Civil Remedy Notice of Insurer Violations
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Filing Number:     794691
Filing Accepted:  12/1/2024
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Complainant
Last/Business Name *  
MANSILLA   First Name   HUGO AND LAUREN
Street Address * 105 W HILLCREST ST
City, State Zip * ALTAMONTE SPRINGS, FL 32714
Email Address * TZALLOUM@ITSABOUTJUSTICE.LAW
Complainant Type: * Insured
Insured
Last/Business Name*   MANSILLA   First Name   HUGO AND LAUREN
Policy # * 0764396489 Claim #* 5028384423-1
Attorney
Attorney is Applicable
Last Name* ZALLOUM First Name * TYVEN Initial
Street Address* 350 N. LAKE DESTINY RD.
City, State Zip* MAITLAND , FLORIDA 32751
Email Address * TZALLOUM@ITSABOUTJUSTICE.LAW
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   TRUCK INSURANCE EXCHANGE
NAIC Company Code 21709
 
Name of individual responsible for violation (if any):* TERRI HOLTHAUS LICENSE NO # 207899
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unfair Trade Practice
Claim Delay
* 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.
* 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 1 – Conditions - Mediation and Appraisal
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On or about February 19, 2024, Hugo and Lauren Mansilla (“Insureds”) suffered significant damage to their home caused by wind and hail. Prior to the loss, Truck Insurance Exchange (“Truck”) issued a homeowner’s insurance policy (policy no. 0764396489) for the Insureds’ home. The policy was in full force and effect on the date of loss and affords coverage for wind and hail damage. After providing prompt notice of the loss, Insureds fully cooperated with Truck’s adjustment of the claim, including making their home available for inspection and providing all documents requested. The Insureds provided estimation and photographs to Truck showing that their roof needed to be replaced as well as necessary repairs to the interior the home as a result of the water damage. Despite the loss and ensuing damages being covered, Truck refused or otherwise failed to fully indemnify Insureds from loss and issue the full amount of insurance benefits owed to repair damage to Insureds’ Property. In an attempt to resolve the claim amicably, Insureds demanded non-binding mediation. The non-binding mediation took place on November 4, 2024 but it was unsuccessful. On November 8, 2024, Insureds demanded binding appraisal under the terms of the policy. Despite the Policy permitting Insureds to invoke binding appraisal, Truck adjuster, Terri Holthaus refuses to engage in appraisal on the basis that it is not required to since the Parties already attempted to resolved this dispute through non-binding mediation. It's clear that Truck is not acting honestly and fairly towards its Insureds. Truck routinely develops pour claims handling procedures by hiring in experienced and unknowledgeable adjuster who continuously misapply policy language to prevent Insureds from invoking their own rights under the policy in hopes that they will abandon the claim or force the insureds to spend money on an attorney to enforce the insureds policy rights. Just like in the claim here, Truck’s refusal to engage in appraisal shows how Truck does not want to resolve this claim outside of court despite the policy, relevant statutes such as Section 627.7015, and binding precedent unambiguously permitting the Insureds to invoke appraisal. This shows how Truck, who already doesn’t want to insure homes in Florida evidenced by its failure to renew thousands of policies, does not want to pay claims it knows it should be paying for. In order to cure this Civil Remedy Notice, Truck must immediately acknowledge in writing that it will engage in appraisal under the terms of the policy. The written acknowledgment should be tendered to Insureds’ attorney, Tyven S. Zalloum, Esq. at 350 N. Lake Destiny Road, Suite 300, Maitland, FL 32751.
Comments
User Id Date Added Comment
cheryl.perez@farmersinsurance.com 01-14-2025 January 14, 2025 Via E-Mail COHEN LAW GROUP 350 N LAKE DESTINY RD MAITLAND, FL 32751-4103 Delivered by email to: tzalloum@itsaboutjustice.law RE: Lauren Mansilla and Hugo Mansilla Claim No.: 5028384423-1 Dear Tyven Zalloum: This correspondence is Truck Insurance Exchange’s (“Truck”) response to the Civil Remedy Notice of Insurer Violation No. 794691 filed on behalf of Complainant Hugo and Lauren Mansilla on December 1, 2024. Complainant alleges that Truck violated various subsections within Sections 624.155 and 626.9541, Florida Statutes, pertaining to Claim No. 5028384423-1 under an insurance policy issued by Truck to Complainant. Truck welcomes the opportunity to respond to the Notice’s allegations. The Notice fails to comply with the specific notice and information requirements set forth in Section 624.155, Florida Statutes, and Form DFS-10-363. Florida law requires strict compliance with the specific notice and information requirements of section 624.155, Florida Statutes. This notice is invalid for the reason related to the failure to include information required on Form DFS-10-363: • The notice does not provide the Complainant’s email address. On the merits, Truck avers it handled the Insured’s claims correctly and with due regard for their interests. On February 20, 2024, Truck received notice of the subject claim, damage to Complainant’s property as a result of a windstorm on February 19, 2024. Truck conducted a prompt and thorough investigation into this claim. We requested an inspection by American Leak Detection and their inspection was completed on February 22, 2024. Their report reflects no loss in water pressure, plumbing leak, however they did identify an area on the roof that showed gaps between the roof flashing and bathroom window. We then enlisted the services of an independent third-party vendor, Hancock Claims Consultants, and the inspection was completed on February 28, 2024 in the presence of our insured. Based on the inspection and photographs of the roof and interior, we found covered damage to a downspout and incorrectly extended coverage to the interior water damage in the kitchen. Water penetration through the roof system or exterior walls or windows is not covered unless the water penetration is a direct result of an opening in the roof, walls or windows created by any peril insured against. Truck also found no signs of wind damage but did find areas of normal wear and tear in the form of granule loss and blistering. Hancock installed tarping over the damaged area of the roof to prevent further damage until repairs could be completed. On March 4, 2024 we received a public adjuster letter of representation from Guard Your Claim that we promptly acknowledged. On April 2, 2024 we reviewed our findings with the insured and public adjuster and issued a partial denial letter of explanation along with our estimate. On April 15, 2024 we received an estimate for $73,715.35 prepared by the public adjuster with a significant difference in scope than the damage originally observed when the loss occurred. Mold Responders completed an inspection on April 18, 2024 and submitted an invoice for $2,650.00. Restoration Doctor installed additional tarping June 27, 2024 and provided a bill of $10,317.75. We subsequently received another bill for the amount of $9,495.25 for additional tarping September 5, 2024. Truck determined the documentation does not support the presence of additional covered damage to our insured’s property. On September 18, 2024, our claim representative sent a partial denial letter of explanation to the tarping contractor with a copy to our insured and their public adjuster. On September 23, 2024 we sent a denial letter to Mold Responders and copied our insured and their public adjuster. The policy has exclusions for continuous water seepage over weeks, months, and/or years and a condition that the property be protected from further damage following the occurrence of a loss. Unfortunately, there is no coverage for mold as a result of water seepage from wear and tear to the roof over a period of time. The public adjuster, Guard Your Claim, requested mediation. On November 4, 2024 moments before attending the scheduled mediation, we received a letter of representation from the Cohen Law Group. We participated in mediation with your office which resulted in an impasse. Following the mediation we acknowledged receipt of your letter and provided the requested documentation. On November 8, 2024 we received a demand for appraisal. We replied on November 11, 2024 and declined to participate in appraisal as Truck had already participated in mediation. Complainant has failed to provide any evidence to support their assertion that Truck failed to properly adjust this claim. The only fact that Complainant alleges to support her allegations that Truck violated Florida law and handled Complainant’s claim in bad faith is that Truck’s adjustment of the claim did not result in payment of Complainant’s exorbitant demand. Truck’s policy only covers accidental direct physical loss or damage to the property that is not otherwise excluded, which is further limited by the deductible, conditions, limits, and other terms of the policy. In accordance with these terms, Truck properly adjusted this claim as outlined above. Therefore, contrary to Complainant’s contention, Truck’s coverage determination was made in good faith. Truck denies any breach of any statutory or contractual duties in the handling of Complainant’s claim. Since we have been advised that a lawsuit has been filed on this claim, our defense counsel will discuss the facts and the perceived issues with you further during the course of the litigation. At this time, our position on coverage and this claim remains unchanged. While this response is meant to be comprehensive, Truck’s response is based on the limited information provided in the Notice filed by Complainant. Also, this letter or any act or failure to act on the part of Truck or any agent or representative of Truck should not be construed as a waiver of any rights or defenses, including but not limited to proper notice and service, available to it by contract or at law as all such right and defenses are hereby specially reserved. We trust that this response addresses the allegations raised in the Notice. Please contact us if you have any questions or should you wish to discuss this matter further. Sincerely, Cheryl Perez, Company Employee Adjuster General Claims Adjuster (913) 274-0230 Truck Insurance Exchange
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