Civil Remedy Notice of Insurer Violations
Login

Filing Number:     795656
Filing Accepted:  12/6/2024
         Print Filing
Complainant
Last/Business Name *  
CHRISTIE   First Name   NADIA
Street Address * 5175 NORTHWEST 57 DRIVE
City, State Zip * CORAL SPRINGS, FL 33067
Email Address * NADCHRI@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   CHRISTIE   First Name   NADIA
Policy # * BWH133208R1 Claim #* 24C03039
Attorney
Attorney is Applicable
Last Name* KRAPF First Name * GRANT Initial W
Street Address* 2790 SUNSET POINT RD
City, State Zip* CLEARWATER , FL 33759
Email Address * GRANT@KRAPFLEGAL.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   EVANSTON INSURANCE COMPANY
NAIC Company Code 35378
 
Name of individual responsible for violation (if any):* BERNARD MCGROARTY, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, EVANSTON INSURANCE COMPANY WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unfair Trade Practice
Other : Misrepresenting the terms of the insurance policy
Other : Not treating the Insured with good faith claims conduct
Other : Looking for ways to deny full recovery to the Insured
Other : Looking for ways to delay full recovery to the Insured
Other : Failing to properly investigate the Insured's loss
Other : Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made
Other : Not adjusting claims and evaluating loss properly
Other : Shifting the burden of insuring the loss to the Insured
Other : Intentionally misstating the terms, conditions, and benefits of the insurance policy to the insured
Other : Failing to implement proper standards for the adjustment and investigation of claims
* 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.
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)(d) Denying claims without conducting reasonable investigations based upon available information.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

627.70131(7)(a)Within 60 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer. The insurer shall provide a reasonable explanation in writing to the policyholder of the basis in the insurance policy, in relation to the facts or applicable law, for the payment, denial, or partial denial of a claim. If the insurer's claim payment is less than specified in any insurer's detailed estimate of the amount of the loss, the insurer must provide a reasonable explanation in writing of the difference to the policyholder. Any payment of an initial or supplemental claim or portion of such claim made 60 days after the insurer receives notice of the claim, or made after the expiration of any additional timeframe provided to pay or deny a claim or a portion of a claim made pursuant to an order of the office finding factors beyond the control of the insurer, whichever is later, bears interest at the rate set forth in s. 55.03. Interest begins to accrue from the date the insurer receives notice of the claim. The provisions of this subsection may not be waived, voided, or nullified by the terms of the insurance policy. If there is a right to prejudgment interest, the insured must select whether to receive prejudgment interest or interest under this subsection. Interest is payable when the claim or portion of the claim is paid. Failure to comply with this subsection constitutes a violation of this code. However, failure to comply with this subsection does not form the sole basis for a private cause of action. Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language. "It is an accepted principle of law that when parties contract upon a matter which is the subject of statutory regulation, the parties are presumed to have entered into their agreement with reference to such statute, which becomes a part of the contract, unless the contract discloses a contrary intention." Westside EKG Assocs. v. Found. Health, 932 So. 2d 214, 216 (Fla. 4th DCA 2005), aff'd, 944 So. 2d 188 (Fla. 2006).
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Evanston Insurance Company (the "Insurer") has committed the following in handling the Insured's claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the policyholder and the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; and 9) failing to render a claims determination within sixty (60) days. On or about November 15, 2023, while the subject policy was in full force and effect, the Insured's property was severely damaged by wind. The areas impacted include but are not limited to the roofing system, exterior, master bathroom, back room, dining room, and family room. The Insured timely submitted a claim on March 29, 2024, to the Insurer for wind damage and the ensuing damage therefrom. Thereafter, the Insurer assigned claim number 24C03039 to the loss and sent a field adjuster to inspect the property on April 17, 2024. The Insurer then retained a engineer who inspected the property nearly two months later on June 7, 2024. The engineer conducted a reinspection on July 9, 2024. Then in a letter dated August 20, 2024, the Insurer notified the Insured that it was denying coverage for the loss. This coverage decision is incorrect. Denying coverage for the damage was wrongful as the damages are covered under the policy. Given the denial, the Insured's disagreement with the coverage decision, and the scope and nature of the damage resulting from wind, the Insured retained a public adjuster. After assessing the damage and the true scope of repairs, the public adjuster produced an estimate identifying $176,767.79 in covered damage to the dwelling and $2,944.19 for contents. The foregoing estimate, photographs, and a letter of representation from the public adjuster were sent to the Insurer. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. However, when the Insurer conducted its inspections of the insured property, the Insurer's representatives failed to conduct a thorough and adequate investigation, or the representatives intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss. The Insurer misrepresented the loss and wrongfully denied coverage for the damage sustained to the Insured's property. According to the claims determination letter, the Insurer's engineer observed damage to the insured property but attributed the cause of this damage to several causes excluded by the policy. However, the Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697. The Insurer intentionally ignored covered damage to deny the reported loss and wrongfully fail to pay the Insured. This is an underhanded attempt to place the financial interests of the Insurer over those of the Insured and to delay and frustrate the Insured's ability to have his claim adjusted promptly to begin restoring his property. Additionally, although there was interior water damage the adjuster did not use a moisture meter. A moisture meter can be purchased online from Amazon for around $40 before tax. The Insurer could purchase a moisture meter and assess thousands of properties with one meter. Instead, the Insurer would rather place its financial interests over those of the Insured by failing to provide the adjuster with the necessary tools to correctly inspect the loss. As a result of the inadequate investigation and surrounding circumstances it is apparent that Insurer significantly underestimated the scope of the loss to the Insured's property. Insurer and its adjuster have colluded to misrepresent the true scope of damages to the insured property and the true replacement costs of the damages. This is an underhanded attempt to place the financial interest of Insurer over those of the Insured, to delay the Insured's claim, and to delay the Insured in restoring his property to its pre-loss condition. The Insurer has placed obstacles to its Insured's ability to have the claim adjusted promptly to begin restoring the home by waiting more than sixty (60) days after receiving notice of the Insured's claim to make a claims determination. The Insured first reported the loss on March 29, 2024. The Insurer rendered its claims determination on August 20, 2024. Under Fla. Stat. 627.70131(7)(a), "[w]ithin 60 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer." There were no factors outside of the Insurer's control. As the Insurer has failed to make a timely determination, it has violated this code. As such, in addition to the below requirements to cure this CRN, any payment made to the Insured must contain interest for the damage as a result of the loss from the date the Insurer received first notice of the loss. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer's claim file and standards and procedures for the adjustment and investigation of claims. In short, the Insurer is not acting with due regard for the Insured's interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully denied coverage for a loss that should have been covered under the subject policy. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer's actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer's actions amount to but are not limited to the following: 1. Claim denial 2. Claim delay 3. Not treating the Insured with good faith claims conduct 4. Looking for way to reduce recovery to the Insured 5. Looking for ways to deny recovery to the Insured 6. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 7. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's interests 8. Placing the financial interest of the Insurer over that of the health and safety of the Insured 9. Shifting the burden of investigating onto the Insured 10. Conducting inadequate investigations 11. Failing to render a written claims determination to the Insured within 90 days pursuant to Florida Statute 627.70131 12. Making material misrepresentations Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1). Admit full coverage for the Insured's loss. (2). Tender full benefits owed to the Insured under the insurance contract. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. Via E-mail: Evanston Insurance Company 4521 Highwoods Pkwy Glen Allen, VA 23060 Rita.riojas@markel.com
Comments
User Id Date Added Comment
legalregulatory@markelcorp.com 01-14-2025 January 14, 2025 VIA EMAIL – Grant@KrapfLegal.com; badfaith@KrapfLegal.com Grant W. Krapf, Esq. Krapf Legal 2790 Sunset Point Road Clearwater, Florida 33759 RESPONSE TO CIVIL REMEDY NOTICE OF INSURER VIOLATIONS, FILING NUMBER 795656 RE: Insureds: Glenford Christie and Nadia Christie Complainant: Nadia Christie Issuing Company: Evanston Insurance Company Our Claim Number: 24C03039 Policy Number: BWH133208R1 Policy Period: 03/08/2023 to 03/08/2024 Date of Loss: 11/15/2023 (As Reported) Dear Mr. Krapf, Markel Service, Incorporated, as claim service manage for Evanston Insurance Company (“Evanston”) previously acknowledged receipt of the above-captioned matter. Evanston has received a Civil Remedy Notice of Insurer Violations (“CRN”) filed with the Florida Department of Financial Services, notice number 795656 (“Notice”). The Notice was purportedly filed on behalf of Complainant and Insured, Nadia Christie (“Complainant”). The Notice alleges wrongdoing by Evanston in relation to a wind damage claim at 5175 NW 57 Drive, Coral Springs, Florida 33067 (the “Property”). Please accept this as Evanston’s response to the Notice pursuant to Fla. Stat. 624.155. The filing accepted date of the CRN is 12/6/2024, thus this response is timely. Evanston welcomes the opportunity to respond to this Notice and specifically denies each and every allegation contained in the Notice in relation to this claim. With that said, Evanston believes that the Notice should be rejected and returned by the Department of Financial Services as it fails to comply with the specific information requirements as set forth in Fla. Stat. 624.155 and Florida case law. As stated by the Florida Supreme Court, the purpose of a CRN filed pursuant to Section 624.155, Florida Statutes, is to put the insurer on notice of an alleged violation, the circumstances surrounding same and indicate the details of the alleged violation to provide an insurer with 60 days to “cure” the alleged claim defects. See Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So. 2d 1278, 1283-4 (Fla. 2000). This is so that the insurer is provided an opportunity to resolve a first-party coverage dispute and otherwise avoid litigation. Id.; see also Lane v. Westfield Ins. Co., 862 So. 2d 744 (Fla. 5th DCA 2003). Further, a notice must be sufficiently specific to provide the insurer with an opportunity to cure the alleged violations. This would include identifying the specific policy provision(s) at issue, citing specific language of the statutory provision(s) the insurer allegedly violated, and specifically identifying what actions the insurer must take to remedy the alleged violations. Heritage Corp. of South Florida v. National Union Fire Ins. Co. of Pittsburg, PA, 580 F. Supp. 2d 1294, 1299-1300 (S.D. Fla. 2008); see also Rousso v. Liberty Surplus Ins. Corp., 2010 U.S. Dist. LEXIS 82328 (S.D. Fla. Aug. 13, 2010). The Notice fails to satisfy the statutory requirements necessary of a CRN and is, therefore, defective. Specifically, the Notice fails to set forth any specific policy language Evanston has purportedly violated, fails to set forth both named insureds, and fails to set forth sufficient accurate facts to support the allegations contained therein. As the insureds, Glenford Christie and Nadia Christie (the “Insureds”)1, are not third-party claimants, they are required to reference the specific policy language at issue in their Notice. Evanston reserves its right to assert any and all defenses regarding the Complainant’s failure to file a legally sufficient CRN. Despite the Notice’s failure to comply with statutory requirements, Evanston hereby responds and provides the following factual summary of its handling of the Complainant’s claim. Evanston is confident the following summary of its claims handling will satisfy any inquiry regarding its conduct and demonstrate Evanston has always acted in the utmost good faith towards its insureds. To the extent that this response does not fully address and respond to the allegations set forth by the CRN, such deficiency is the direct result of the lack of specificity and the overall vague nature of the allegations contained therein. Evanston issued a homeowners insurance policy to the Insureds under policy number BWH133208R1 for the Property with effective dates of March 8, 2023 through March 8, 2024 subject to the terms, conditions, endorsements and limitations set forth therein (the “Policy”). The Property was constructed in 2000. Based on the information presently available to us, it was determined that the covering of the Property is original, meaning it was roughly 23 years old as of the reported date of loss. On March 29, 2024, Evanston received a first notice of loss from the Complainant’s public adjuster, Alpha Claims Consultants (“ACC”), claiming there had been roof damage from a windstorm at the Property. The date of loss reported was November 15, 2023, approximately 135 days before Evanston received notice of the loss. Evanston assigned claim number 24C03039 to the claim for identification purposes. On April 2, 2024, Evanston issued correspondence to the Insureds acknowledging receipt of the claim. On April 3, 2024, Evanston contacted Alpha Claims Consultants requesting their letter of representation and stating that Evanston had retained independent adjusting firm Johns Eastern Company (“Johns Eastern”) to inspect the Property. On April 4, 2024, Evanston received a letter of representation and W-9 from Alpha Claim Consultants stating it had been retained as the public adjuster for the Insureds. On April 17, 2024, Johns Eastern inspected the Property in the presence of a representative with ACC. That same day, Evanston received an estimate from ACC via email on behalf of the Insureds. The estimate totalled $176,767.79 (RCV) for damages to the dwelling and $2,944.19 (RCV) for damages to the contents. On April 19, 2024, Evanston received an email from Jurassic Environmental Specialists, Inc. (“Jurassic”). The e-mail included a mold report, lab results, bacteria analysis and two invoices. One invoice totalling $1,358 for moisture mapping and thermal imaging and one invoice totalling $1,550 for a mold assessment. Evanston reviewed all of the documents received. Evanston issued an e-mail to Jurassic that same day acknowledging receipt of the documents and stating that Evanston was awaiting information from Johns Eastern. On April 23, 2024, Evanston received an unsolicited sworn proof of loss purportedly signed by an insured, Glenford Christie, which claimed $157,294.07 (less the Policy deductible) in damages and relied upon the 1 The Civil Remedy Notice identifies the Complainant as Glenford Christie, only. However, the named Insureds on the subject Policy of insurance, Policy number BWH133208R1, are Glenford Christie and Nadia Christie. ACC estimate as a predicate for the damages. On April 24, 2024, Evanston received the report from Johns Eastern following the inspection of the Property on April 17, 2024. A representative from ACC was present for the inspection. The inspection revealed roof leaks at the Property resulting from age/wear, tear and deterioration of the roof surface. Widespread evidence of wear and tear was noted along with manufacturing-related defects, and what appeared to be more recent foot traffic. Pursuant to permit records and available public data, the roof of the Property was approximately 23 years old at the time of the claimed date of loss. Regarding the interior of the Property, Johns Eastern observed water damage in the master bedroom, utility closet, playroom, and dining room. Upon reviewing Johns Eastern’s findings and photographs, Evanston retained an independent engineering firm, Vertex, to inspect the Property and determine the cause and origin of the claimed damages. Vertex’s inspection was coordinated to take place on June 7, 2024. On May 29, 2024, Evanston received an e-mail from Paul Davis Restoration with a tarp invoice totalling $7,896.78, estimate, and photographs regarding tarp services provided to the Insureds. On June 7, 2024, Vertex was able to complete only a partial inspection of the Property as the tarp was not removed from the roof prior to the inspection. A subsequent inspection was set for and completed on July 9, 2024. On July 22, 2024, Evanston received a report prepared by Vertex titled “Building Condition Assessment”2 and dated July 13, 2024. The report sets forth Vertex’s findings and conclusions based upon its inspections of the Property. The general conclusions set forth in the report read as follows: Based on our investigation and with reasonable analysis at this time, it is the opinion of Vertex that the condition of tile roofing cover and interior finishes was not caused by the subject reported storm activity on or about November 15, 2023 (RDTOL). It is Vertex’s opinion, that the cracking distress observed on the tiled roof of the residence, was not wind- or storm-related distress but was caused by thermal expansion and contraction, foot traffic, material degradation, and/or age-related deterioration of the roof. In our opinion, roof tile cover was at or beyond the end of their useful service lives. Additionally, Vertex was able to correlate interior staining/distress with rooftop valleys and deficiently installed AC ductwork, therefor in our opinion, based on colocation below said rooftop valleys and AC ductwork, moisture-emission exposure from these features was the proximate cause of interior staining and distress, not wind effects. Based on historical imagery and current roof conditions, deferred maintenance and insufficient roof drainage concentration at roof valleys was likely the proximate cause of historical issues and moisture migration through the roofing assembly and attic into interior, which had initiated and/or exacerbated historical deterioration/degradation of the roofing cover and the assembly/interior below years ago in the past. While incidental moisture entry may have occurred into interior due to historical issues/conditions of deferred maintenance and deficiently-installed roof drainage during subject storm activity, such was de minimis compared to moisture exposure due to historical issues/conditions from AC ductwork and rooftop valley drainage concentration prior to subject storm activity; not recent occurrence of the subject storm activity. Based on historical imagery, historical roof repair and related issues depicted had existed prior to the subject storm activity; i.e., not due to the reported storm activity. 2 Please refer to the Vertex report included with Evanston’s coverage disclaimer letter on August 20, 2024, for further information regarding the engineer’s findings. On July 23, 2024, Evanston received an e-mail from Paul Davis Restoration with an updated invoice for tarp services totalling $11,524.46. Thereafter, Evanston reviewed the inspection results, photographs, reports, and Policy to evaluate coverage for the Complainant’s claim. On August 20, 2024, Evanston issued written correspondence titled “Coverage Disclaimer” setting forth Vertex’s findings, Evanston’s coverage position, and applicable policy provisions. Further, Evanston requested that the Complainant contact Evanston if any of the information relied upon by Evanston in the letter was materially incorrect or if the Complainant possessed any additional information that may impact Evanston’s coverage position. On September 20, 2024, Evanston received a Property Insurance Notice of Intent to Initiate Litigation filed by you on behalf of the Glenford Christie and Nadia Christie. Evanston timely responded to the Property Insurance Notice of Intent to Initiate Litigation in accordance with Florida Statute 627.70152. On September 30, 2024, Evanston received a CRN filed by Krapf Legal on behalf of Glenford Christie, filing number 784881. Evanston timely responded on November 20, 2024. Evanston’s response addressed the allegations set forth in that CRN and set forth how the CRN failed to comport with Florida law. In lieu of addressing any of the issues within that CRN, a second, nearly identical, CRN was filed, which this correspondence responds to. The sole difference between the first CRN, filing number 784881, and this subsequent Notice, is the named Complainant. The foregoing chronology clearly evidences that Evanston has not violated any statutes nor administrative codes in handling the Complainant’s claim. Instead, the facts demonstrate that Evanston has always acted timely and in good faith in its investigation of the Complainant’s claim and applied the clear and unambiguous terms of the Policy to the claim in coming to its coverage determination. The Complainant’s disagreement with that determination is not evidence of any wrongdoing by Evanston. As such, Evanston denies each and every statutory violation allegation and addresses each statutory allegation accordingly: Fla. Stat. 624.155(1)(b)(1) Evanston has not acted in violation of the above-referenced statute at any time. Further, there are absolutely no facts nor evidence contained in the Notice to substantiate the Complainant’s allegation that Evanston has acted in violation of this section. To the contrary, Evanston, in good faith, promptly performed a detailed and reasonable investigation into the claim. Upon the completion of its investigation, Evanston expeditiously and thoroughly explained the basis and rationale for its coverage determination. The Complainant has not alleged any facts to support this allegation. Evanston has acted fairly and honestly towards its Insureds and with due regard for their interests. Fla. Stat. 624.9541(1)(i)(2) Evanston has not acted in violation of the above-referenced statute at any time. Further, there are absolutely no facts nor evidence contained in the Notice to substantiate the Complainant’s allegation that Evanston has acted in violation of this section. To the contrary, Evanston has acted fairly and honestly towards the Complainant at all times. At no time has Evanston acted dishonestly or unfairly towards the Complainant. Following the Complainant’s notice of the loss to Evanston, Evanston immediately performed an investigation to assess the cause and scope of the loss. Thereafter, Evanston sent correspondence to the Complainant that outlined in detail the bases for Evanston’s coverage determination, including citing to specific policy provisions pertinent to same. All of Evanston’s actions have been performed in good faith and for the purpose of moving the Complainant’s claim towards a just and proper determination of coverage under the Policy of insurance. Evanston promptly initiated an investigation into the claim and promptly made a claim determination disclaiming coverage pursuant to the terms of the Policy and timely provided same in writing to the Complainant. Further, Evanston did not issue a claims payment under the applicable claim therefore it is not possible for Evanston to violate this statute. Fla. Stat. 626.9541(1)(i)(3)(a) Evanston has not acted in violation of the above-referenced statute at any time. Further, there are absolutely no facts nor evidence contained in the Notice to substantiate the Complainant’s allegation that Evanston has acted in violation of this section. Evanston has adopted and implemented standards for the proper investigation of insurance claims and has complied with those standards at all times during the investigation of the Complainant’s claim. The standards and methods utilized by Evanston in examining its claims have met and exceeded its obligations and industry standards. Evanston has conducted the handling of this claim to such standards and the Complainant has failed to allege any factual support or evidence to substantiate the Complainant’s allegation. Fla. Stat. 626.9541(1)(i)(3)(b) Evanston has not acted in violation of the above-referenced statute at any time. Further, there are absolutely no facts nor evidence contained in the Notice to substantiate the Complainant’s allegation that Evanston has acted in violation of this section. Evanston has acted fairly and honestly towards the Complainant at all times. Following the Complainant’s notice of the loss to Evanston, Evanston immediately performed an investigation to assess the cause and scope of the loss. Thereafter, Evanston sent correspondence to the Complainant that outlined in detail the bases for Evanston’s coverage determination, including citing to specific policy provisions pertinent to same. All of Evanston’s actions have been performed in good faith and for the purpose of moving the Complainant’s claim towards a just and proper determination of coverage under the Policy. Fla. Stat. 626.9541(1)(i)(3)(d) Evanston has not acted in violation of the above-referenced statute at any time. Further, there are absolutely no facts nor evidence contained in the Notice to substantiate the Complainant’s allegation that Evanston has acted in violation of this section. Evanston has acted fairly and honestly towards the Complainant at all times. Following the Complainant’s notice of the loss to Evanston, Evanston immediately performed an investigation to assess the cause and scope of the loss. Thereafter, Evanston sent correspondence to the Complainant that outlined in detail the basis for Evanston’s coverage determination, including citing to specific policy provisions pertinent to same. All of Evanston’s actions have been performed in good faith and for the purpose of moving the Complainant’s claim towards a just and proper determination of coverage under the Policy. Fla. Stat. 627.70131(7)(a) Evanston has not acted in violation of the above-referenced statute at any time. Further, there are absolutely no facts nor evidence contained in the Notice to substantiate the Complainant’s allegation that Evanston has acted in violation of this section. To the contrary, Evanston has acted fairly and honestly towards the Complainant at all times. At no time has Evanston acted dishonestly or unfairly towards the Complainant. Following the Complainant’s notice of the loss to Evanston, Evanston immediately performed an investigation to assess the cause and scope of the loss. This process was delayed due to scheduling conflicts outside the control of Evanston and further delayed as the tarp was not appropriately removed to permit Evanston to perform a timely inspection. Evanston timely sent correspondence to the Complainant that outlined what was still outstanding regarding the Complainant’s claim throughout the claim handling process. Upon completion of those items, such as completion of the engineer’s follow up inspection and receipt of the engineer’s report, Evanston timely reviewed the documents and provided correspondence detailing the basis for Evanston’s coverage determination, including citing to specific policy provisions pertinent to same. All of Evanston’s actions have been performed in good faith and for the purpose of moving the Complainant’s claim towards a just and proper determination of coverage under the Policy of insurance. Evanston promptly initiated an investigation into the claim and promptly made a claim determination disclaiming coverage pursuant to the terms of the Policy and timely provided same in writing to the Complainant. Further, Evanston did not issue a claims payment under the applicable claim therefore this statute is not applicable to the instant matter. Evanston desires to resolve this matter amicably with the Insureds, if possible. At the same time, by sending this response, Evanston in no way waives, but rather expressly reserves the right to raise any and all available objections and defenses to the Complainant’s claim and to the Notice. Further, please be advised that the Policy is governed by the terms, conditions and exclusions together with any endorsements set forth therein. This correspondence does not waive any such provisions of the Policy. Any action taken by or on behalf of Evanston or its authorized representative(s), whether in the past or future, to investigate the alleged loss, adjust any claim or request for payment, or in any other way related to or arising out of the Complainant’s claim or loss, shall not waive any terms, conditions, or any other provisions of the Policy. We hope our response has provided the information needed to understand our handling of this claim and to address the concerns outlined in the above referenced complaint. Please feel free to contact us with any questions. We can be reached by email at: legalregulatory@markel.com Sincerely, Legal/Regulatory Team
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