Civil Remedy Notice of Insurer Violations
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Filing Number:     795265
Filing Accepted:  12/4/2024
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Complainant
Last/Business Name *  
NICHOLS   First Name   JOHN NICHOLS AND MARILYN
Street Address * 7853 CROSSWINDS WAY
City, State Zip * MOUNT DORA,, FL 32757
Email Address * JTNICHOL12@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   NICHOLS   First Name   JOHN NICHOLS AND MARILYN
Policy # * 80EDH6840 Claim #* 5975K950C
Attorney
Attorney is Applicable
Last Name* DRAKE First Name * VICTORIA Initial
Street Address* 2300 MAITLAND CENTER PKWY STE. 106
City, State Zip* MAITLAND , FL 32751
Email Address * VDRAKE@SERRANOCAGAN.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   STATE FARM FLORIDA INSURANCE COMPANY
NAIC Company Code 10739
 
Name of individual responsible for violation (if any):* N/A
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
624.155(1)(b)(3) Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(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 10/9/2024, JOHN NICHOLS AND MARILYN NICHOLS ("Insured"), sustained a covered direct physical loss to Insured's property due to HURRICANE. Insured reported the loss thereafter to STATE FARM FLORIDA INSURANCE COMPANY ("Insurer"). Prior to the date of loss, Insurer issued a policy of insurance, believed to be policy #80EDH6840 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 # 5975K950C. 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 10/18/2024, 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 $58,574.00 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
lalfano@alfanokingsford.com 01-22-2025 Dear Mr. and Mrs. Nichols: This letter has been directed to you through your attorney as State Farm Florida Insurance Company’s (“State Farm”) formal response to the allegations set forth in the purported Civil Remedy Notice (“Notice”) of insurer violation dated December 4, 2024. This Notice was filed on your behalf by Attorney Victoria Drake, Esq. of Serrano, Cagan & Cagan and purports to comply with Florida Statute §624.155. (A copy of the Notice is attached as Exhibit A). In your purported Notice, there is an indication that State Farm did not handle your claim in good faith because State Farm delayed your claim, it denied your claim, it committed some unidentified form of unfair trade practice, and it did not issue payment of insurance benefits that you believe you are entitled to, among many other unfounded claims. State Farm denies these allegations, and as the facts below will demonstrate, your claim was properly investigated, and State Farm did not treat you unfairly in its adjustment of the claim. To begin, your Notice is defective as a matter of law due to its apparent adoption of form-type allegations that lack the specificity required by Florida Statute §624.155, Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So. 2d 1278 (Fla. 2000). For example, in the Notice you are required to identify the person representing the insurer who is most responsible for the allegations, and you simply inputted “N/A” This response demonstrates a lack of credibility, as you are unable to identify anyone at the company responsible for your allegations of bad faith. As a result, State Farm cannot adequately assess your allegations so that the Notice is therefore invalid. Julien v. United Prop. & Cas. Inc. Co., 2021 Fla. App. LEXIS 3131 (Fla. 4th DCA 2021). On October 15, 2024, you submitted the subject wind damage claim to State Farm with a reported date of loss of October 9, 2024. On October 17, 2024, State Farm Representative Miguel Matamoros spoke with you, at which time you advised of wind damage to your roof. An inspection was scheduled to occur on October 18, 2024. The same day, State Farm sent correspondence advising you of your Duties After Loss and the Homeowner Claims Bill of Rights. (Please see attached Exhibit B and Exhibit C). On October 18, 2024, Mr. Matamoros inspected your property with you and Ricardo Cameron from Florida Elite Roofing present. Following the inspection, State Farm sent you its coverage determination explaining that it had completed its evaluation of the claim and determined that the cost of repairs for the loss does not exceed the $8,550.00 policy deductible. As such, State Farm was unable to make payment on the claim. (Please see attached Exhibit D). The letter attaches State Farm’s estimate totaling $2,076.45. Additionally, on October 18, 2024, State Farm received email correspondence from Florida Elite Roofing attaching a contract executed by you on October 15, 2024. (Please see attached Exhibit E). The email also attaches Florida Elite Roofing’s estimate totaling $46,770.68, along with a photo report. On October 19, 2024, State Farm sent email correspondence to Florida Elite Roofing acknowledging receipt of the contractor’s estimate and photographs and advised that it would review these materials and provide a response. (Please see attached Exhibit F). On October 22, 2024, State Farm received a Letter of Representation from Fransisco Serrano, Esq. of Serrano, Cagan & Cagan on your behalf. (Please see attached Exhibit G). On October 24, 2024, Mr. Matamoros sent email correspondence to Serrano, Cagan & Cagan acknowledging your attorney’s request for a copy of the policy and claim documentation. (Please see attached Exhibit H). On October 26, 2024, State Farm sent an updated coverage determination, dated October 25, 2024, to Serrano, Cagan & Cagan reiterating that the amount of covered damages does not exceed the policy deductible. State Farm further advised that the hurricane deductible is applied on an annual basis and that you are required to document any repair expenses incurred on the subject loss. (Please see attached Exhibit I). The same day, State Farm sent correspondence to Serrano, Cagan & Cagan advising them of your right to participate in the Florida Department of Financial Services mediation program. (Please see attached Exhibit J). Additionally, on October 26, 2024, State Farm sent correspondence to Serrano, Cagan & Cagan again advising of your Duties After Loss and the Homeowner Claims Bill of Rights. (Please see attached Exhibit K and Exhibit L). On November 5, 2024, State Farm sent correspondence to Serrano, Cagan & Cagan enclosing a certified copy of the subject policy. (Please see attached Exhibit M). On December 2, 2024, Victoria Drake, Esq. of Serrano, Cagan & Cagan filed a Notice of Intent to Initiate Litigation (“NOIL”) in the amount of $58,574.00 on your behalf. (Please see attached Exhibit N). The NOIL attaches an estimate prepared by Rockwell Estimating totaling $61,4448.75. On December 4, 2024, Ms. Drake filed the subject Notice on your behalf. On December 11, 2024, State Farm sent correspondence to Serrano, Cagan & Cagan responding to the NOIL and advising that its loss estimate is accurate. As such, no payment was due. (Please see attached Exhibit O). As the above-referenced facts demonstrate, there is no support for your allegations against State Farm, and State Farm has properly handled this claim and treated you fairly in its adjustment. Florida Statute §624.155 requires specificity in Civil Remedy Notices. Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So. 2d 1278 (Fla. 2000).; Julien v. United Prop. & Cas. Inc. Co., 2021 Fla. App. LEXIS 313 (Fla. 4th DCA 2021). Your Notice lacks any specific information in support of any of its allegations. For instance, your Notice alleges that State Farm “refused to pay the full amount due and owed to its Insured,” and “has paid $0.00 to Insured on this claim even after numerous attempts by the Insured to provide documentation of additional damages and compensation owed.” However, your Notice fails to provide any information to demonstrate that State Farm owes any payment for the claim. State Farm determined that the amount of covered damage to your property does not exceed the policy deductible, and you have not identified any information to the contrary. Moreover, the facts above show that you have not made “numerous attempts” to provide documentation in support of your claim. In fact, your Notice completely fails to identify any such communications or even describe what supporting documentation, if any, exists. The only documentation you have provided to State Farm in support of your claim is a contractor’s estimate that does nothing to demonstrate causation of damages and how it applies to the policy in favor of coverage beyond State Farm’s evaluation of the loss. As you fail to provide any factual support for your allegations, your Notice fails to adhere to its statutory purpose of providing an insurer with the opportunity to resolve legitimate disputes. Lane v. Westfield Ins. Co., 862 So. 2d 774, 779 (Fla. 5th DCA 2003); Julien, 2021 Fla. App. LEXIS 3131. State Farm denies these allegations and all others in your Notice. Your Notice then alleges that State Farm “has continually failed to negotiate this claim with the Insured’s attorney and/or failed to provide a satisfactory settlement offer to resolve the subject claim.” Yet, your Notice does not show that State Farm is or ever was obligated to negotiate a settlement to pay for damages in an amount that does not exceed the deductible. Despite this, you insist on alleging that “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.” Again, you fail to identify any evidence to show that State Farm either intentionally seeks to harm its insureds or does so unintentionally by failing to properly train its adjusters. Either way, your allegations are purely speculative and draw conclusions of bad faith based solely on your disagreement with State Farm’s estimate. You have not provided any information whatsoever to demonstrate that State Farm has engaged in the alleged wrongful behaviors. As such, your Notice fails to meet its statutory purpose of providing an insurer with the opportunity to resolve legitimate disputes. Lane, 862 So. 2d 774; Julien, 2021 Fla. App. LEXIS 3131. Lastly, your Notice alleges that State Farm has violated several Florida Statutes without providing any specific information to demonstrate how State Farm’s actions amounted to such violations. For instance, your Notice alleges that State Farm violated Fla. Stat. § 624.155(1)(b)(1) by “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” and violated Fla. Stat. § 624.155(1)(b)(3) by “failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear.” As previously discussed, you have not identified any facts about this claim to show that State Farm should have or was obligated to settle this claim at any time. Your Notice alleges that State Farm has violated Fla. Stat. § 626.9541 (1)(i)(3)(a) by “failing to adopt and implement standards for the proper investigation of claims.” Yet, you fail to identify any conduct or standards exercised by State Farm during the investigation of your claim that would be considered improper. The facts above show that State Farm completed a prompt and proper investigation, including a complete inspection of your roof. Your Notice alleges that State Farm has violated Fla. Stat. § 626.9541 (1)(i)(3)(c) by “failing to acknowledge and act promptly upon communications with respect to claims.” Yet, your Notice does not identify any communications from you or your representatives that State Farm has failed to respond to. State Farm made timely responses to all communications and materials received on your behalf during the adjustment of your claim. Your Notice alleges that State Farm has violated Fla. Stat. § 626.9541 (1)(i)(3)(d) by “denying claims without conducting reasonable investigations based upon available information.” This is clearly untrue, and you fail to identify how State Farm’s investigation was unreasonable in any way. The above facts demonstrate that State Farm considered all available information when determining the amount of coverage. Your Notice alleges that State Farm has violated Fla. Stat. § 626.9541 (1)(i)(3)(e) by “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.” You fail to identify the specific action prescribed by the statute that State Farm failed to comply with. State Farm issued its coverage determination letter to affirm its full acceptance of coverage, and you did not provide State Farm with any proof of loss statements. Your Notice alleges that State Farm has violated Fla. Stat. § 626.9541 (1)(i)(3)(f) by “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.” This is demonstrable false, as State Farm did not deny your claim, nor has it offered a compromise settlement. Your Notice alleges that State Farm has violated Fla. Stat. § 626.9541 (1)(i)(3)(g) by “failing to promptly notify the insured of any additional information necessary for the processing of a claim,” and violated Fla. Stat. § 626.9541 (1)(i)(3)(h) by “failing to clearly explain the nature of the requested information and the reasons why such information is necessary.” You fail to include these statutes in the specific section of your Notice that requires you to indicate all statutory provisions alleged to have been violated. Regardless, the language of these statutes clearly indicates that there can be either a violation of § 626.9541 (1)(i)(3)(g) or § 626.9541 (1)(i)(3)(h), but not both, as these behaviors conflict with each other. Either way, your Notice fails to identify any information to demonstrate that State Farm has violated either statute. As the facts show, State Farm completed its investigation will all of the necessary information available and made no such further requests from you. Your Notice alleges that State Farm has violated Fla. Stat. § 626.9541 (1)(i)(3)(i) through “unfair claim settlement practices, and any other applicable statutes to the factual allegations included herein.” This is a misstatement of the statutory language, as § 626.9541 (1)(i)(3)(i) is not a broad prohibition of unfair claims settlement practices, but rather, provides that it is in an unfair settlement practice to fail to pay personal injury protection insurance claims within the time periods required by § 627.736(4)(b). Interestingly, although your Notice includes the correct language of this statute in the field of your Notice that requires you to indicate all statutory provisions alleged to have been violated, you misapply § 626.9541 (1)(i)(3)(i) here, as the subject claim is a first party property claim, and not a personal injury claim. Your Notice fails to provide any evidence demonstrating that State Farm violated any of the referenced statutes aside from a mere recitation of the statutory language. State Farm denies that it violated any statutory provisions in its handling of the claim. As has already been a problem with the Notice, it continues to fail to adhere to its statutory purpose of providing an insurer with the opportunity to resolve legitimate disputes. Lane, 862 So. 2d 774; Julien, 2021 Fla. App. LEXIS 3131. State Farm denies that this claim has been handled in bad faith, unfairly, or with delay. State Farm hereby denies each and every allegation against it as put forth in your Notice. State Farm has in the past, and continues at the present time, to make all efforts to promptly resolve this claim in a fair and reasonable fashion and in full accord with the insurance policy and Florida law.
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