Civil Remedy Notice of Insurer Violations
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Filing Number:     795209
Filing Accepted:  12/4/2024
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Complainant
Last/Business Name *  
LAKE CENTER OF H.O.P.E., PA   First Name   KENNETH
Street Address * 33057 PROFESSIONAL DR (STE 102)
City, State Zip * LEESBURG, FL 34788
Email Address * LUDYUNGSON@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   LAKE CENTER OF H.O.P.E., PA   First Name  
Policy # * BPG9406Y Claim #* 01­007­584380
Attorney
Attorney is Applicable
Last Name* FOULADI First Name * ANTHONY Initial
Street Address* 2300 MAITLAND CENTER PKWY STE. 106
City, State Zip* MAITLAND , FL 32751
Email Address * AFOULADI@SERRANOCAGAN.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   MAIN STREET AMERICA PROTECTION INSURANCE COMPANY
NAIC Company Code 13026
 
Name of individual responsible for violation (if any):* N/A
Type of Insurance * Commercial 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)(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)(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.

SECTION I – PROPERTY COVERAGE A. Coverage A – Dwelling (Entire Section) B. Coverage B – Other Structures (Entire Section) C. Coverage C – Personal Property (Entire Section) D. Coverage D – Loss of Use (Entire Section).
 
* 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 04/03/2024, Lake Center of H.O.P.E., PA ("Insured"), sustained a covered direct physical loss to Insured's property due to wind. Insured reported the loss thereafter to MAIN STREET AMERICA PROTECTION INSURANCE COMPANY ("Insurer"). Prior to the date of loss, Insurer issued a policy of insurance, believed to be policy # G9406Y which afforded coverage for the aforementioned property for losses caused by the covered peril. The policy was in full force and effect on the date of loss. The Insured promptly notified Insurer of the loss, who then assigned the loss claim # 01-007-584380. Insurer was fully afforded any and all opportunity to inspect the loss and document the loss. To date, Insurer has paid $0 to Insured on this claim even after numerous attempts by the Insured to provide documentation of additional damages and compensation owed. Insured had no choice but to retain legal representation on or about 6/11/2024, as the Insurer refused to pay the full amount due and owed to its Insured. Insurer has continually failed to negotiate this claim with Insured’s attorney and/or failed to provide a satisfactory settlement offer to resolve the subject claim. This has severely harmed the Insured's ability to remedy their losses and continue with repairs to the property. The only purpose for Insurer's refusal to negotiate the claim is to increase profits and harm their insured. This is either done intentionally as a pattern and practice of Insurer to deny coverage and harm their insureds, or Insurer has failed to properly train and supervise its adjusters to the harm and detriment of their insureds. This pattern and practice is done for only one reason, which again, is to maximize profits and harm their insureds. Insurer has violated 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; 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)(c): Failing to acknowledge and act promptly upon communications with respect to claims; 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)(3)(i): Unfair claim settlement practices, and any other applicable statutes to the factual allegations included herein. To remedy and/or cure this CRN, Insurer must immediately tender payment in the amount of $131,908.00 less any applicable deductible and prior payment to the Insured to complete the repairs for the Insured property. The payment shall be tendered to the Insured’s attorneys, Serrano Cagan & Cagan at 2300 Maitland Center Parkway, Suite 106, Maitland, Florida 32751.
Comments
User Id Date Added Comment
scott.miller@qpwblaw.com 01-10-2025 January 10, 2025 Anthony Fouladi, Esq. Serrano Cagan & Cagan 2300 Maitland Center Pkwy, Suite 106 Maitland, FL 32751 afouladi@serranocagan.com service@serranocagan.com cholliday@serranocagan.com Insured : Lake Center of Hope PA Plaintiff : Lourdes Ungson as Representative with Authority for Lake Center of Hope PA Claim Number : 01-007-584380 Date of Loss : April 3, 2024 DFS Filing Number : 795209 Dear Mr. Fouladi: This correspondence constitutes MAIN STREET AMERICA PROTECTION INSURANCE COMPANY’S (hereinafter “MAIN STREET”) response to the Civil Remedy Notice of Insurer Violation you filed on behalf of LAKE CENTER OF HOPE PA (hereinafter the “Insured”), regarding the above-listed claim. MAIN STREET welcomes the opportunity to respond to this Civil Remedy Notice and specifically denies each and every allegation contained therein. MAIN STREET also asserts the Civil Remedy Notice fails to comply with the specific notice and information requirements set forth in both § 624.155, Florida Statutes, and Florida Case law. First, the Notice fails to name any individual(s) who are most responsible or knowledgeable of the purported violation, as required by §624.155(3)(b)3, Fla. Stat. This failure to identify any specific individual(s) involved with the purported violations prevents MAIN STREET from properly addressing the facts giving rise to the allegations in the Notice. This failure renders the Notice noncompliant with § 624.155, Fla. Stat. Second, the Civil Remedy Notice requires the Complainant, pursuant to § 624.155, Fla. Stat., to indicate all statutory provisions alleged to have been violated. The Notice you filed includes numerous statutory provisions 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 identify any specific statutes, it does not comply with § 624.155, Fla. Stat. and, as such, MAIN STREET is unable to properly respond. Third, § 624.155(2)(b), Fla. Stat., requires the Notice to state with specificity the facts and circumstances giving rise to the purported violations. This notice provides template, unsupported and incorrect allegations and fails to provide the requisite specificity required by § 624.155(2)(b), Fla. Stat. Without the benefit of specific facts and circumstances giving rise to the purported violations, MAIN STREET is unable to provide a detailed response. Fourth, the Civil Remedy Notice contains “cures” that are unavailable under either the insurance policy or the Civil Remedy Statute. For the aforementioned reasons, MAIN STREET believes the Civil Remedy Notice does not comply with § 624.155, Fla. Stat. Additionally, MAIN STREET denies any and all allegations contained in the Civil Remedy Notice. MAIN STREET’s response is based on the limited information provided in the Civil Remedy Notice and the information we have to date. If LAKE CENTER OF HOPE PA feels we do not have all the facts, we ask that he please inform us immediately. Please note that MAIN STREET’s response is not necessarily exhaustive and, as a result, it does not preclude us from asserting any other valid reasons for the lack of compliance with § 624.155, Fla. Stat. Additionally, neither this response, nor any act or failure to act on the part of MAIN STREET, or any agent or representative of MAIN STREET, should be construed as a waiver of any rights or defenses. This includes, but is not limited to, proper notice and service by LAKE CENTER OF HOPE PA, or other defenses available by contract or at law. All such rights and defenses are hereby reserved. We believe this response addresses the allegations contained in the Civil Remedy Notice. If you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned.. Sincerely, /s/ Scott Miller Scott G. Miller, Esq Melinda R. Shabka., Esq. QUINTAIROS, PRIETO, WOOD & BOYER, P.A. Attorneys for Main Street America Protection Insurance Company
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