hardship. Upon information and belief, TypTap, as part of its general business practice, initially low-balls its policyholders. TypTap 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 TypTap issues its adjusters estimating software which contains construction pricing below the fair market value. It also appears that TypTap trains its claim adjusters to overlook and/or turn a blind eye to a number of routine costs that TypTap 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 – TypTap stalls and intentionally delays the claim, conducting re-inspections, all under the false pretense that its “investigating” the claim. TypTap 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 insureds. TypTap has also violated Florida Statute § 624.155(1)(b)(3) by failing to promptly settle this obviously 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 an obviously covered loss, submitting to every demand of TypTap, and making a good faith effort to resolve in an attempt to amicably come to a fair resolution. TypTap 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. TypTap was informed multiple times of the discrepancies and inconsistencies of the low-ball payment issued to the Insured. TypTap accepted that information and has used it to play the delay game with the Insured, knowing all too well the additional damage and hardship that was being placed on the Insured by its actions. TypTap 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. TypTap 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, TypTap has yet to rectify their actions and do right by the Insureds by paying the money they are contractually owed. TypTap 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 TypTap to this date, despite TypTap being presented with the flawed rationale behind their underpayment of the Insureds’ claim. TypTap 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 TypTap. In the event TypTap 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 TypTap 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 insureds throughout the insurance claim process. Several duties and responsibilities to the Insureds 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 TypTap approaching the investigation and settlement in a manner prejudicial to the Insureds, failing to allow a fair settlement with the Insureds, 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 Insured was not afforded the professional duties entrusted on TypTap by the public. To date, TypTap has failed to adequately compensate the Insured for the damage that occurred on November 15, 2023. As a direct result of TypTap’s delay, the Insured was 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 TypTap knowingly and intentionally is delaying the claims process in order to further disadvantage the Insured. The financial detriment caused to the Insured is a direct result of TypTap’s reckless delay of the claim process. The Insured is a dutiful customer who made it a priority to pay her insurance premiums to ensure that in such an event as this devastating incident, her home would be covered. The Insured timely filed her claim and fulfilled all of her post-loss obligations. All requested information and documentation has been turned over to TypTap and their representatives promptly by the Insured. However, TypTap 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 she may remedy any deficiencies in their claim, and failed to provide her with qualified representatives to ensure the claim was initially adjusted, evaluated, and estimated properly. To deny the Insured the benefit of her bargain after she satisfied all of their obligations is morally and ethically reprehensible, and is evidence of Unfair Trade Practice. Upon information and belief, the aforementioned actions complained of, among others, were made by TypTap so often as to constitute a general business practice, evidencing a motive to enhance TypTap’s profits, and designed to cause a detrimental effect to its policy holders. TypTap was aware that the Insured’s damages were covered and took advantage of its Insured in an attempt to force her into an irreparably disadvantaged position, which they hope will force the Insured to settle for less coverage than she is 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 TypTap fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. This notice is given to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should TypTap 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, TypTap must: (1) Immediately tender all proceeds due and owing to the Insureds that are fairly owed to the Insureds under the insurance policy that would reasonably compensate the Insureds in order to put the loss property back to its pre-loss condition; (2) Agree to reimburse the Insureds' reasonable attorneys’ fees and costs for having to become involved to resolve the claim; and (3) 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.

Comments

User Id		Date Added		Comment
claims@typtap.com		01-24-2025		This is TypTap Insurance Company’s (“TypTap”) response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed on behalf of Jamie Blum (“Insured”). TypTap reviewed this CRN and conducted a thorough review of the subject claim (“claim”) and confirmed it handled the claim properly. 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