Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 795440

Filing Accepted: 12/5/2024

Print Filing

Complainant

Last/Business Name *

PASCALEVENEGA

First Name

MICHELLE

Street Address *

14825 NW 151 LN

City, State Zip *

ALACHUA, FL 32615

Email Address *

ALACHUAGIRL@GMAIL.COM

Complainant Type: *

Insured

Last/Business Name*		PASCALEVENEGA		First Name		MICHELLE
Policy # *		765885929		Claim #*		50240900731

Attorney

Attorney is Applicable

Last Name*	SANDON First Name * JOY Initial
Street Address*		2300 MAITLAND CENTER PKWY STE. 106
City, State Zip*		MAITLAND , FL 32751
Email Address *		JSANDON@SERRANOCAGAN.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		TRUCK INSURANCE EXCHANGE
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 21709

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 06/24/2023, Michelle Pascale-Venega ("Insured"), sustained a covered direct physical loss to Insured's property due to WATER DAMAGE. Insured reported the loss thereafter to TRUCK INSURANCE EXCHANGE ("Insurer"). Prior to the date of loss, Insurer issued a policy of insurance, believed to be policy # 76588-59-29 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 # 5024090073-1. 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 7/13/2023, 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 $5,692.00 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
dgonzalez@chartwelllaw.com		02-01-2025		To Whom It May Concern, This firm represents Truck Insurance Exchange (hereinafter “TIE”) in connection with a claim submitted by Michelle Pascale-Venega (hereinafter “Insured” or “Complainant”), following an alleged loss occurring on June 24, 2023. This correspondence shall serve as a formal response by TIE to the Civil Remedy Notice of Insurer Violation (“CRN”), filing number 795440, submitted on behalf of Michelle Pascale-Venega and associated with Policy number 0765885929, and a date of loss of November 20, 2023. TIE denies each and every allegation brought forth in the CRN and denies any wrongdoing in the handling of this mater. Below we include a detailed factual history of the claim handling and actions by TIE, which clearly reveals TIE acted properly in responding to the claim, and is in compliance with both its contractual and legal obligations. TIE would further state that the Complainants’ CRN is defective as it fails to comply with the strict governing requirements contained within Florida Statute Section 624.155. Namely, the statute requires that a CRN shall “state with specificity . . . [t]he facts and circumstances giving rise to the violation.” Fla. Stat. § 624.155(3)(b)2. Under Florida law, a civil remedy notice must state the facts and circumstances that give rise to an alleged violation with such specificity sufficient to allow an insurer to cure any alleged violation within the 60-day statutory period. See Lane v. Westfield Insurance Company, 862 So. 2d 774 (Fla. 5th DCA 2003). However, the Complainant’s CRN is deficient as the limited facts and circumstances set forth therein are false, incomplete, and misleading, as well as insufficient to establish a violation of any statute or policy provision. Additionally, the CRN includes a list of eight (8) statutory provisions alleged to have been violated. The referenced statutes and code sections, however, do not appear to be pertinent to the subject claim, and the CRN fails to specify each statutes’ relative applicability to same. Further, the CRN does not contain specific facts addressing and supporting each alleged statutory violation against TIE, but rather sets forth only stock, conclusory allegations of purported bad faith. For these reasons alone, the CRN is defective on its face. In light of the incomplete, misleading, and false allegations set forth in the CRN, TIE hereby provides the Department of Financial Services with the following facts of the claim that, in and of themselves, disprove all of the allegations brought forth in the CRN. TIE hereby asserts that all actions taken in the handling of this claim were done so in good faith for the purpose of fair and timely disposition of this matter. CLAIM FACTS TIE received notice of this claim on July 7, 2023. The claim was reported as water damage with a reported date of loss of June 24, 2023. The Insured stated she noticed water pooling on the porch of the insured property. She stated she would remove the water each time but it continued to appear. There was a leak coming from the shower located on the interior of the home that allowed water to exit onto the porch. The Insured retained a contractor who removed some of shower tiles and found the shower did not contain a cement board, shower pan or mastic. Additionally, the tile grout was not sealed. The aforementioned items should all be present in a properly constructed shower. The photographs revealed the wood of the shower framing was rotted and black. Additionally, the siding on the exterior of the home where the water was exiting was rotted. These factors indicated a long-term leak. The claim was subsequently denied under the terms of the policy on July 10, 2023. TIE asserts that it acted diligently and in good faith in the evaluation and handling of the underlying claim and complied at all times with the provisions of the Policy and applicable Florida Statutes. ALLEGED REASON FOR NOTICE: Claim Denial: There is no basis for this allegation, thus it is denied. The Insureds submit no facts or circumstances to support this allegation. Claim delay: TIE denies any delay in the claims handling and process of the loss as is evident from the facts outlined above. TIE promptly acknowledged the Insured’s claim and timely initiated its investigation of the loss. TIE acted in accordance with its duties and obligations pursuant to the policy of insurance and acted promptly under the circumstance to advise the Insureds of the determination as to coverage for the alleged loss. Unfair Trade Practice: There is no basis for this allegation, thus it is denied. The Insured submits no facts or circumstances to support this allegation. It is clear from the facts outlined herein that the handling and administration of this claim occurred with the utmost expediency and timeliness allowed by the statutory and contractual requirements imposed upon TIE. At no time did TIE, its agents, or its employees act improperly in the handling, administration, or disposition of this claim. The facts show that TIE acted promptly with respect to the investigation of the underlying claim. TIE made all communications required to adjust this claim in a prompt and appropriate matter. Specifically, information necessary and relevant to the proceeding of this claim was communicated to the Insured and/or her representatives in an appropriate manner. As outlined above, the facts of this claim set forth herein evidence expedient and timely administration of this claim and full and strict compliance with the statutory and contractual requirements imposed upon TIE. Unsatisfactory Settlement Offer: There is no basis for this allegation, thus it is denied. TIE promptly inspected and adjusted this loss, and issued a timely coverage determination to the named insured in compliance with both the terms of the policy and Florida Law. As outlined above, the facts of this claim set forth herein evidence the administration of this claim in strict compliance with statutory and contractual requirements imposed upon TIE. ALLEGED STATUTORY VIOLATIONS The Insured alleges multiple statutory violations in the CRN; however, no specific facts or circumstances are provided to support these allegations. The CRN is simply a recitation of general, stock allegations of bad faith conduct, along with a list of statutory violations that are not specifically alleged or described. Notwithstanding, TIE denies each and every allegation of statutory violation individually as follows: 624.155(1)(b)(1): Denied. TIE has not failed to attempt to settle this claim in good faith and has always acted fairly and honestly towards the Insureds. As shown above, the conduct of TIE following its receipt of the first notice of the loss has complied with all aspects of Florida law. TIE timely investigated the claim and issued a timely coverage determination to the named insured in compliance with both the terms of the policy and Florida Law. 624.155(1)(b)(3): Denied. TIE has not failed to promptly settle this claim. As supported by the above claim facts, TIE asserts its full and strict compliance with the statutory requirements imposed upon it. Moreover, the Insured has submitted absolutely no facts or circumstances supporting this allegation. 626.9541(1)(i)(3)(a): Denied. This allegation is without basis. TIE has adopted and implemented standards for the proper investigation of claims at all times. The aforementioned facts demonstrate that TIE employed proper and customary claims practices in the investigation and adjustment of this claim, and in strict compliance with the statutory requirements imposed upon it. Furthermore, the Insured has submitted absolutely no facts or circumstances supporting this allegation. 626.9541(1)(i)(3)(c): Denied. This allegation is without basis. TIE has consistently acted promptly upon all communications with respect to this claim as previously outlined. Moreover, TIE asserts its full and strict compliance with the statutory requirements imposed upon it. The Insured’s assertions to the contrary are unsupported by the facts. 626.9541(1)(i)(3)(d): Denied. This allegation is without basis. TIE asserts its full and strict compliance with the statutory requirements imposed upon it. The Insured’s assertions to the contrary are unsupported by the facts. 626.9541(1)(i)(3)(e): Denied. This allegation is without basis. TIE asserts its full and strict compliance with the statutory requirements imposed upon it. The Insured’s assertions to the contrary are unsupported by the facts. 626.9541(1)(i)(3)(f): Denied. This allegation is without basis. TIE asserts its full and strict compliance with the statutory requirements imposed upon it. The Insured’s assertions to the contrary are unsupported by the facts. 626.9541(1)(i)(3)(i): Denied. This allegation is without basis and not related to a property insurance claim. ALLEGED VIOLATIONS OF THE INSURANCE POLICY The Insured’s CRN includes blanket statements regarding alleged Policy violations and general allegations that TIE has violated a number of policy related sections. The CRN provides no indication or specificity as to how the provisions apply to the Insured’s claim. Notwithstanding, TIE denies violating any provision or duties set forth in the Policy and further asserts compliance with the Policy and all of its provisions and endorsements. TIE handled the Insured’s claim with diligence and at all times acted fairly in administration of this claim and treated its Insured with honesty and with due regard for their interests. All actions by TIE were done in complete and strict compliance with the Policy. TRUCK INSURANCE EXCHANGE DENIES ALL ALLEGATIONS IN THE CRN TIE hereby denies any and all allegations of bad faith by the Complainant, and states that it has, at all times material, handled and adjusted the Insured’s claim with utmost good faith. Any and all allegations of bad faith contained within the CRN are expressly rejected by TIE. As stated above, the CRN is simply a recitation of general, stock allegations of bad faith conduct, along with a list of statutory violations that are not specifically alleged or described. The CRN is therefore non-compliant with Florida Statute Section 624.155(3), which requires that a civil remedy notice of insurer violation “state with specificity”, inter alia, the facts and circumstances giving rise to the violation and the “specific” language of the subject insurance policy that is relevant to any alleged violation(s). The Complainant wholly fails to provide any specific facts or circumstances giving rise to the alleged violations in the CRN, and instead simply alleges a litany of non-specific, boilerplate allegations against TIE as alleged acts of bad faith. Moreover, there is not a single reference in the CRN to any specific policy language that is relevant to the allegations of bad faith. Failure to provide such specific reference to policy language is direct and clear noncompliance with the requirements of Fla. Stat. § 624.155, and renders the CRN deficient on its face, as to form and substance. Accordingly, the CRN does not provide the contemplated and mandated notice of alleged bad faith that is required as a condition precedent to any civil claim for bad faith pursuant to Fla. Stat. § 624.155. For these reasons, the CRN is denied and rejected. Additionally, as described in detail above, the facts alleged in the CRN are contrary to the actual facts underlying the subject claim. TIE further denies any and all other allegations not specifically addressed in this response related to the above-referenced Civil Remedy Notice. There has been no violation of the referenced statutory sections by TIE. By responding to the Civil Remedy Notice filed Michelle Pascale-Venega, TIE neither waives nor abandons but expressly reserves any and all rights, claims and defenses it has or may have under the terms and conditions of the Policy and applicable Florida law. Herein, TIE has attempted to fully and adequately respond to the allegations alleged in the CRN. Should the Florida Department of Financial Services have any questions or further inquiry with respect to this matter, please contact the undersigned. Thank you for your attention to this matter. Very truly yours, THE CHARTWELL LAW OFFICES, LLP David A. Gonzalez

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