Civil Remedy Notice of Insurer Violations
Login

Filing Number:     794909
Filing Accepted:  12/2/2024
         Print Filing
Complainant
Last/Business Name *  
OSTEEN   First Name   BARBARA
Street Address * 354 N ELLISON RD
City, State Zip * PERRY, FL 32347-06
Email Address * JMANTEN@HSTALAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   OSTEEN   First Name   BARBARA
Policy # * 80-55-6407-5 Claim #* 5974V754G
Attorney
Attorney is Applicable
Last Name* MANTEN First Name * JASON Initial
Street Address* 2598 E. SUNRISE BLVD.
City, State Zip* FORT LAUDERDALE , FL 33304
Email Address * JMANTEN@HSTALAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   STATE FARM FLORIDA INSURANCE COMPANY
NAIC Company Code 10739
 
Name of individual responsible for violation (if any):* N/A
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)(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)(d) Denying claims without conducting reasonable investigations based upon available information.
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)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

VARIOUS LANGUAGE THROUGHOUT THE POLICY, INCLUDING BUT NOT LIMITED TO PROVISIONS GOVERNING COVERAGE FOR ROOF DAMAGE, WATER DAMAGE, MOLD, HAIL DAMAGE, AND/OR WINDSTORM DAMAGE, THE LOSS PAYMENT PROVISION(S), THE PROVISIONS GOVERNING THE DUTIES AND OBLIGATIONS OF THE INSURER; AND COVERAGE A – DWELLING; COVERAGE B – OTHER STRUCTURES; COVERAGE D – ADDITIONAL LIVING EXPENSES.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

IN FLORIDA, THE WORK OF ADJUSTING INSURANCE CLAIMS ENGAGES THE PUBLIC TRUST. STATE FARM FLORIDA INSURANCE COMPANY BREACHED THIS DUTY THROUGH ITS HANDLING OF THE CLAIM. THE INSURER HAS FAILED TO EVALUATE CLAIMS HANDLING AND TRAINING AND SUPERVISION OF ITS EMPLOYEES AND REPRESENTATIVES RESULTING IN STATUTORY VIOLATIONS AS SET FORTH WITHIN THIS CRN: 1) FAILURE TO PAY CLAIM IN FULL; 2) FAILURE TO PROMPTLY INVESTIGATE CLAIM; 3) FAILURE TO PROPERLY INVESTIGATE CLAIM; 4) FAILURE TO ADJUST LOSS; 5) FAILURE TO ACT IN DUE DILIGENCE AND GOOD FAITH TO RESOLVE CLAIM; 6) PLACING FINANCIAL INTEREST OF INSURER BEFORE THAT OF POLICY HOLDERS AND CLAIMANTS; 7) FAILURE TO PROPERLY TRAIN, EVALUATE AND MANAGE ADJUSTERS; 8) LOOKING FOR WAYS TO DENY COVERAGE, PAY LESS, DELAY PAYMENT AND OTHERWISE “LOW BALL” OR “STONE WALL” CLAIM; 9) THE REASONS FOR THIS MAY BE ATTRIBUTED TO IMPROPER TRAINING, SUPERVISION, AND/OR MOTIVATION OF ADJUSTERS AND CLAIMS SUPERVISORS. THE INSURER APPEARS TO HAVE FAILED TO ADOPT THE PROPER STANDARDS OF INVESTIGATION AND ADJUSTMENT OF LOSSES OR IS OTHERWISE NOT IMPLEMENTING THOSE STANDARDS BECAUSE FULL PAYMENT AND PROMPT PAYMENT FOR THE LOSS IS NOT OCCURRING. THIS COMPLAINT IS MADE ON BEHALF OF THE NAMED INSURED, BARBARA OSTEEN IN CONSIDERATION OF THE PREMIUM PAID TO THE INSURANCE COMPANY, STATE FARM FLORIDA INSURANCE COMPANY, A POLICY OF INSURANCE TO, BARBARA OSTEEN. WHICH PROVIDED COVERAGE FOR CERTAIN LOSSES-INCLUDING HURRICANE RELATED DAMAGES. DURING THE POLICY PERIOD A HURRICANE CAUSED CONSIDERABLE DAMAGE TO THE INSURED RESIDENCE PREMISES AND OTHER STRUCTURES. THE INSURED PROPERTY SUFFERED DAMAGE WHICH WAS AND IS COVERED BY THE TERMS AND CONDITIONS OF THE INSURANCE POLICY. THE LOSS WAS SUDDEN AND ACCIDENTAL, AND THEREFORE A COVERED PERIL UNDER THE POLICY. THE INSURED PROMPTLY REPORTED THE LOSS TO THE INSURANCE COMPANY AND HAS COMPLIED WITH ALL THE CONDITIONS OF THE POLICY. AFTER AN INSUFFICIENT INVESTIGATION AND THE PREPARATION OF A LACK LUSTER ESTIMATE, THE INSURANCE COMPANY UNDERVALUED AND UNDERPAID THE DAMAGES TO THE INSURED PROPERTY. DUE TO CONCERNS WITH THE DELAY IN THE INVESTIGATION AND THE INSURANCE COMPANY’S UNDERVALUE AND UNDERPAYMENT OF THE CLAIM, THE INSURED RETAINED AN EXPERIENCED AND HIGHLY QUALIFIED PUBLIC ADJUSTER, CORBITT PUBLIC ADJUSTING, LLC. TO PREPARE AN ESTIMATE OF DAMAGE. THE ESTIMATED COST OF REPAIRS TO THE INSURED PROPERTY CURRENTLY STANDS AT APPROXIMATELY $ 179,551.22. THE INSURED HAS PROVIDED THE INSURER WITH DOCUMENTATION SUPPORTING THE REPAIRS OF THE DAMAGES ASSOCIATED WITH THEIR CLAIM FROM CORBITT PUBLIC ADJUSTING, LLC. AND THAT THE INSURED HAS MADE AN APPLICATION FOR INSURANCE BENEFITS UNDER THE POLICY BUT THE INSURANCE COMPANY HAS FAILED AND/OR REFUSED TO PAY THE FULL BENEFITS TO WHICH THE INSURED IS ENTITLED FOR THE LOSS. THE INSURANCE COMPANY HAS BREACHED THE POLICY OF INSURANCE BY FAILING TO PAY ALL OF THE BENEFITS DUE UNDER THE POLICY. THE INSURANCE COMPANY HAS FAILED TO SATISFACTORILY SETTLE THIS CLAIM AND HAS DEPRIVED THE INSURED OF A PROPER RESOLUTION OF THIS CLAIM. THE INSURANCE COMPANY HAS FAILED AND/OR REFUSED TO PROPERLY INVESTIGATE THE LOSS AND HAS FAILED AND/OR REFUSED TO TENDER THE PROPER AMOUNT OF INSURANCE BENEFITS DUE AND OWING TO THE INSURED. IN ORDER TO CURE THE CONDUCT GIVING RISE TO THE VIOLATIONS DESCRIBED HEREIN, THE INSURANCE COMPANY MUST COMPLETE A PROPER EVALUATION OF THE DAMAGES VIA QUALIFIED PROFESSIONALS AND IMMEDIATELY ISSUE PAYMENT FOR ALL THE COVERED DAMAGES PRESENTED BY THE INSURED, AND CORBITT PUBLIC ADJUSTING, LLC. IN ADDITION, THE INSURANCE COMPANY MUST ISSUE PAYMENT TO THE INSURED FOR REASONABLE FEES, COSTS, AND PRE-JUDGMENT INTEREST IF REQUIRED BY THE APPLICABLE FLORIDA STATUTES. AS AN ALTERNATIVE CURE OPTION, THE INSURANCE COMPANY MAY CURE THE ALLEGATIONS GIVING RISE TO THIS NOTICE BY TENDERING A CHECK IN THE AMOUNT OF $ 179,551.22 LESS THE APPLICABLE DEDUCTIBLE, WITHIN THE 60-DAY , CURE PERIOD, JOINTLY PAYABLE TO ” CORBITT PUBLIC ADJUSTING, LLC. ” AND THE NAMED INSURED, “BARBARA OSTEEN.”
Comments
User Id Date Added Comment
kfernandes@kelleykronenberg.com 01-14-2025 As stated by the Florida Supreme Court, the purpose of a Notice is to put the insurer on notice of an alleged violation, the circumstances surrounding same, and indicate the details of the alleged violation in order to provide an insurer with 60 days to “cure” the alleged claim defects. See Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So. 2d 1278 (Fla. 2000). Under Florida law, a first-party bad-faith action is not recognized as common law. Baxter v. Royal Indemnity. Co., 285 So. 2d 652 (Fla. 1st DCA 1973). In 1982, the Florida Legislature enacted § 624.155, which created a statutory first-party bad-faith cause of action by an insured against the insurance carrier. See § 624.155, Fla. Stat.; State Farm Mut. Auto. Ins. Co. v. Laforet, 658 So. 2d 55, 59 (Fla. 1995). As a derogation of common law, this statute is strictly construed. Nowak v. Lexington Ins. Co., 464 F. Supp. 2d 1248 (S.D. Fla. 2006); Aetna Cas. & Sur. Co. v. Buck, 594 So. 2d 280, 281 (Fla. 1992) (stating that a person seeking the benefit of a statutorily created remedy has to strictly comply with the requirements of the statute because the remedy is "purely a creature of statute"). The Florida Supreme Court has specifically applied this rule of construction to section 624.155. See Talat, 753 So. 2d at 1283-84. As stated by the Florida Supreme Court, the purpose of a Notice is to put the insurer on notice of an alleged violation, the circumstances surrounding same, and indicate the details of the alleged violation in order to provide an insurer with 60 days to "cure" the alleged claim defects. See Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278 (Fla. 2000). The purpose of Section 624.155, Florida Statutes, is to provide the insurer with an opportunity to resolve a first-party coverage dispute and otherwise avoid litigation. See Talat Enterprises, Inc.; see also Lane v. Westfield Ins. Co., 862 So.2d 744 (Fla. 5th DCA 2003). The statute requires this notice to: [S]tate with specificity the following information . . . (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 such violation[;] (3) the name of any individual involved in the violation[;] (4) reference the specific policy language that is relevant to the violation, if any . . . [;] (5) a statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. Fla. Stat. § 624.155(3)(a). This statute has been interpreted to require that the Notice must be sufficiently specific to provide the insurer with an opportunity to cure the alleged violations. This would include i) identifying the specific policy provision(s) at issue, ii) citing the specific language of the statutory provision(s) the insurer allegedly violated, and iii) specifically identifying what actions the insurer must take to remedy the alleged violations. Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059 (S.D. Fla. August 13, 2010); Heritage Corp. of S. Fla. v. Nat’l Union Fire Ins. Co. of Pittsburg, PA, 580 F. Supp. 2nd 1294, 1299-1300 (S.D. Fla. 2008). In addition, providing vague reference to the policy is insufficient to put the insurer on notice of its alleged policy violation. See Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875, 879 (Fla. 4th DCA 2021). In contravention of these requirements, the subject Notice is vague and lacks fundamental information that would allow State Farm to respond. Specifically, the CRN contains "cures" which are improper pursuant to Florida case law. The Florida Supreme Court in Talat Enterprises, Inc. v. Aetna provides that the scope of what can be "cured" is limited to the alleged non-payment of the contractual amounts due to an insured. The Court held "the contractual amount due the insured is the amount owed pursuant to the express terms and conditions of the policy after all of the conditions precedent of the insurance policy in respect to payment are fulfilled...” Here, the Insured demands State Farm (1) complete a proper evaluation of the damages via qualified professionals; (2) issue payment for all damages presented by the Insured; (3) issue payment for reasonable fees, costs, and pre-judgment interest; or, alternatively, (4) issue payment in the amount of $179,551.22, less the deductible. State Farm properly investigated the Insured’s claim, timely paid the claim pursuant to the terms and limitations contained in the insurance policy, and further investigated and adjusted the claim after the Insured presented its public adjuster’s estimate of the damages. Accordingly, the Department should strike the Notice and consider it a nullity for failing to comply with §624.155. Second, the civil remedy is insufficient on its face and should be rejected since, contrary to the requirements of Section 624.155 of Florida Statutes, the civil remedy does not specifically describe the facts or circumstances giving rise to each specific violation alleged against State Farm, nor a specific manner to cure. The civil remedy makes generalized, unsupported, and incorrect statements without specifically identifying the facts that give rise to each allegation pursuant to the cited statutory provisions. There is no nexus to any of the alleged statutory violations within the narrative to provide any notice to State Farm of the violations allowing for a time to cure. The notice filed in this matter also includes alleges 8 statutory code violations and references coverage A, coverage B, coverage D, and “provisions governing coverage for roof damage, water damage, mold, hail damage, windstorm damage, loss payment provisions, and duties and obligations of the insurer.” However, there is no specific allegations as to the conduct giving rise to the allegation or the policy provision. Notwithstanding the above-mentioned civil remedy notice deficiencies, the following are State Farm’s responses to each of the alleged violations noted in the civil remedy notice: Fla. Stat. §624.155(1)(b)(1): Denied. There are no facts, nor specificity, demonstrating how State Farm failed to operate in good faith. State Farm conducted a complete, thorough, and timely investigation of the loss including inspection of the property, and determined a covered loss occurred, and issued payment based on its finding, including payment for a roof replacement, repairs to a shed, and repairs to a fence. Therefore, no violations of §624.155(1)(b)(1) have occurred. The only allegation asserted by the Insured is that State Farm “failed to satisfactorily settle this claim,” which is an insufficient allegation of wrongdoing. Fla. Stat. §624.155(1)(b)(3): Denied. This section is facially invalid as it is contradicted by the facts of the claim. Additionally, the Insured provides no specificity as to how this provision was violated. There are no facts supporting the allegation that State Farm utilized one policy coverage to influence the other. State Farm issued payment to the Insured for damages to the insured dwelling and other structures. No allegation of a need for additional living expenses has ever been made by the Insured under this claim, nor has any proof of incurring such damages been provided to State Farm by the Insured. Fla. Stat. §626.9541(1)(i)(3)(a): Denied. There are no specific allegations regarding State Farm’s lack of proper standards regarding claims investigation. This allegation is unsupported by the facts of this case. The standards and methods utilized by State Farm in examining its claims have met and exceeded its obligations and industry standards. State Farm has conducted the handling of this claim according to such standards. Furthermore, the Notice fails to allege any factual support or offer any evidence that State Farm has failed to adopt and implement standards for the proper investigation of claims, but instead – as with the remainder of the Insured’s meritless allegations of statutory violations - simply resorts to merely including a recitation of the statutory language it alleges was violated, such as a “delay in investigation,” “insufficient investigation,” and “undervalue and underpayment of the claim.” State Farm timely adjusted and paid this claim, as evidenced by the timeline of events provided below. The Insured has not alleged any factual statements supporting the contention that State Farm failed to follow reasonable and accurate standards in its investigation of the claim. Therefore, no violation of §626.9541(1)(i)(3)(a) has occurred. Fla. Stat. §626.9541(1)(i)(3)(b): Denied. There is no specific allegation regarding policy misrepresentation. An allegation of misrepresentation requires and not one allegation of a misrepresentation is made in the CRN, making it impossible for State Farm to respond to this baseless allegation of a statutory violation. Therefore, no violation of §626.9541(1)(i)(3)(b) has occurred. Fla. Stat. §626.9541(1)(i)(3)(c): Denied. There is no specific allegation regarding a failure to acknowledge and act promptly upon communications. This claim was reported to State Farm by a public adjuster representative of the Insured on October 4, 2024, and, on that same day, State Farm issued several notification letters to the Insured, including a homeowner’s bill of rights, instructions for temporary repairs, and confirmation of receiving this new claim. State Farm conducted an interview of the Insured’s public adjuster representative on October 11, 2024, to learn more about the claim. State Farm conducted an inspection of the insured property on October 21, 2024, in the presence of the public adjuster. State Farm sent a copy of the insurance policy to the public adjuster three (3) days after a request was made. On or about October 25, 2024, State Farm issued its estimate of the covered damages, payment for the covered damages, and a letter of explanation of its coverage decision. This was done twenty-one (21) days after State Farm received notice of this claim. On October 30, 2024, State Farm issued a letter explaining the state mediation program available to the Insured. On November 26, 2024, State Farm received an estimate which was prepared by the public adjuster. Six (6) days later, the Insured filed this CRN. State Farm reviewed its coverage decision based upon its receipt of the public adjuster’s estimate and issued a new estimate and additional payment for damages on December 23, 2024. This was done less than thirty (30) days after State Farm’s receipt of the Insured’s public adjuster’s estimate. In light of these facts and no specific allegations of a delay in State Farm’s claims handling in the CRN, it is impossible for State Farm to respond to this baseless allegation of a statutory violation. Therefore, no violation of §626.9541(1)(i)(3)(c) has occurred. Fla. Stat. §626.9541(1)(i)(3)(d): Denied. This allegation is without merit. State Farm conducted a timely inspection with a competent field adjuster to investigate the claim and, based upon that field adjuster’s observations, State Farm paid for the damages covered under the claim. Upon receipt of the public adjuster’s estimate, State Farm further investigated the claim and its prior coverage decision and amended the scope of its coverage decision, making a second payment to the Insured for damages. Again, no specific allegation of the unreasonableness of State Farm’s investigation has been made in the CRN, thus making it impossible for State Farm to respond to this allegation of a statutory violation. Therefore, no violation of §626.9541(1)(i)(3)(d) has occurred. Fla. Stat. §626.9541(1)(i)(3)(f): Denied. This allegation is without merit. State Farm timely issued a written explanation of its coverage decision, including the applicable policy language, and an estimate quantifying the covered damages, twenty-one (21) days after State Farm received notice of this claim. Upon receipt of the public adjuster’s estimate, State Farm further investigated the claim and its prior coverage decision and amended the scope of its coverage decision, making a second payment to the Insured for damages twenty-seven (27) days after receiving the Insured’s estimate. Again, no specific allegation of untimeliness or unreasonableness in State Farm’s explanation of its coverage decision has been made in the CRN, thus making it impossible for State Farm to respond to this allegation of a statutory violation. Therefore, no violation of §626.9541(1)(i)(3)(f) has occurred. Fla. Stat. §626.9541(1)(i)(3)(i): Denied. This provision does not apply to this claim at all, as it involves a statutory requirement to pay personal injury protection insurance claims and no such claim has been made in association with the Insured’s property damage claim. Therefore, no violation of this provision has occurred and this erroneous allegation warrants striking this CRN from consideration. State Farm denies that it has acted in bad faith in any capacity with regard to this matter. State Farm promptly responded to the Insured’s notice of loss, had the property inspected, and promptly paid for the covered damages under this claim. Furthermore, State Farm asserts that the Insured’s broad and nonspecific allegations and attacks upon State Farm are patently false, which is proven by the Insured’s own documentation. The CRN alleges that “due to concerns with the delay in the investigation and the insurance company’s undervalue and underpayment of the claim, the Insured retained an experienced and highly qualified public adjuster. . . to prepare an estimate of damage.” Contrary to this assertion, the Insured contracted with the public adjuster before even reporting this claim to State Farm. In fact, the Insured did not participate in the reporting of the claim or in State Farm’s initial investigation call on the claim, the public adjuster handled both matters on the Insured’s behalf. State Farm does not waive, but rather expressly reserves, the right to raise any and all available objections and defenses to this matter and to the Notice. Please also be advised that the subject policy issued by State Farm is governed by the policy’s terms, conditions, and exclusions together with any endorsements. This letter does not waive any such provisions of the policy. Similarly, any action taken by or on behalf of State Farm or its authorized representative(s), whether in the past or future, to investigate the alleged loss, to adjust any claim or request for payment, or in any way related to or arising out of the subject claim or loss, shall not waive any of the terms, conditions, or any other provisions of the policy.
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