Civil Remedy Notice of Insurer Violations
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Filing Number:     795826
Filing Accepted:  12/9/2024
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Complainant
Last/Business Name *  
PETERSON   First Name   KAREN
Street Address * 15 GRAYTWIG COURT WEST
City, State Zip * HOMOSASSA, FL 34446
Email Address * KARENPET1942@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   PETERSON   First Name   KAREN
Policy # * OH-513860646 Claim #* 11000000136
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*   FIRST PROTECTIVE INSURANCE COMPANY
NAIC Company Code 10897
 
Name of individual responsible for violation (if any):* SAMUEL MAYOR, PAUL BORAH, JOSHUA COOK, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, FIRST PROTECTIVE INSURANCE COMPANY D/B/A OPENHOUSE INSURANCE 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 : 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. 627.444(2)(a) Notwithstanding any other law, an insurer shall provide to an insured within 15 calendar days after an individual or entity designated by the insurer receives the insured's written request, either: A loss run statement; 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.

First Protective Insurance Company d/b/a OpenHouse Insurance (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; 9) failing to provide an estimate that complies with the Florida Building Codes; 10) failing to provide a loss run statement; and 11) failing to render a claims determination within sixty (60) days. On or about February 4, 2024, while the subject policy was in full force and effect, the Insured's property was severely damaged by wind and hail. The areas impacted include but are not limited to the roofing system, patio, gutters, breakfast area, and living room. The Insured timely submitted a claim on July 3, 2024, to the Insurer for wind and hail damage and the ensuing damage therefrom. Thereafter, the Insurer assigned claim number 11000000136 to the loss and sent a field adjuster to inspect the property on July 9, 2024. The Insurer also retained an engineer who inspected the property on August 9, 2024. Then in a letter dated September 30, 2024, the Insurer notified the Insured that it was extending partial coverage for the loss. However, the Insurer wrongfully determined that it would only require $1,192.67 to restore the insured property to its pre-loss condition, which failed to exceed the policy deductible. The Insurer's lowball estimate is that of a classic under scope and under value of the claim. The Insurer erroneously denied coverage for the Insured's roof damage. Given the partial denial, the Insured's disagreement with the coverage decision, and the scope and nature of the damage resulting from wind and hail, the Insured retained a public adjuster. After assessing the damage and the true scope of repairs, the public adjuster produced an estimate identifying $51,118.60 in covered damage to the dwelling. 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 inspection of the insured property, the Insurer's adjuster failed to conduct a thorough and adequate investigation, or the adjuster 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 roof but attributed the cause of this damage to causes excluded under the policy. 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 July 3, 2024. The Insurer has did not render a claims determination under September 30, 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 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. Lastly, the Insurer and its agents failed to comply with Fla. Stat. 627.444 by not providing the Insured and the Insured's representatives with a loss run statement. On November 18, 2024, the Insured's legal counsel provided the Insurer with a letter of representation. Within the letter, legal counsel requested a copy of a loss run statement. The Insurer and its agents have not acknowledged the request for a loss run statement nor has a loss run statement been provided. Upon an Insurer receiving a written request for a loss run statement, the Insurer is required, within fifteen (15) calendar days, to provide either a loss run statement or information on how to obtain a loss run statement at no charge through a consumer reporting agency. There has been no response within fifteen (15) calendar days of the Insured's written request and the Insurer has not provided information on how to obtain a loss run statement at no charge through a consumer reporting agency. This Insurer has breached its duty to settle claims in good faith when, under all the circumstances, it could and should have done so. The Insurer and its agents have not acted fairly and honestly toward the Insured and the Insured's representatives. Lastly, the Insurer has failed or refused to promptly acknowledge the Insured's communications in an attempt to frustrate and delay the resolution of the Insured's claim. 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 determined that it would only require $1,192.67 to restore the insured property to its pre-loss condition. 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. Failing to provide an estimate that complies with the Florida Building Codes 10. Shifting the burden of investigating onto the Insured 11. Conducting inadequate investigations 12. Failing to render a written claims determination to the Insured within 60 days 13. Failing to provide a loss run statement 14. 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: First Protective Insurance Company d/b/a OpenHouse Insurance 500 International Parkway Lake Mary, FL 32746 info@flhi.com
Comments
User Id Date Added Comment
grant@krapflegal.com 04-11-2025 The details herein have been amicably resolved between the parties; therefore, we withdraw this Civil Remedy Notice.
dmontgomery@kelleykronenberg.com 01-30-2025 Dear Mr. Krapf, This is First Protective Insurance Company’s (“FPIC”) formal response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed on behalf of Karen Peterson (the “Insured”), by Grant Krapf, Esq., as it relates to Claim number 11000000136. The Department of Financial Services (“DFS”) accepted the CRN on December 9, 2024 and assigned it filing number 795826 The following reply has been uploaded to the Department of Financial Services. After reviewing the CRN, FPIC denies any of its actions taken with regard to the Insureds’ claim has resulted in a violation of Florida’s bad faith laws, including §624.155 and §626.9541, as alleged in the CRN. Rather, FPIC has acted at all times in good faith in its investigation and handling of this claim and with regard to the best interest of the Insured. FPIC conducted a thorough review of its handling of the subject claim, Subject Claim No.: 11000000136. While FPIC welcomes the opportunity to respond to this CRN, and specifically denies each and every allegation contained in the CRN referenced above, FPIC requests the CRN be rejected as it fails to comply with several of the requirements of the Civil Remedy Notice of Insurer Violation document provisions as set forth in Florida Statute §624.155, and Florida case law. Under Florida law, a first-party bad faith action is not recognized at common law. Baxter v. Royal Indemnity. Co., 285 So. 2d 652 (Fla. 1st DCA 1973). In 1982, the Florida Legislature enacted § 624.155, which created a statutory first-party bad-faith cause of action by an insured against the insurance carrier. See § 624.155, Fla. Stat.; FPIC Mut. Auto. Ins. Co. v. Laforet, 658 So. 2d 55, 59 (Fla. 1995). As a derogation of common law, this statute is strictly construed. Nowak v. Lexington Ins. Co., 464 F. Supp. 2d 1248 (S.D. Fla. 2006); Aetna Cas. & Sur. Co. v. Buck, 594 So. 2d 280, 281 (Fla. 1992) (stating that a person seeking the benefit of a statutorily created remedy had to strictly comply with the requirements of the statute because the remedy is “purely a creature of statute”). The Florida Supreme Court has specifically applied this rule of construction to section 624.155. See Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278, 83-84 (Fla. 2000). As stated by the Florida Supreme Court, the purpose of a Notice is to put the insurer on notice of an alleged violation, the circumstances surrounding same, and indicate the details of the alleged violation in order to provide an insurer with 60 days to "cure" the alleged claim defects. See Talat, 753 So. 2d at 1283-84. The purpose of Fla. Stat. Section §624.155 is to provide the insurer with an opportunity to resolve a first-party coverage dispute and otherwise avoid litigation. Id.??? The statute requires this notice to:? [S]tate with specificity the following information . . . (1) the statutory provision, including the specific language of the statute, which the authorized insurer allegedly violated[;] (2) the facts and circumstances giving rise to such violation[;] (3) the name of any individual involved in the violation[;] (4) reference the specific policy language that is relevant to the violation, if any . . . [;] (5) a statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section.? Fla. Stat. § 624.155(3)(a).?? This statute has been interpreted to require that the Notice must be sufficiently specific to provide the insurer with an opportunity to cure the alleged violations. This would include i) identifying the specific policy provision(s) at issue, ii) citing the specific language of the statutory provision(s) the insurer allegedly violated, and iii) specifically identifying what actions the insurer must take to remedy the alleged violations. Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059 (S.D. Fla. August 13, 2010); Heritage Corp. of S. Fla. v. Nat’l Union Fire Ins. Co. of Pittsburg, PA, 580 F. Supp. 2nd 1294, 1299-1300 (S.D. Fla. 2008). In addition, providing vague reference to the policy is insufficient to put the insurer on notice of its alleged policy violation. See Julien v. United Prop. & Cas. Ins. Co., 2020 Fla. App. LEXIS 13520, *7 (Fla. 4th DCA September 23, 2020).?? The civil remedy fails to explain how any provision of the policy was violated. The Insureds provide a generalized assertions of multiple policy provisions, but does not set forth factual support for how those provisions were breached, let alone, addressed in bad faith. This is the very type of notice that was rejected in Julien, 2020 Fla. App. LEXIS 13520, *7. In contravention of these requirements, the subject Notice is vague and lacks fundamental information to allow FPIC to respond. Specifically, the CRN contains "cures" that are improper pursuant to Florida case law. Talat provides the scope of what can be "cured" is limited to the alleged non-payment of the contractual amounts due to an insured holding "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..."? Here, the Insured demands FPIC :? 1. FPIC must admit full coverage for the Insured’s loss. 2. FPIC must tender full benefits owed to the Insured under the insurance contract. This is squarely what the Supreme Court of Florida rejected in Talat. 753 So.2d at 1284. According to Talat, the only amount properly sought within the remedy is the contractual amount due. Id. at 1283. Insured requests that FPIC admit full coverage for the loss, whether it is covered under the policy or not. Insured then demand the tender of full amounts owed but does not expressly state the amount. While the civil remedy does refer to an estimate prepared by a public adjuster retained by the Insured, it does not provide a value or method for determining the value that the Insured believes he is owed and will cure the alleged civil remedy violation. Accordingly, the Insureds have given FPIC a Hobson’s choice of paying a cost that it is not required to pay by law or fail to cure the civil remedy. The entire purpose of the civil remedy is to put a carrier on notice and allow them to cure by paying a contractual amount owed. Accordingly, the Department should strike the Notice and consider it a nullity for failing to comply with §624.155. There is no specific or completable cure pursuant to the terms and conditions of the policy. The notice filed in this matter includes multiple statutory provisions regardless of whether they are relevant or applicable to the alleged facts contained in the Civil Remedy Notice. Specifically, the Insured alleges that FPIC violated the following statutes and applicable language (as taken from the Notice of Insurer Violations). Because the CRN fails to identify the specific facts applicable to the listed statutes that were allegedly violated with respect to the subject claim, FPIC is unable to properly respond and said CRN should be rejected and returned. Notwithstanding above-mentioned deficiencies, the following are, the Insureds alleges and FPIC’s responses to each of the alleged violations noted in the Civil Remedy Notice: • § 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 and his interests. This allegation is facially deficient as Insured does not specify how this provision was violated. Insured generally asserts a violation through a conclusory statement of the statute. This is deficient as a matter of law. The Insured implies that a moisture meter was necessary for the interior inspection. However, FPIC opened coverage for interior water damage, in the expect rooms claimed by the Insured. A moisture meter would only have confirmed what both the Insured and FPIC have already determined. FPIC strictly denies any violation of any section of Florida Statute § 624.155(1)(b)(1), as FPIC conducted a complete and thorough investigation of the loss utilizing a field adjuster and licensed engineer to inspect the property. FPIC identified covered damages, which fell below the policy deductible. FPIC timely advised the Insured of the findings. • 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.? This allegation is facially deficient as Insured does not specify how this provision was violated. Insured generally asserts a violation through a conclusory statement that “The Insurer misrepresented the loss and wrongfully denied coverage for the damage sustained to the Insured's property.” This allegation contains no factual basis as to what the purported misrepresentation of the loss was. This is deficient as a matter of law. FPIC strictly denies any violation of any section of Florida Statute § 624.155(1)(i)(2), as FPIC conducted a complete and thorough investigation of the loss utilizing a field adjuster and licensed engineer to inspect the property. FPIC identified covered damages, which fell below the policy deductible. FPIC timely advised the Insured of the findings. • § 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. FPIC strictly denies any violation of Florida Statute §626.9541(1)(i)(3)(a). The allegations are deficient as the Insureds provide no basis for the violation of this section. The Insureds make unsupported generalizations regarding the sufficiency of FPIC’s standards and systems with only a conclusory generalization for such. This is deficient as a matter of law as it fails to notify FPIC of a violation other than disagreement regarding the scope of coverage. A disagreement over the scope of coverage is not bad faith. FPIC has adopted all proper and best practices and standard operating procedures for claims-handling with regard to §626.9541(1)(i)(3)(a). FPIC conducted a complete, thorough, and timely investigation. • 626.9541(1)(i)(3)(b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. FPIC strictly denies any violation of Florida Statute §626.9541(1)(i)(3)(a). The allegations are deficient as the Insureds provide no basis for the violation of this section. The allegation that FPIC has misrepresented facts or coverage terms under 626.9541(1)(i)(3)(b) is entirely without merit and basis in fact. Insured’s disagreement regarding the scope of coverage is not a misrepresentation. The Insureds make unsupported conclusion that FPIC misrepresented policy provisions with no specificity as to what provision or the representation. Insured does not explain how and provide any factual support as to what constituted an effort to effect settlement on one portion of the claim. Otherwise, denied. This allegation is unsupported by the facts of this case. At no time did FPIC misrepresent pertinent facts or insurance policy provisions. Nowhere in the Civil Remedy Notice does it explicitly state what pertinent facts or policy provisions were misrepresented. The Civil Remedy Notice lacks a single fact to substantiate a single instance wherein FPIC misrepresented the pertinent facts or insurance policy provisions pertinent to this claim. Therefore, no violations of 626.9541(1)(i)(3)(b) have occurred. • § 626.9541(1)(i)(3)(d): Denying claims without conducting reasonable investigations based upon available information. FPIC strictly denies any violation of Florida Statute §626.9541(1)(i)(3)(d). The allegations are deficient as the Insureds provide no basis for the violation of this section. The allegation that FPIC did not conduct a reasonable investigation is entirely without merit and basis in fact, as FPIC contracted a licensed Field Adjuster and Professional Engineer to inspect the property and further, requested supplemental and supporting documents from the Insured on multiple occasions. The Insured does not explain how and provide any factual support as to what constituted an effort to effect investigation was not reasonable other than to imply a moisture meter was required. This allegation is unsupported by the facts of this case. Therefore, no violations of §626.9541(1)(i)(3)(d) have occurred. In addition to the statutory allegations discussed about the Insureds allege the following as giving rise to the Insurer’s violation: 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; 9) failing to provide an estimate that complies with the Florida Building Codes; 10) failing to provide a loss run statement; and 11) failing to render a claims determination within sixty (60) days. FPIC specifically denies each of these allegations. FPIC acted in good faith, fairly and honestly toward the named Insured, Karen Peterson, in the adjustment of the instant claim. In this case, on July 3, 2024, the Insured reported a loss for hail damage limited to the exterior of the property as having occurred on or about February 4, 2024. On July 5, 2024, FPIC requested a Sworn Proof of Loss, any photos/videos of the damage and prior to the damage, Linear Roofing report/itemized estimate and any photos they may have taken. Thereafter FPIC, followed up on this request on July 16, 2024, July 30, 2024, and September 25, 2024 via telephone, and August 14, 2024, and August 23, 2024 via email. No responsive documents were received until October 29, 2024. Despite the more than five (5) month delay in reporting, and the Insureds’ failure to submit the requested documents, FPIC did everything in its power to properly adjust this pursuant the Statute and the terms of the subject Policy. On July 5, 2024, a representative from FPIC contacted this Insured, who advised that there were prior roof damages to the area surrounding the chimney, but the associated interior leak had not yet been repaired. FPIC contracted a licenses Field Adjuster to inspect the property, investigate the reported damages and document any damages observed. FPIC also contracted a licenses Engineer to investigate the reported damages. Therefore, FPIC denies that it did not retain the necessary experts, it did not implement standards of proper investigation, and it did not conduct a reasonable investigation.to identify the repairs necessary to restore the property to its pre-loss condition. Based upon the Field Adjuster and the Engineer’s observations and findings, FPIC opened coverage for the interior water damage caused by wind driven rain. However, the Engineer reported: the roof covering and building did not display any evidence to indicate hail or wind related damages; the roof displayed localized granule loss of the roof covering shingles which was the result of age related deterioration, standard wear/tear, manufacturing variations, and not the result of a single recent weather-related event; the living room ceiling displayed evidence of pre-existing water stains attributable to intermittent rainwater intrusion into the building as a result of age-related deterioration of the associated shingle’s sealant strip and deteriorating materials; and pre-existing moisture-related distress along the rear patio ceiling attributable to intermittent rainwater intrusion into the building as a result of flashing failure along the associated exhaust vent beginning. Thereafter, FPIC received a letter of representation on October 2, 2024, from the Insured’s Public Adjuster, Coastal Claims. On October 3, 2024 and again on October 15, 2024, FPIC requested the Public Adjuster’s itemized estimate, any photos taken, and any documents that would alter the previous coverage determination. On October 18, 2024, FPIC received the Insured’s supplemental estimate. FPIC once again requested the Public Adjuster’s photos on October 29, 2024. The photos were submitted later that day. Upon review of the supplemental documents submitted by the Insured and/or her representative, FPIC issued a letter advising the Insured that the documents submitted did not substantiate additional coverage in excess of the original coverage determination letter issued on September 30, 2024, and as such the same coverage for the interior of the dwelling was afforded through it fell below the policy deductible. FPIC adamantly denies each and every allegation outlined in the CRN of insurer violation. The Insured also fails to state any factual basis for bad faith. The Insured does not list any policy language are part of its violation, but conclusory alleges that the violations are statutorily based. Rather than including the necessary policy provisions which the Insured purports FPIC violated, the Insured cites only statute numbers 627.70131(7)(a), 627.444(2)(a), and further states “the violations alleged are statutorily based and do not rely on any specific policy language.” However, the statutes relied upon are all premised upon conduct arising from FPIC 's duties under the policy in good faith towards its insured. In short, you cannot seek bad faith unless there is a prima facie showing of bad faith conduct of a carrier pursuant to its obligations under the policy. Additionally, the CRN is insufficient on its face and should be rejected since, contrary to the requirements of Section 624.155 of Florida Statutes, the CRN does not explicitly describe the facts or circumstances giving rise to each specific violation alleged against FPIC . Further, the CRN misrepresents the facts and mischaracterizes the actions of FPIC regarding the claims asserted by the Insureds. The CRN makes generalized, unsupported, and incorrect statements without specifically identifying the facts that give rise to each allegation pursuant to the cited statutory provisions. Notwithstanding the deficiencies, FPIC denies that it acted in any manner that would have violated the statutes cited or any other statutory provisions, and it asserts this is another reason why the CRN should be rejected. The following factual background demonstrates that FPIC did not act in bad faith.? 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 provides unsupported, vague, ambiguous, and incorrect allegations with no basis in fact or circumstances. Aside from the fact that the allegations are devoid of any specific facts, the tenor and inferences of the allegations are wholly without merit and FPIC denies each and every one. Because Section 624.155, Florida Statutes, “is in derogation of the common law,” the Florida Supreme Court has directed that “it must be strictly construed.” Talat Enters., Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000); see also Evergreen Lakes HOA, Inc. v. Lloyd’s Underwriters at London, 230 So. 3d 1, 2 (Fla. 4th DCA 2017) (recognizing Talat’s instruction that the statute’s “notice condition ‘must be strictly construed’”). As such, the CRN is insufficient as a matter of law and should be rejected and returned by the DFS. See generally Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021) (affirming dismissal of bad faith lawsuit with prejudice due to Plaintiff’s failure to satisfy the requirement that the insured identify the specific statute and specific policy provision relevant to the insurer’s alleged violation in the CRN). The allegation of the CRN creates inferences that FPIC purposefully delayed resolution of the claim. When in fact the Insured time after time, delayed the claim by failing to respond to FPICs requests. A review of the CRN narrative fails to set forth any specific acts of misconduct or otherwise advise FPIC of specific facts underlying the alleged insurer violations. The facts reveal that FPIC promptly and adequately investigated the Insureds’ claim. As can be seen from the facts of this claim, the allegations in the CRN are baseless and wholly without merit. Thus, the CRN is purposely drafted in a manner which does not allow FPIC proper notice of the allegations or any meaningful opportunity to respond and/or evaluate the claims being asserted. Based on the foregoing, the CRN is insufficient on its face and should be rejected. Talat Enterprises Inc. vs. Aetna Cas. & Sur. Co., 753 So. 2d 1278 (Fla. 2000); Lane v. Westfield Ins. Company, 862 So. 2d 744 (Fla. 5th DCA 2003). It is important to note, that while an insurance company is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested. Florida law continually affirms the principle that an insurer has the right to investigate claims presented for payment. An insurance company is expressly afforded an opportunity to evaluate its rights and liabilities. Neither the subject policy nor does Florida law provide that a carrier must accept whatever demand for repairs it is provided by its Insured as the amount necessary to repair a loss. FPIC takes the position that the CRN should be rejected and returned by the Department of Financial Services due to its failure to comply with Florida Statute. Regardless of the rejection, as demonstrated above, FPIC denies all allegations contained in the CRN and submits there are no violations to the Insureds, as FPIC has acted in good faith at all times, with due diligence, and in accordance with the terms of its insurance policy and Florida Statutes with respect to the requests made by the Insureds and their representatives. FPIC respectfully disagrees with all of the assertions made and expressly denies all allegations contained in the CRN.? While this response is meant to be comprehensive, FPIC’s response above is based upon the limited information provided in the CRN and the information it has to date. If the Insured or her representatives are in possession of information or facts that FPIC is not in possession of, FPIC requests all such information or facts be provided to it immediately. Please note that FPIC’s response is not necessarily exhaustive and does not preclude it from asserting any other valid reason for seeking rejection and return of the CRN. Also, this letter or any act or failure to act on the part of FPIC or any agent or representative of FPIC should not 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. In closing, FPIC 's actions in handling the Insured's claim were prompt, thorough, conducted in accordance with the Policy and Florida law, and most importantly, in good faith. Furthermore, FPIC complied with all obligations under the Policy and the Florida Statutes. Therefore, FPIC denies each and every allegation contained in the Notice. ? We trust this response adequately addresses the allegations of violation in the CRN. In addition, you will find a copy of the response submitted to the Florida Department of Financial Services on its website. Please do not hesitate to contact the undersigned if you have any questions regarding this matter or need anything further.? Respectfully, By: /s/ Daniel Montgomery Daniel Montgomery, Esq Kelley Kronenberg, P.A.
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