Civil Remedy Notice of Insurer Violations
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Filing Number:     794995
Filing Accepted:  12/3/2024
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Complainant
Last/Business Name *  
HARMONY POINTE AT EMERSON SQUARE CONDOMINIUM ASSOCIATION, INC.   First Name  
Street Address * 17450-17503 OLD HARMONY DRIVE
City, State Zip * FORT MYERS, FL 33908
Email Address * PAULVACCARI216@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   HARMONY POINTE AT EMERSON SQUARE CONDOMINIUM ASSOCIATION, INC.   First Name  
Policy # * CRP 0000399-02 Claim #* ICAT-20220V-0000030047
Attorney
Attorney is Applicable
Last Name* AUSTIN First Name * LUCAS Initial B
Street Address* 777 S. HARBOUR ISLAND BLVD., SUITE 950
City, State Zip* TAMPA , FL 33602
Email Address * LAUSTIN@MERLINLAWGROUP.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   CENTAURI SPECIALTY INSURANCE COMPANY
NAIC Company Code 12573
 
Name of individual responsible for violation (if any):* SYLVIA BIRICA (BOULDER CLAIMS, LLC – COMMERCIAL CLAIMS EXAMINER II), ERIK SANDERS (CLAIMS ADJUSTER), AS WELL AS ALL ADJUSTERS, SUPERVISORS, MANAGEMENT, AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY CENTAURI SPECIALTY INSURANCE COMPANY WITH RESPECT
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Claim Delay
Claim Denial
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Failure to Properly Investigate Claim and with Due Regard to Insured's Interest
Other : Failure to Timely Respond to Communications
* 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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
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)(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.
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Specific policy language that is relevant to the violations includes, but is not limited to, the following: CONDOMINIUM ASSOCIATION COVERAGE FORM CP 00 17 06 07 Page 1 of 14 A. Coverage We will pay for direct physical loss of or damage to Covered Property at the premises described in the Declarations caused by or resulting from any Covered Cause of Loss. Page 10 of 14 4. Loss Payment a. In the event of loss or damage covered by this Coverage Form, at our option, we will either: (1) Pay the value of lost or damaged property; (2) Pay the cost of repairing or replacing the lost or damaged property, subject to b. below; (3) Take all or any part of the property at an agreed or appraised value; or (4) Repair, rebuild or replace the property with other property of like kind and quality, subject to b. below. We will determine the value of lost or damaged property, or the cost of its repair or replacement, in accordance with the applicable terms of the Valuation Condition in this Coverage Form or any applicable provision which amends or supersedes the Valuation Condition. b. The cost to repair, rebuild or replace does not include the increased cost attributable to enforcement of any ordinance or law regulating the construction, use or repair of any property. c. We will give notice of our intentions within 30 days after we receive the sworn proof of loss. * * * g. We will pay for covered loss or damage to Covered Property within 30 days after we receive the sworn proof of loss, if you have complied with all of the terms of this Coverage Part and: (1) We have reached agreement with you on the amount of loss; or (2) An appraisal award has been made. FLORIDA CHANGES CSCR FL CHG 09 14 Page 1 of 3 D. The Loss Payment Condition dealing with the number of days within which we must pay for covered loss or damage is replaced by the following: Provided you have complied with all the terms of this Coverage Part, we will pay for covered loss or damage upon the earliest of the following: (1) Within 20 days after we receive the sworn proof of loss and reach written agreement with you; (2) Within 30 days after we receive the sworn proof of loss and: (a) There is an entry of a final judgment; or (b) There is a filing of an appraisal award with us; or (3) Within 90 days of receiving notice of an initial, reopened or supplemental claim, unless we deny the claim during that time or factors beyond our control reasonably prevent such payment. If a portion of the claim is denied, then the 90-day time period for payment of claim relates to the portion of the claim that is not denied.
 
* Facts and circumstances giving rise to the violation.
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This Notice is made on behalf of Harmony Pointe at Emerson Square Condominium Association Inc. (the “INSURED”). In consideration for the premium paid to it by the INSURED, CENTAURI SPECIALTY INSURANCE COMPANY (“CENTAURI”) issued Commercial Residential Property Insurance Policy number CRP 0000399-02 (the “Policy”). The Policy provides coverage for losses of certain real property located at 17450-17503 Old Harmony Drive, Fort Myers, FL 33908 (Collectively the “Property”). On or around September 28, 2022, while the Policy was in full force and effect, the INSURED suffered a loss at the insured Property as a result of Hurricane Ian. The loss caused direct physical damage to the Property, including wind damage to the roofs of all the buildings, damage to the exterior elevations, as well as damage to multiple windows and doors. The loss was sudden and accidental, and, therefore, a covered peril under the Policy. The INSURED promptly notified CENTAURI of the loss and CENTAURI assigned claim number ICAT-2022-V-0000030047 to the INSURED’S loss. Adjusters on behalf of CENTAURI inspected the Property in October 2022 and a team from Keystone Expert & Engineers, LLC (“Keystone”) inspected the Property on November 1 and 2, 2022. Keystone issued a report detailing its findings on November 22, 2022. Keystone determined that Hurricane Ian had caused damage to the roofing system of every building, but that the roofs could be spot-repaired and replacement was not required. CENTAURI eventually extended coverage based on the findings of Keystone and an estimate apparently prepared by Loyacona Fountain Group (“LFG”). To date, no estimate from LFG has been produced to the INSURED, making it impossible to evaluate the extent of CENTAURI’s covered damages. On March 23, 2023, CENTAURI advised the INSURED that the covered repair cost values per building fell below the hurricane policy deductibles, and therefore no payment would be issued. At the time, CENTAURI also denied coverage for certain damages being claimed by the INSURED based on the conclusions of Keystone. CENTAURI subsequently retained Keystone to complete a re-inspection of the multiple buildings at the Property on October 3, 2023. Keystone issued a supplemental report on October 10, 2023 wherein they advised that the conclusions included in the November 22, 2022 remained unchanged, but that the supplemental inspection had identified minimal damages to a number of doors and windows at the property. CENTAURI subsequently issued an updated payment position letter on November 27, 2023 reiterating that the INSURED’s loss did not exceed the deductible and thus no payments would be made. Due to its ongoing concerns regarding CENTAURI’s coverage position, the INSURED retained Structural Engineering & Inspections, Inc. (“SEI”) to perform a Hurricane Damage Assessment of all insured buildings. SEI completed its inspections between January 29, 2024 and February 1, 2024, and subsequently issued a report detailing their findings on March 29, 2024. A copy of the SEI report, as well as other documents related to prior repairs and the ongoing roof replacement project were provided to CENTAURI on April 4, 2024. Based on its investigation, SEI concluded that the roofing system of all buildings sustained damage as a result of Hurricane Ian. SEI recommended that all roofing systems at the Property be replaced. Replacement of the roofing systems at the Property began in February 2024 and has since been completed. A copy of the contract for roof replacement entered into by the INSURED with Elias Brothers has been provided to CENTAURI. In summary, CENTAURI rendered a coverage position on the INSURED’s claim on March 23, 2023, and then reiterated that position on November 27, 2023. On April 4, 2024, the INSURED provided CENTAURI with an engineering report in support of the position that Hurricane Ian had caused much more extensive damage than what had been agreed to by CENTAURI. The SEI report provided on behalf of the INSURED included historical aerial photographs clearly illustrating the extent of Ian-related damage at the Property. Meanwhile, Keystone conducted a muti-day inspection on behalf of CENTAURI and found only limited Ian-related damages. Per their report, Keystone identified only a small number of damaged tiles that appeared to be pre-Ian. CENTAURI has requested information related to the claim the INSURED had for damages suffered as a result of Hurricane Irma. The INSURED has advised that they have no additional documentation regarding the claim with AmCap for damages from Hurricane Irma. Regardless, and in spite of Keystone’s own conclusions regarding the limited pre-Ian damage at the site, CENTAURI has expressed continued interest in the scope of damages which the Hurricane Irma settlement addressed. As has been made clear to CENTAURI on multiple occasions, the Irma settlement does not appear to be for any specific scope of damages. In fact, the Release itself specifically states that the agreement is “a compromise of a doubtful and disputed claim, and the agreement made is not and does not have the effect of any admission of liability or damages by RELEASEES, and that said RELEASEES deny any liability and intend merely to avoid litigation and buy their peace.” CENTAURI is in possession of all Irma-related settlement documents in possession of the INSURED. On July 15, 2024, counsel for Centauri sent correspondence to the INSURED’s representative advising that further information was required to evaluate the INSURED’s claim. Notwithstanding this new position regarding the need for further information, the same correspondence also stated that CENTAURI was maintaining its current claim position. Despite most, if not all, of the requested documentation having been previously provided, the INSURED’s representatives sent correspondence to counsel for CENTAURI on July 29, 2024 enclosing documents responsive to CENTAURI’s requests. Since that time, no updated coverage position has been provided by CENTAURI, leaving the INSURED to infer that CENTAURI continues to maintain its prior claim position. As of the filing of this Notice, it has been almost 8 months since the INSURED provided an expert report in support of the position that Hurricane Ian damages necessitated roof replacement at the Property. CENTAURI has not acknowledged receiving the report or responded to it in any way. To date, CENTAURI has failed and/or refused to provide the INSURED with all the insurance benefits due and owing for the INSURED’s loss, despite knowing that the INSURED has sustained covered damages to the Property far in excess of the coverage extended. CENTAURI has continually delayed to investigation and evaluation of the INSURED’S claim and ignored the supporting documents provided on behalf of the INSURED. The facts above indicate that CENTAURI has failed to adopt and implement standards for the proper investigation of claims in violation of Fla. Stat. 626.9541(1)(i)(3)(a). The facts further indicate that CENTAURI’S adjusters adjust claims in a manner that is prejudicial to the INSURED in violation of Florida Administrative Code 69B-220.201(3)(c) and Florida Statutes. The adjusters assigned to this claim have a duty to adjust and treat all claims equally. Since the beginning of this claim, the representatives on behalf of CENTAURI have approached this investigation in a manner prejudicial to the INSURED. CENTAURI is using either overloaded, untrained or improperly trained adjusters in connection with this claim. If CENTAURI handles all the claims in the manner in which the INSURED’S claim was adjusted, then it is improperly handling all claims. CENTAURI’S conduct has been reckless and unfair to the INSURED. The INSURED has been, and continues to be, forced to expend out-of-pocket monies and incur additional costs in order to force CENTAURI to honor its obligations under the insurance policy and pay all the insurance proceeds due and owing. CENTAURI has refused and/or failed to comply with the Policy’s cooperation and/or “Loss Payment” provision. Under the Policy, CENTAURI was to timely tender insurance benefits to the INSURED. CENTAURI has failed and/or refused to timely tender all owed insurance benefits for building damages and incurred mitigation costs. This is a breach of the Policy. CENTAURI has refused and/or failed to cooperate and/or “Adjust the Loss” by cooperating with the INSURED during the claims adjustment process in compliance with the Policy’s “Loss Payment” provision. This is a breach of the Policy. The concept of insurance is that insurance is the insurer’s granting of timely and prompt indemnity or security against a contingent loss. Florida Statute §624.02 defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that the insured may mitigate their damages and to put them back into the position they were in prior to the loss as quickly as possible. The INSURED has taken the steps necessary to mitigate their damages and has incurred substantial sums as a result of those actions. Despite this, CENTAURI has breached its duty to timely and promptly indemnify its INSURED. CENTAURI has refused and/or failed to tender insurance proceeds owed to the INSURED despite being in possession of sufficient evidence and documentation showing that such amounts are presently owed. CENTAURI’S refusal and/or failure to issue payment for the incurred mitigation work, when under all circumstances it could have and should have done so had it acted fairly and honestly towards the INSURED, is wrongful conduct. Furthermore, the INSURED contend that CENTAURI’S adjusters and/or representatives financially benefit by such wrongful conduct. In Florida, the work of adjusting insurance claims engages the Public Trust. CENTAURI has breached this duty by its adjustment of its INSURED’S claim of loss. CENTAURI’S handling and adjustment of its INSURED’S claim of loss and the conduct of the adjusters, supervisors, management and individuals associated with or retained by CENTAURI in this claim to date evidence that CENTAURI has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees resulting in statutory violations set forth above. This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statute, including any and all bad faith/extra contractual, should CENTAURI fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. The INSURED also intends to seek punitive damages against CENTAURI as it appears that CENTAURI’S violations occur with such frequency as to evidence a general business practice and the violations were willful, wanton, and malicious and were in reckless disregard for the rights of the INSURED. While no specific “cure amount” is required for this Civil Remedy Notice to be valid, the INSURED will consider the allegations contained herein “cured” if CENTAURI: (1) Immediately tenders $3,053,032.63, less deductible, with no requirement for the INSURED to sign a release. While the INSURED is requesting that this be done to “cure” this Civil Remedy Notice, the INSURED is willing to consider, and may accept, any reasonable counteroffer. Therefore, if CENTAURI disagrees with the requests, the INSURED requests that CENTAURI make a counteroffer before the end of the “cure period” and provide supporting documentation for any such offer so that they may understand any discrepancies that could exist between the estimates. If we receive additional information that changes the scope and price of the claim, we will notify you. This demand is based on the information in our possession at this time.
Comments
User Id Date Added Comment
crr@lcba-law.com 01-31-2025 Submitted Via DFS Online Website: Department of Insurance Department of Financial Services Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399-6322 Insured: Harmony Pointe at Emerson Square Condominium Assoc, Inc. Complainant: Harmony Pointe at Emerson Square Condominium Assoc, Inc. Insurer: Centauri Specialty Insurance Company Policy: CRP 0000399-02 Claim #: ICAT-2022-V-0000030047 DFS File Number: 794995 RESPONSE TO CIVIL REMEDY NOTICE Dear Sir or Madam: Please be advised that the undersigned represents Centauri Specialty Insurance Company (hereinafter “Centauri” or “Insurer”) in the dispute filed by Lucas Austin on behalf of Harmony Pointe at Emerson Square Condominium Assoc, Inc. (“Insured”) on December 3, 2024. This correspondence is Centauri’s formal response to the Civil Remedy Notice of Insurer Violation (hereinafter “Civil Remedy Notice” or “CRN”) submitted on behalf of the Insured. To provide context to the Insured’s CRN and this Response, the following is a short summary of the issues. This matter arises out of a Hurricane Ian claim for 21-building condominium property located at 17450-17473 Old Harmony Drive, Fort Myers, Florida. The Insured filed suit on this claim the same day as it filed the CRN. At the time the claim was reported, the Insured had an open Hurricane Irma claim with American Capital Assurance Company. The claim was being administered by FIGA following the carrier’s insolvency. Centauri initially inspected the property on October 22, 2022, and again on November 1, 2022. During that inspection, evidence of pre-existing roof damage was observed and the there was limited evidence of damage attributable to Hurricane Ian. The estimate for covered damage did not exceed the sizeable windstorm deductibles. The total, combined deductible is $1,118,092. Centauri’s position was communicated, in writing, to the Insured on February 7, 2023. The Insured later retained Merlin Law Group who now claims the roofs require replacement as a result of Hurricane Ian and provided a $2,726,000 roofing contract dated September 18, 2023, for all 21 buildings as well as ancillary repairs. Counsel also provided an engineering report that acknowledges the pre-existing damage from Hurricane Irma. It appears the Insured did not replace the roofs following receipt of the payment received for its Hurricane Irma claim. A search of county building records shows roof replacement permit applications in 2023, but none between Hurricane Irma and Hurricane Ian. Permitting records also indicate the applications were submitted shortly after the execution of a release of the Irma claim with FIGA paying $2,366,733.22 to resolve the Hurricane Irma claim in August 2023. Documentation from the insured shows payments of approximately $2.1 million to Elias Brothers Roofing and it appears the roof replacement was completed as of March 2024. The Insured submitted a Notice of Intent to Initiate Litigation with a demand in the amount of $1,750,000 based on a roof replacement estimate. Centauri responded to request additional information regarding the Irma claim and post-Irma repairs. The Insured responded by providing limited repair information that had been provided prior to the NOI as well as information regarding the settlement of the Irma claim with FIGA. The Insured refused to provide documentation evidencing the damages claimed against FIGA. Centauri believes the Insured claimed full roof replacements as part of its Hurricane Irma claim, and now seeks payment for full roof replacements from Centauri in an effort to obtain double recovery for the same repairs. In its CRN, the Insured appears to take the position that it has provided Centauri with all requested information regarding the Hurricane Irma damage claim. Centauri notes that claim was the subject of a lawsuit. Significantly, the Insured has failed to provide Centauri with a copy of any reports or estimates setting forth the extent of damage claimed for Hurricane Irma. Instead, the Insured has taken the position that “the Irma settlement does not appear to be for any specific scope of damages”. This argument is obviously transparent as FIGA did not pay in excess of $2 million to settle a claim without any underlying itemization of damage. Just as in the Hurricane Ian claim, the Insured undoubtedly produced a damage estimate to support its Hurricane Irma claim, and is now attempting to withhold that estimate from Centauri. The Civil Remedy Notice alleges that Centauri violated the following Florida Statutes: 1. 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. 2. 626.9541(1)(i)(3)(a) - Failing to adopt and implement standards for the proper investigation of claims. 3. 626.9541(1)(i)(3)(c) - Failing to acknowledge and act promptly upon communications with respect to claims. 4. 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. 5. 626.9541(1)(i)(3)(g) - Failing to promptly notify the insured of any additional information necessary for the processing of a claim claims. Centauri denies any violation of the aforementioned statutory provisions and denies that it improperly handled the claim or that it failed to settle or adjust the claim in good faith. Centauri has maintained an open channel of communication throughout the claim process and has recently attempted to reach a resolution as to the disputed portion of the claim. Centauri generally denies each and every allegation contained within the CRN. The Insured’s allegations are wholly without merit. A review of the facts and circumstances surrounding the investigation reflects that Centauri timely and diligently continues to investigate and adjust the claim at issue in this dispute. All actions taken by Centauri regarding this claim have been made in good faith and for the purposes of fair, just and timely disposition of the matter. Centauri reserves its right to assert any and all applicable defenses. The purpose of the civil remedy notice is to give the insurer an opportunity to “cure” a violation of subdivision (1)(a) or (b) of section 624.155 of the Florida Statutes – “not to give the insured a right of action to proceed against the insurer even after the insured’s claim has been paid or resolved.” Lane v. Westfield Insur. Co., 862 So.2d 774, 779 (Fla. 5th DCA 2003); see also Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278, 1283 (Fla. 2000). In order for there to be a “cure” available to an insurer, “what ha[s] to be “cured is the non-payment of the contractual amount due to the insured. In the context of a first-party insurance claim, 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 with respect to payment are fulfilled.” Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., supra. The CRN was filed in bad faith and is being used solely for the improper purpose of intimidating and coercing Centauri into a settlement of the claim for damages which are not due. Centauri acted fairly and honestly toward the Insured with respect to the claimed Loss. The Insureds attempt to withhold and conceal estimates and other documents related to its Hurricane Irma claim is evidence of its own bad faith. Centauri considers this a full and complete response to the Insured’s CRN. Should the Department determine it requires any additional information, the undersigned remains available to discuss any questions or concerns with respect to this matter. Sincerely, /s Charles R. Rumbley
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