Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 795022

Filing Accepted: 12/3/2024

Print Filing

Complainant

Last/Business Name *

LITTLE

First Name

JACK (DOUG)

Street Address *

12191 167TH COURT

City, State Zip *

CEDAR KEY, FL 32625

Email Address *

DOUG@LITTLEOIL.COM

Complainant Type: *

Insured

Last/Business Name*		LITTLE		First Name		JACK (DOUG)
Policy # *		456242		Claim #*		944327

Attorney

Attorney is Applicable

Last Name*	DUNNAVANT First Name * ERIN Initial E
Street Address*		901 W. SWANN AVENUE
City, State Zip*		TAMPA , FLORIDA 33606
Email Address *		SERVICE@DANDDLAW.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		HOMEOWNERS CHOICE PROPERTY & CASUALTY INSURANCE COMPANY, INC.
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 12944

Name of individual responsible for violation (if any):* HOMEOWNERS CHOICE PROPERTY & CASUALTY INSURANCE COMPANY, INC., CLAIMS DEPARTMENT, SUPERVISORS, MANAGEMENT, AGENTS, AND ADJUSTERS, INCLUDING THE FOLLOWING REPRESENTATIVE & ADJUSTER, CANDACE LOBEL AND GARY ROWEN.
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)(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.

Upon information and belief, the Insured believes that the policy language relevant to Homeowners’ violations includes the following provisions of Policy No. HCPC-HW2-456242-11, including: From the Declarations: a) Coverage A – Dwelling Protection $354,000 b) Coverage B – Other Structures Protection $7,080 c) Coverage C – Personal Property Protection $88,500 d) Coverage D – Loss of Use $35,400 … Dwelling Structure Coverage (Place of Residence) Limit of Insurance: $354,000 … Personal Property Coverage Limit of Insurance: $88,500 … Check List of Coverage (continued) The above Limit of Insurance, deductibles, and Loss Settlement Basis apply to the following perils insured against: (Items marked below Y (Yes) indicate coverage IS included, those marked N (No) indicate coverage is NOT included) … Y Hurricane … SECTION I – PROPERTY COVERAGE Coverage A – Dwelling Protects against covered loss to your dwelling and structures attached to your dwelling. It also protects against covered loss to building materials located on your residence premises which are being used in connection with your residence premises. … Coverage C – Personal Property Protects against covered loss to your personal property such as clothing and furniture…. … PROPERTY COVERAGES 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”. … 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. … PERIL INSURED AGAINST 1. We insure for direct physical loss to the property described in Coverages A, B and C caused only by the peril of windstorm or hail unless the loss is excluded in EXCLUSIONS. VIII. TO ENABLE THE INSURER TO INVESTIGATE AND RESOLVE YOUR CLAIM, DESCRIBE THE FACTS AND CIRCUMSTANCES GIVING RISE TO THE INSURER'S VIOLATION AS YOU UNDERSTAND THEM AT THIS TIME. In addition of the above statutory provisions alleged to have been violated, see also the following statutes and rules: 624.155(1)(a)1 Any person may bring a civil action against an insurer when such person is damaged: (a) by violation of any of the following provisions by the insurer: (1) Section 626.9541(1)(i), (o), or (x) 69B-220.201(3)(b)(2) An adjuster shall adjust all claims strictly in accordance with the Insurance contract. 69B-220.201(3)(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured. 69B-220.201(3)(d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. 626.877 Every adjuster shall adjust or investigate every claim, damage, or loss made or occurring under an insurance contract, in accordance with the terms and conditions of the contract and of the applicable laws of this state. 626.878 An adjuster shall subscribe to the code of ethics specified in the rules of the department. The rules shall implement the provisions of this part and specify the terms and conditions of contracts, including a right to cancel, and require practices necessary to ensure fair dealing, prohibit conflicts of interest, and ensure preservation of the rights of the claimant to participate in the adjustment of claims. 624.155(5) No punitive damages shall be awarded under this section unless the acts giving rise to the violation occur with such frequency as to indicate a general business practice and these acts are: (a) Willful, wanton and malicious; (b) In reckless disregard for the rights of any insured; or (c) In reckless disregard for the rights of a beneficiary under a life insurance contract.

* 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 September 26, 2024, the Property located 12191 167th Court, Cedar Key, Florida 32625 (“the Insured Property”) belonging to Jack (Doug) Little (“the Insured” or “Mr. Little”) sustained damage resulting from Hurricane Helene. Mr. Little promptly reported the loss to his property insurer, Homeowners Choice Property & Casualty Insurance Company, Inc. (“Homeowners”) upon discovering the loss. Homeowners’ administrative, home, and mailing address is registered as 3802 Coconut Palm Drive, Tampa, Florida 33619. Homeowners assigned claim examiner, Candace Lobel, to Mr. Little’s loss. Ms. Lobel sent out field adjuster, Gary Rowen, to inspect the Insured Property and to prepare an estimate of damages on behalf of the insurer. On or about October 3, 2024, Mr. Rowen inspected the Insured Property on behalf of Homeowners. He subsequently prepared an estimate of damages dated October 5, 2024, with an RCV of $46,027.39 and an ACV of $41,800.28 as to his assessment of losses caused directly by Hurricane Helene. On or about October 16, 2024, Ms. Lobel sent correspondence to Mr. Little enclosing a copy of Mr. Rowen’s estimate pursuant to section 627.70131(3)(e), Florida Statutes. However, she made it clear that production of Homeowners’ estimate should not “be construed as an approval or denial of coverage or acceptance of the scope of damages” by the insurer. Following public backlash of Heritage Property & Casualty Insurance Company in response to the 60 Minutes report on its apparent manipulation of adjuster estimates during Hurricane Ian claims, the Florida Legislature promulgated section 627.70131(3)(e), Florida Statutes, requiring carriers to provide an Insured a copy of the insurer’s estimate if one is prepared regardless of the carrier’s ultimate coverage decision. It is evident that this is why Homeowners produced Mr. Little a copy of its estimate but did not provide a coverage decision as to his claim. In any event, due to the severity of damage sustained by Hurricane Helene, Mr. Little was skeptical of Homeowners’ adjustment and estimate of damages as to the full amount of losses incurred to the Insured Property. Mr. Little retained Silverhall LLC (“Silverhall”) to begin repairs at the subject property after Helene in order to protect the property damage from worsening. Thus far, Silverhall has been retained to repair/replace the deck but they are awaiting a permit. Silverhall has also completed some repairs on the ground floor, as well as some framing of walls, and electric, in part. Silverhall has been commissioned to complete the staircase, as well, but that has not yet been completed. In addition, Mr. Little retained Granite Building Contractors, LLC (“GBC”) to conduct separate and independent inspections of the Insured Property, and to review and incorporate the incurred repairs by Silverhall and to review the estimate provided to the Insured by Homeowners’ Choice. GBC also evaluated the personal property at the Insured Property which was damaged as a result of Hurricane Helene and prepared a loss inventory for the Insured. GBC ascertained that the full scope of covered losses to the Dwelling amounts to $185,894.13 as the costs required to fully and adequately restore the Insured Property to a pre-loss condition. Ultimately, despite agreeing that the Insured Property sustained damage by Hurricane Helene at least in the amount of $41,800.28 (ACV) via its own estimate, Homeowners chose to wrongfully deny the claim. In sum, the Insured timely reported his claim for the damage and loss to Homeowners, complied with Homeowners’ requests including allowing Homeowners to inspect his Insured property. Based on its failure to adequately pay this claim or instruct it preferred vendor to complete repairs, it is readily apparent that Homeowners has failed to create and implement adequate guidelines for proper claims investigation, claims evaluation, claims handling, and for training and supervision of employees and independent contractors handlings its claims resulting in statutory violations as set forth above. Homeowners has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s’ claim for damages. The concept of insurance is that it is the insurer's granting of timely and prompt indemnity or security against a contingent loss. Fla. Stat. §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 Insured may mitigate his damages and be put back into the position they were in prior to the loss as quickly as possible. Homeowners has failed to comply with its duty to indemnify the Insured. Homeowners has failed and/or refused to timely adjust, repair, and pay the Insured’s insurance claim for damages. Homeowners has refused and/or failed to pay any insurance proceeds to date owed to the Insured as required by the policy and law. Refusal and/or failure to pay or/and settle the Insured’s claim when under all the circumstances it could have and should have done so had it acted fairly and honestly towards the Insured is wrong. The actions taken by Homeowners and/or its representatives in the handling and adjustment of the Insured’s claim were willful, wanton, and in disregard for the rights of its Insured and occur with such a frequency as to indicate a general business practice, and further, are in violation of Florida Statutes §624.155 and §626.9541. Based on the foregoing actions and omissions, Homeowners has engaged in wrongful claims handling conduct, including but not limited to, the following: 1. Improper claim denial; 2. Improper claim delays; 3. Not conducting a full and fair investigation of the Insured’s claim; 4. Looking for ways to deny recovery to the Insured; 5. Looking for ways to delay recovery to the Insured; 6. Overlooking covered damages to the Insured Property upon an initial review of the loss and damages; 7. Failing to pay the necessary amounts due and owing to restore the Insured Property to its pre-loss condition; 8. Not adjusting the claim and not evaluating the loss properly, promptly, and fairly so as to provide full and prompt indemnity to its Insured. 9. Failing to implement proper standards for the adjustment and investigation of insurance claims; 10. Failing to pay the requisite monies owed for the Insured’s loss. 11. Not training, supervising or managing adjusters and independent contractors properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholders’ interests by attempting to deny or minimize payments owed; 12. Establishing severity control initiatives and otherwise establishing a culture of not fully and promptly paying claims following losses. Therefore, to cure the defects outlined in this Civil Remedy Notice, Homeowners must: Tender the full amount of insurance monies owed to the Insured for the Hurricane Helene loss and resulting damage to the Insured Property. A copy of this form has been submitted to the FDFS and has been printed out and mailed to the following parties providing them notice of the filing of the Civil Remedy Notice: cc: Homeowners Choice Property & Casualty Insurance Company, Inc. via Certified Mail, R.R.R. Homeowners Choice Property & Casualty Insurance Company, Inc. via U.S. Mail Claims Dept, Homeowners Choice Property & Casualty Insurance Company, Inc. via Certified Mail, R.R.R. Supervisors, Homeowners Choice Property & Casualty Insurance Company, Inc. via U.S. Mail Candace Lobel, Claims Examiner via Certified Mail, R.R.R. Jack (Doug) Little via electronic mail

Comments

User Id		Date Added		Comment
Legal@hcpci.com		01-30-2025		This is Homeowners Choice Property & Insurance Company’s (“HCPCI”) response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed by Erin Dunnavant, Esq. on behalf of Jack (Doug) Little (“Insured”). HCPCI reviewed this CRN and conducted a thorough review of the subject claim (“claim”) and confirmed it handled the claim properly. Under the relevant facts and circumstances, the applicable insurance contract did not provide coverage for the claim. Ultimately, HCPCI handled the claim in accordance with the policy and all statutory and regulatory requirements. HCPCI denies each allegation of bad faith and improper conduct in the CRN. At all times, HCPCI 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; failed to offer a valid cure; 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). The CRN must be rejected, and it cannot serve as the basis of any action against HCPCI. Upon request by the Florida Department of Financial Services, HCPCI will provide to the DFS detailed correspondence HCPCI 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