Civil Remedy Notice of Insurer Violations
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Filing Number:     795109
Filing Accepted:  12/3/2024
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Complainant
Last/Business Name *  
CLAY   First Name   JOHN AND SAKINAH
Street Address * 1079 SOUTHERN HILLS DRIVE
City, State Zip * ORANGE PARK, FL 32065
Email Address * JOHNNYCBOYCLAY@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   CLAY   First Name   JOHN AND SAKINAH
Policy # * 0472161483 Claim #* 01000111016
Attorney
Attorney is Applicable
Last Name* O'NEIL First Name * JONATHAN Initial
Street Address* 203 FORT WADE ROAD, SUITE 260
City, State Zip* PONTE VEDRA , FLORIDA 32081
Email Address * JONATHAN@WOOLSEYMORCOM.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   FIRST PROTECTIVE INSURANCE COMPANY
NAIC Company Code 10897
 
Name of individual responsible for violation (if any):* BAKIR WILLIAMS (FLA. ADJ. LIC. #P067552)
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Other : Wrongful claim denial
Unfair Trade Practice
Other : Unfair claim settlement practices
Other : Unreasonable investigation
Other : Failure to act on claim
Other : Failure to conduct a reasonable investigation based on available information
Other : Failure to maintain proper complaint handling procedures
Other : Misrepresenting the insurance policy provisions to the insured
Other : Misrepresenting Florida statutory provisions to the insured
Other : Misrepresenting facts to the insured
Other : Failure to acknowledge and act promptly upon communications with respect to claims
Other : Denying claims without conducting reasonable investigations based upon available information
* 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)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
626.9541(1)(i)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
* 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 A. Coverage A – Dwelling And Coverage B – Other Structures 1. We insure for sudden and accidental physical loss to covered property described in Coverages A and B unless the loss is otherwise excluded or limited in this policy. **** B. Coverage C – Personal Property We insure for sudden and accidental direct physical loss to covered property described in Coverage C caused by any of the following perils unless the loss is otherwise excluded or limited in this policy . . . 2. Windstorm or hail **** [A]ny ensuing loss to property described in Coverages A and B not precluded by any other provision in this policy is covered. **** D. Coverage D – Loss of Use The limit of liability for Coverage D is the total limit for the coverages in 1. Additional Living Expense, 2. Fair Rental Value and 3. Civil Authority Prohibits Use below. **** E. Additional Coverages 1. Debris Removal. a. We will pay your reasonable expense for the removal of: (1) Debris of covered property if a Peril Insured Against that applies to the damaged property causes the loss; or (2) Ash, dust or particles from a volcanic eruption that has caused direct loss to a building or property contained in a building. This expense is included in the limit of liability that applies to the damaged property. If the amount to be paid for the actual damage to the property plus the debris removal expense is more than the limit of liability for the damaged property, an additional 5% of that limit is available for such expense. ***** 2. Reasonable Emergency Repairs. a. We will pay up to the greater of $3,000 or 1% of your Coverage A limit of liability for the reasonable costs incurred by you for necessary measures taken solely to protect covered property from further damage when the damage or loss is caused by a Peril Insured Against. **** 11. Ordinance Or Law. a; You may use up to the Ordinance or Law percentage shown on the Declarations for the increased costs you incur due to the enforcement of building, zoning, or land use ordinances or laws. This coverage applies if the enforcement is directly caused by the same insured loss and is a covered cause of loss. **** 13. “Fungi”, Mold, Wet Or Dry Rot, Or Bacteria a. The amount shown in the Schedule above is the most we will pay for: (1) The total of all loss payable caused by “fungi”, mold, wet or dry rot, or bacteria; (2) The cost to remove “fungi”, mold, wet or dry rot, or bacteria from covered property; (3) The cost to tear out and replace any part of the building or other covered property as needed to gain access to the “fungi”, mold, wet or dry rot, or bacteria; and (4) The cost of testing of air or property to confirm the absence, presence or level of “fungi”, mold, wet or dry rot, or bacteria whether performed prior to, during or after removal, repair, restoration or replacement. The cost of such testing will be provided only to the extent that there is a reason to believe that there is the presence of “fungi”, mold, wet or dry rot, or bacteria. **** Also refer to: Coverage A provision, coverage B provision, coverage C provision, coverage D provision, all additional coverages provisions, all coverages provided by endorsement or rider, the declarations page, loss payment or settlement provision, duties in event of loss policy provision, all terms and conditions of section I of the insurance policy, the insurance policy definitions section, the insurance policy‘s exclusion of coverage provisions, all insurance policy provisions that provide coverage to the insured property, and all policy provisions.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

624.155(1)(a)(1) – violating 626.9541(1)(i) 626.9541(1)(a)(1) -- misrepresenting the terms of an insurance policy. 626.9541(1)(i) -- unfair claim settlement practices. Facts of the case: First Protective Insurance Company (“FRONTLINE”) has committed the following in handling the insureds’ claim: 1) failure to pay benefits owed; 2) failure to act in due diligence and good faith to resolve claims; 3) placing the financial interest of the insurer before that of the policy holder and claimant; 4) failure to properly train, evaluate, and manage adjusters retained to represent the policies and procedures of FRONTLINE; 5) looking for ways to delay benefit payments and otherwise “low ball” or “stone wall” claims; 6) looking for ways to deny the insureds’ claim; 7) looking for ways to reduce recovery to the insureds; 8) failure to perform a reasonable investigation; 9) misrepresenting Florida statutory provisions to its insureds; 10) misrepresenting insurance policy provisions to the insureds; 11) FRONTLINE has failed and refused to acknowledge coverage and promptly pay the benefits due and owed to the insureds; 12) the reasons for this may be attributed to improper training, supervision, and/or motivation of outside adjusters and claims supervisors to promptly and fairly adjust and pay full benefits available to the insureds. The insurer may have failed to adopt proper standards of investigation and adjustment of losses or is otherwise not implementing those standards because a proper investigation and full and prompt payment for the loss is not occurring. In Florida, the work of adjusting insurance claims engages the public trust. FRONTLINE has breached this duty by its adjustment of the insureds’ claim of loss. FRONTLINE has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees resulting in violations as set forth above. FRONTLINE has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the insureds’ insurance claim for damages. Despite the insureds’ timely notification to FRONTLINE of their insurance claim, FRONTLINE has failed and refused to acknowledge the covered loss and pay all amounts due and owing to the insureds under the policy of insurance. FRONTLINE has failed to promptly settle the insureds’ insurance claim, when the obligation to settle the claim had become reasonably clear, under one portion of the insurance, in order to influence settlements under other portions of the insurance policy coverage. Despite the insureds’ pleas otherwise, FRONTLINE has failed and refused to acknowledge its obligation to tender all insurance proceed monies due and owing the insured or assist the insureds in mitigation of the damages. In exchange for a premium paid by the insureds, FRONTLINE issued the subject all-risk insurance policy which provided coverage for the insured property from May 10, 2023, through May 10, 2024, for “sudden and accidental physical loss to covered property described in Coverages A and B unless the loss is otherwise excluded or limited in this policy.” As such, the subject all-risk Policy contains coverage for all direct physical losses to the insured property unless the loss is specifically and unambiguously excluded from coverage by the Policy. On or about January 9, 2024, the insured property suffered a windstorm loss, and the insureds immediately submitted a claim to FRONTLINE for property damage, i.e., storm and wind damage throughout the insured property. Hence, the insureds suffered a substantial loss regarding the real property and continue to suffer such loss. Having suffered such substantial damage, the insureds promptly notified FRONTLINE of the loss in an effort to mitigate the current damage and prevent the exacerbation of any additional losses. The desired result did not follow. FRONTLINE since being presented the Insureds’ claim has misrepresented policy provisions to avoid paying the insured what they are owed under the policy. Ultimately, FRONTLINE has failed and refused to properly settle the insureds’ claim in good faith. The insureds have requested that FRONTLINE conduct an investigation, admit coverage, and pay damages; FRONTLINE has failed and refused to do so. In short, FRONTLINE has failed to handle its insureds’ claim in good faith in violation of Fla. Stat. 624.155(1)(b)(1), 624.155(1)(b)(3), and 626.9541(1)(i). Based upon FRONTLINE’s investigation and property inspection, which confirmed windstorm damage, FRONTLINE nevertheless sent correspondence to the insureds dated September 13, 2024, (signed by FRONTLINE’s adjuster, Bakir Williams (Fla. Adj. Lic. #P067552)) and communicated its unequivocal denial of the claim. In regard to insurance contracts, a specific refusal to pay a claim is the breach which triggers the cause of action. Allstate Ins. Co. v. Kaklamanos, 843 So. 2d 885, 892 (Fla. 2003); Donovan v. FRONTLINE Fire and Cas. Co., 574 So. 2d 285, 286 (Fla. 2nd DCA 1991) (finding that a breach of contract takes place at the moment the insurance company refuses to pay a claim). Therefore, FRONTLINE breached the Policy. Moreover, FRONTLINE’s argued exclusions and/or limitations to coverage are devoid of anti-concurrent causation language. Thus, “coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause.” Sebo v. Am. Home Assurance Co., Inc., 208 So. 3d 694, 699 (Fla. 2016). In addition, under the Policy, any ensuing loss to property not excluded or excepted in this policy is covered. Hence, there are a myriad of coverages under the Policy that would provide coverage for the loss. Nevertheless, FRONTLINE failed and refused to acknowledge the covered loss and pay all amounts due and owing for the loss. Therefore, FRONTLINE breached the Policy. Questioning the propriety of FRONTLINE’s coverage denial, and given the extensive nature of the physical damage, the insureds retained a loss consultant, Property Pros Consulting (“PPC”), to perform an investigation and damage evaluation in accordance with industry standards and Florida law. Based on its investigation, PPC determined that a windstorm on or about January 9, 2024, caused damage throughout the exterior of the insured property (particularly the roof warranting its replacement). Moreover, PPC determined that at least $59,106.91 worth of repairs would be required to return the property to its pre-loss condition as a result of the windstorm loss. Nevertheless, FRONTLINE failed and refused to acknowledge the covered loss and pay all amounts due and owing under the Policy. Therefore, FRONTLINE breached the Policy. Thereafter, the insureds sent correspondence to FRONTLINE enclosing the supporting PPC report outlining the cause, scope, and cost of the loss along with other supporting documents and requested FRONTLINE to reconsider its coverage denial. Nevertheless, FRONTLINE failed and refused to acknowledge the covered loss and pay all amounts due and owing under the Policy. Therefore, FRONTLINE breached the Policy. On December 3, 2024, the insureds sent correspondence to FRONTLINE enclosing their Sworn Statement in Proof of Loss, the supporting PPC report outlining the cause, scope, and cost of the loss along with other supporting documents, the Notice of Intent to Initiate Litigation, and requested FRONTLINE to reconsider its coverage denial. To date, FRONTLINE has failed and refused to acknowledge the covered loss and pay all amounts due and owing under the Policy. Therefore, FRONTLINE breached the Policy. As such, FRONTLINE’S coverage denial is a blatant misrepresentation of the available coverages under the Policy in direct violation of Fla. Stats. 626.9541(1)(a)(1), 626.9541(1)(i)(3)(b), 626.9541(1)(a)(1), and 626.9541(1)(i)(2) and is nothing more than a mere pretext to wrongfully deny and delay this claim. As a result, FRONTLINE has materially misrepresented the coverages under the subject policy to the insured for the purpose and with the intent of effecting settlement of the insureds’ claim on less favorable terms than those provided in, and contemplated by, the subject policy in direct violation of Fla. Stat. § 626.9541(1)(i)(2). Further, FRONTLINE is in violation of Florida statutes §§ 626.9541(1)(a)(1), 626.9541(1)(i)(3)(b), and 626.9541(1)(a)(1) by misrepresenting pertinent facts and insurance policy provisions relating to coverages at issue; and also in violation of Fla. Stat. 626.9541(1)(i)(3)(d) by denying the insureds’ claim without conducting a reasonable investigation based upon available information. In summary, the insureds’ loss is clearly covered by the terms of the policy of insurance with FRONTLINE. However, FRONTLINE chose to deny coverage for the insureds’ loss. Despite clear evidence that the damage was covered and caused by a covered peril, the claim was denied. To date, FRONTLINE continues to deny the insureds and its insured full indemnity for the claim. While FRONTLINE refuses to honor this claim, a jury in Clay County will likely do what FRONTLINE has refused; exercise the benefit of doubt in favor of the insureds in finding full coverage for this loss. Indeed, the insureds will undoubtedly meet the burden of proof at trial, under the FRONTLINE all-risk policy, to show that, while FRONTLINE provided insurance coverage, damage occurred to the insured property. See Jones v. Federated Nat'l Ins. Co., 235 So. 3d 936, 942 (Fla. 4th DCA 2018). With the data presented within FRONTLINE’s investigation and PPC’s investigation, FRONTLINE’s burden to demonstrate by the greater weight of the evidence that all the physical damage to the insured property was caused solely by excluded perils under the policy and not in combination with a covered peril has not and cannot be met. See Sebo v. Am. Home Assurance Co., Inc., 208 So. 3d 694 (Fla. 2016). Despite clear indicators of covered damage, FRONTLINE nevertheless inexplicably denied the insureds’ claim. As of today, FRONTLINE has failed and refused to inform the insureds of their rights under the policy of insurance and Florida statutes, has improperly delayed the insureds’ claim, has wrongfully denied the insureds’ claim, and has failed and refused to adequately indemnify the insured for the loss and defiantly continues to do so. Indeed, from the time of receiving the claim, FRONTLINE has purposely and maliciously delayed in adjusting the subject claim in an effort to either avoid paying the claim altogether or, at the very least, avoid paying the full extent of the loss. Notably, under Florida law, “[t]he filing of a lawsuit does not extinguish the insurer’s obligations under the policy to adjust and pay the claim.” Tristar Lodging, Inc. V. Arch Specialty Ins. Co., 434 F. Supp. 2d 1286, 1289 (M.D. Fla. 2006). To date, the insureds have made a good faith effort to comply with all of the requirements under the subject policy of insurance, and it is only fair that FRONTLINE do the same. Yet, that is not the case. The insureds feel that the insured property is a valuable asset, and, by continuously delaying the proper handling of this claim, FRONTLINE is putting the insured property at risk. As responsible property owners, the insureds purchased insurance to protect the property, paid all of the premiums, and have kept up to date with the responsibilities under the policy. Yet, when the insureds needed to rely on the insurance because of this unforeseen loss, FRONTLINE turned its back and delayed and wrongfully denied coverage that the insureds are rightfully owed. Ultimately, FRONTLINE has failed and refused to properly investigate the loss. The insureds have requested that FRONTLINE admit coverage and pay damages, FRONTLINE has failed and refused to do so, and continues to refuse to fully indemnify the insureds for the loss and pay the amounts necessary to properly repair the insureds’ property, despite knowing it is required to do so. In short, FRONTLINE has failed to handle its insureds’ claim in good faith. In Florida, the work of adjusting insurance claims engages the public trust; FRONTLINE has breached this duty by its insufficient adjustment of the insureds’ claim. FRONTLINE 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. FRONTLINE has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the insureds’ insurance claim for damages. Florida statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a 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 to put them back into the position they were prior to loss as quickly as possible. FRONTLINE breached this duty. The actions taken by FRONTLINE in the handling / adjustment of the insureds’ claim were willful, wanton, and with complete disregard for the rights of its insured and occur with such a frequency as to indicate a general business practice and are in violation of Fla. Stat. 624.155 and 626.9541. FRONTLINE’S actions amount to but are not limited to the following: 1. Claim delay 2. Wrongful claim denial 3. Unfair trade practice 4. Unfair claim settlement practices 5. Unreasonable investigation 6. Failure to act on claim 7. Failure to conduct a reasonable investigation based on available information 8. Failure to maintain proper complaint handling procedures 9. Misrepresenting the insurance policy provisions to the insured 10. Misrepresenting Florida statutory provisions to the insured 11. Misrepresenting facts to the insured 12. Failure to acknowledge and act promptly upon communications with respect to claims 13. Denying claims without conducting reasonable investigations based upon available information 14. Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed. 15. 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. 16. Failing to promptly notify the insured of any additional information necessary for the processing of a claim. 17. Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. 18. Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 90 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by an act of God, prevented by the impossibility of performance, or due to actions by the insured or claimant that constitute fraud, lack of cooperation, or intentional misrepresentation regarding the claim for which benefits are owed. Therefore, to cure the defects outlined in this civil remedy notice, FRONTLINE must: (1): Admit full coverage for the insureds’ loss; (2): Tender all insurance monies due and owing to the insured for the loss under the subject Policy; A copy of this form submitted to the FDFS has been emailed and/or uploaded and also printed out and mailed to the following parties providing them notice of the filing of this civil remedy notice: First Protective Insurance Company P.O. Box 958405 Lake Mary, FL 32795 claims@flhi.com
Comments
User Id Date Added Comment
tsalehi@salehiboyer.com 01-29-2025 VIA ELECTRONIC SUBMISSION: civilremedy@myfloridacfo.com Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Re: Complainant: John and Sakinah Clay Policyholder: John and Sakinah Clay Filer: Jonathan O’Neil Claim #: 01000111016 Policy #: 0472161483 CRN filing No.: 795109 CRN filing date: December 3, 2024 To Whom It May Concern at The Department of Financial Services: With this correspondence, First Protective Insurance Company d/b/a Frontline Insurance (“FRONTLINE”) responds to the Civil Remedy Notice of Insurer Violations (“CRN”) filed by Jonathan O’Neil, naming John and Sakinah Clay, as the Complainants. Notably, the Insured has formally withdrawn this CRN as the matter has been resolved amicably; however, FRONTLINE provides the following in response in an abundance of caution. After reviewing the CRN, FRONTLINE conducted a thorough review of its handling of the Complainants’ claim. FRONTLINE denies that it has violated any of the statutes referenced in the CRN. At all times, FRONTLINE has acted in good faith, fairly and honestly toward the Insured and Complainants and with due regard for their interests. FRONTLINE also argues that the CRN fails to adequately describe the alleged violations and fails to provide sufficient information such as facts and circumstances which would allow FRONTLINE to correct the alleged violations. The Complainants allege violations of the following statutory provisions: 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. FRONTLINE denies the allegation that it violated the above referenced statute. 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. FRONTLINE denies the allegation that it violated the above referenced statute. 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. FRONTLINE denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. FRONTLINE denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. FRONTLINE denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims. FRONTLINE denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(d): Denying claims without conducting reasonable investigations based upon available information. FRONTLINE denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(e): Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed. FRONTLINE denies the allegation that it violated the above referenced statute. 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. FRONTLINE denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(g): Failing to promptly notify the insured of any additional information necessary for the processing of a claim. FRONTLINE denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(h): Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. FRONTLINE denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(4): Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5). FRONTLINE denies the allegation that it violated the above referenced statute. FRONTLINE specifically denies each and every one of the Complainants’ allegations that it violated any of the above referenced statutes. In addition to the allegations specifically denied above, FRONTLINE generally denies all allegations presented in this CRN as FRONTLINE has not violated any statute or rule. CRN MUST BE DISMISSED The CRN must be dismissed first and foremost because the Complainants failed to allege any specific, actual facts in support of any of their statutory allegations. Next, the CRN requires that the Complainants “pursuant to section 624.155, F.S., please indicate all statutory provisions alleged to have been violated.” The CRN filed in this matter includes almost every statutory provision that could be claimed against an insurance company, regardless of whether they are relevant or applicable to the alleged facts contained in the Notice. Because the Civil Remedy Notice fails to allege any specific facts and/or circumstances in support of its allegations, FRONTLINE is unable to properly respond; as such, the CRN should be rejected and returned. The CRN is wholly devoid of any factual allegations relating to the monetary amount of any claims, or any reference to communications (or lack thereof) possibly giving rise to any alleged violation. See Rousso v. Liberty Surplus Ins. Corp., No. 10-cv-20554, 2010 WL 7367059, at *4 (S.D. Fla. Aug. 13, 2010) (“In this case, the Plaintiffs do not explain how or identify which claims or suits the Defendant responded to in a manner that was contrary to good faith, unfair, or dishonest. This vagueness continues in the Plaintiffs' claim that the Defendant failed to respond to repeated pleas for assistance.”). These glaring deficiencies fail to apprise FRONTLINE of the nature of any purported violation and cannot satisfy the statutory standard of “pleading the facts and circumstances” giving rise to the violation with specificity. The CRN also fails to set forth the applicable policy language or the policy provisions that have been violated. The CRN first identifies Section 624.155(1)(b)(1), Florida Statutes, which addresses an insurer’s refusal to attempt to settle in good faith. The CRN, however, does not specify when any settlement opportunity or proposal existed, the details of the settlement proposal, the nature of the underlying claim(s), or the circumstances supporting the conclusion that the unspecified refusal to settle was not in good faith. To the extent the CRN suggests that FRONTLINE should tender payment due on the claim, the CRN fails to provide a sufficient description of the facts and circumstances supporting this contention. As to Section 624.155(1)(b)(3), Florida Statutes, the CRN does not identify any facts to support the assertion that, except as to liability coverages, FRONTLINE failed to promptly settle claims, when the obligation to settle a claim became reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage. As to Section 626.9541(1)(i)(2), Florida Statutes, the CRN does not identify any facts to support the assertion that FRONTLINE made a material misrepresentation 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. As to Section 626.9541(1)(i)(3)(a), Florida Statutes, the CRN does not identify any facts to support the assertion that FRONTLINE failed to adopt and implement standards for the proper investigation of claims. As to Section 626.9541(1)(i)(3)(b), Florida Statutes, the CRN does not identify any facts to support the assertion that FRONTLINE mispresented pertinent facts of policy provisions relating to the coverages at issue. Moreover, as to as to Section 626.9541(1)(i)(3)(c), Florida Statutes, the CRN does not identify any facts to support the assertion that FRONTLINE failed to acknowledge and act promptly upon communications with respect to claims. Moreover, as to as to Section 626.9541(1)(i)(3)(d), Florida Statutes, the CRN does not identify any facts to support the assertion that FRONTLINE denied claims without conducting reasonable investigations based upon available information. Moreover, as to as to Section 626.9541(1)(i)(3)(e), Florida Statutes, the CRN does not identify any facts to support the assertion that FRONTLINE failed to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed. Moreover, as to as to Section 626.9541(1)(i)(3)(f), Florida Statutes, the CRN does not identify any facts to support the assertion that FRONTLINE failed 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. Moreover, as to as to Section 626.9541(1)(i)(3)(g), Florida Statutes, the CRN does not identify any facts to support the assertion that FRONTLINE failed to promptly notify the insured of any additional information necessary for the processing of a claim. Moreover, as to as to Section 626.9541(1)(i)(3)(h), Florida Statutes, the CRN does not identify any facts to support the assertion that FRONTLINE failed to clearly explain the nature of the requested information and the reasons why such information is necessary. Moreover, as to as to Section 626.9541(1)(i)(4), Florida Statutes, the CRN does not identify any facts to support the assertion that FRONTLINE failed to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5). Furthermore, contrary to the requirement to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time,” the purpose of which is “to enable the insurer to investigate and resolve [the] claim,” the CRN itself only provides unsupported and incorrect allegations with no basis in fact or circumstance. The tenor and inferences of the allegations are wholly without merit and FRONTLINE denies each and every one. Additionally, the CRN fails to identify specific policy language relevant to an alleged violation. Blanket references to policy provisions and statutes without specification deems the Civil Remedy Notice deficient. Julien v. United Property and Casualty Insurance Co., 311 So. 3d 875 (Fla. 4th DCA 2021). The Complainants failed to state specific policy language or provide the specific facts underlying the basis for policy language relevant to any alleged violation. The allegations set forth in the CRN are denied as they are mere conclusory allegations unsupported by facts, devoid of logic and intended solely to tarnish FRONTLINE’s name and reputation. FRONTLINE, at all times, acted fairly, honestly and in good faith in its dealings with the Complainants. FRONTLINE did not engage in unfair settlement practices nor did FRONTLINE fail to promptly settle the claim or attempt to settle the claim in order to influence settlement under a different portion of the policy. FRONTLINE at no time misrepresented any pertinent facts or insurance policy provisions. FRONTLINE conducted a reasonable and prudent investigation of the claim and acted upon all communications from the Complainants. Finally, FRONTLINE promptly and appropriately communicated with the Complainants and provided explanations for the actions and decisions that were made. FRONTLINE retained an independent adjuster and conducted inspections of the subject property to investigate the Complainants’ claim. Thereafter, FRONTLINE made timely coverage decisions. As it relates to the facts of the claim, FRONTLINE received notice of the subject loss on March 29, 2024, alleged to have occurred on January 9, 2024. Specifically, it was alleged that there were damages to the Property from wind. On April 1, 2024, an independent adjuster inspected the Property on behalf of FRONTLINE. Thereafter, FRONTLINE continued to investigate the alleged loss, including obtaining a recorded statement from John Clay. On August 20, 2024, an engineer inspected the property on behalf of FRONTLINE. After analysis of the subject policy of insurance, and based on the above factual investigation, FRONTLINE issued a coverage determination on September 13, 2024, denying coverage and providing its basis for same. The correspondence was in writing and was promptly sent to the Complainants with pertinent policy excerpts. The above demonstrates quite clearly that FRONTLINE acted in good faith, acted fairly and honestly, acknowledged and acted promptly upon receipt of the claim, attempted to determine coverage for the claim pursuant to the terms of the policy, took reasonable steps to investigate the claim, communicated reasonably with the Complainants about the claim, and provided the Complainants a reasonable explanation for each of its actions. Clearly, FRONTLINE conducted a comprehensive investigation into the subject claim and rendered its coverage decision based on the terms and conditions of the subject policy. Additionally, the CRN contains “cures” for the alleged defects; however, the listed “cures” are improper pursuant to Florida case law, specifically the case of Talat Enterprises, Inc., v. Aetna Casualty and Surety Co., 753 So.2d 1278, 1281 (Fla. 2000). The Talat case provides that the scope of what can be "cured" is limited to the alleged non-payment of the contractual amount due to the insureds. Talat also commented that, “[i]t naturally follows that for there to be a ‘cure,’ what had to be ‘cured’ is the non-payment of the contractual amount due 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 in respect to payment are fulfilled....” As a result, only a demanded “cure” relating to the specific amount needed to repair covered damages is proper and legal – any remaining “cures” are improper remedies and contrary to Florida law. In closing, FRONTLINE first believes that the CRN should be rejected and returned by the Department of Financial Services due to its failure to comply with Florida Statute § 624.155, Florida Statute § 626.9541, and Florida case law, and regardless of the rejection, FRONTLINE denies all allegations contained in the CRN and submits that there are no violations. While this response is meant to be comprehensive, FRONTLINE based the above-mentioned statements upon the limited information provided in the CRN and the information FRONTLINE has been provided to date. If the Complainants feels that FRONTLINE is not in possession of all the facts, please provide such additional information as soon as possible. Please note that FRONTLINE’s response is not necessarily exhaustive and does not preclude the assertion of other valid reasons for seeking rejection and return of the CRN. Also, nothing in this letter, or any act or failure to act on the part of FRONTLINE or any agent or representative of FRONTLINE should be construed as a waiver of any rights or defenses available to it by contract or at law as all such rights and defenses are hereby specifically reserved. We trust that this response addresses the allegations of insurer violation alleged in the CRN. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Regards, Donald Lavigne, Esquire On behalf of First Protective Insurance Company d/b/a Frontline Insurance
jonathan@woolseymorcom.com 01-28-2025 2025-01-28 - WITHDRAWN
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