Civil Remedy Notice of Insurer Violations
Login

Filing Number:     795869
Filing Accepted:  12/9/2024
         Print Filing
Complainant
Last/Business Name *  
BRICENO   First Name   LUISA
Street Address * 4107 HAMPSHIRE VILLAGE CT
City, State Zip * ORLANDO, FL 32822
Email Address * LBRICENO2016@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   BRICENO   First Name   LUISA
Policy # * H36-251-581240-70 Claim #* 056665767
Attorney
Attorney is Applicable
Last Name* LOUIS First Name * PIERRE Initial
Street Address* 290 NW 165TH STREET, SUITE M-500
City, State Zip* MIAMI , FL 33169
Email Address * SERVICE@LOUISLAWGROUP.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   FIRST LIBERTY INSURANCE CORPORATION (THE)
NAIC Company Code 33588
 
Name of individual responsible for violation (if any):* NA
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)(d) Denying claims without conducting reasonable investigations based upon available information.
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Governed by the cited authorities, the insurance policy (“Policy”) provides coverage on an “all risk” basis, which clearly, unambiguously and per well-settled Florida Supreme Court case law, requires the insurer to issue full payment for all covered losses and damages that arise during the Policy period as a consequence of a direct physical loss to property. Specifically, the Policy states, “[w]e insure against risk of direct loss to property described in Coverages A and B.” FMHO 943 03 17 pg. 6 of 17. The only exceptions being fraud, intentional damage, and/or the determination that a Policy exclusion or limitation applies. That said, and to lawfully assert any exclusion and/or limitation, the insurer must have a good faith basis to conclude that it can prove the application of the exception or privilege by a preponderance of the evidence gathered during its reasonable and prompt investigation and adjustment of the claim. At a very minimum, the insurer is required to issue full payment for any losses or damages for which such exceptions and/or limitations cannot be promptly verified per the evidentiary considerations referenced, and for an amount that corresponds with the actual cash value of the loss, or the amount necessary to perform repairs in relation to the losses or damages.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The Complainant and Insured, Luisa P. Briceno, (including his/her authorized representative, hereinafter “Complainant”), maintained a homeowner’s insurance policy (hereinafter “Policy”) with The First Liberty Insurance Corporation (hereinafter “FLIC”), which generally and broadly provided coverage for any direct physical loss to the residential property, 4107 Hampshire Village Ct., Orlando, FL 32822, (hereinafter “Property”), that occurred during the Policy period. On or about, April 13, 2024, while the Policy was in full force and effect, Complainant suffered a covered loss; to wit: an accidental discharge of water from a plumbing system causing sudden and immediate physical damage to the insured property (hereafter the “loss”).The interior of the Complainant’s property sustained significant damage, due to an accidental discharge of water, to which loss FLIC assigned claim number 056665767. To date, FLIC has refused to remit all proceeds due and owing to the Complainant for her loss, despite Complainant’s compliance with her post loss obligations, and despite FLIC’s receipt of an estimate contradictory to its unilateral assessment of the loss’ value. On December 9, 2024, Complainant, with the assistance of counsel, filed a lawsuit against FLIC. Although hundreds of days have passed since the claims for losses and damages were presented for payment under the Policy, FLIC has refused to remit all proceeds due and owing to Complainant for her loss. Despite Complainant’s compliance with her post loss obligations, despite no express language in the policy excluding damage caused to the Complainant’s property by the accidental water discharge, and despite FLIC receipt of an estimate of damages contradictory to its unilateral assessment of the loss. The Complainant has established that the loss occurred during the policy, but FLIC has failed to meet its burden that all of the damage is caused by a policy exclusion. FLIC has attempted, in bad faith, to close Complainant’s claim by denying coverage for the loss. Since this loss occurred, FLIC’s strategy has been to prolong and delay the fair adjustment of Complainant’s claim. As a result of the deficient adjustment of the loss, Complainant’s property has remained in a state of disrepair, while FLIC has collected a premium on a policy that was designed to protect insureds like the Complainant during her hour of need. Complainant is requesting that FLIC live up to the insurance contract in which FLIC promised to adjust all losses with its Complainant. This promise to adjust all losses with its Complainant is one that FLIC must undertake in good faith, which means it cannot unilaterally determine the value of its Complainant’s losses and remit payment to the Complainant that is grossly insufficient to cover the estimated damages, or, as in this instance, refuse to remit any payment Complainant under the Policy and deny coverage of the loss. Complainant placed her trust in FLIC and has paid all premiums due and owing, and in exchange for said premiums, she is asking FLIC to pay the damages that it agreed to cover when it issued the insurance policy. The work of adjusting insurance claims in Florida requires insurers to engage the public trust. FLIC has clearly breached this trust with respect to its deficient handling of Complainant’s claim. FLIC is obviously motivated by a desire to protect its own interest to the detriment of its Complainant, and has pursued a course, which is only advantageous to itself. FLIC’s general business practice of willful, wanton, deceptive and bad faith claim handling policies, procedures, guidelines, protocol, adjusting, investigating, drawing valuations and issuing payment for the claims has caused the Complainant to suffer further harm and extra-contractual damages that have accrued, and will continue to accrue. The stated misconduct is collectively referred to as “Bad Faith,” and the specific factual and/or legal considerations in relation thereto are further outlined below for its consideration in accordance with Fla. Stat. Sec. 624.155 and the cited legal authorities associated therewith. 1. FLIC insures hundreds of homes throughout the area where the Complainant’s residence is located. That said, it failed to institute the necessary policies, procedures, guidelines, protocol, personnel and contingencies in relation to fully, promptly and equitably indemnify its insureds who are impacted by accidental discharge of water losses. Consequently, insureds such as the Complainant were forced to fend for themselves to mitigate damages arising from FLIC’s Bad Faith; absorb the burden, expense, inconvenience and delay associated with an insurer who was not equipped (because it didn’t want to incur the expense associated therewith) to meet their contractual obligations; risk health hazards associated with the presence of moisture and/or mold due to FLIC’s failure to perform pursuant to the Policy; hire experts/professionals/counsel to force FLIC to abide by its fiduciary duty and avoid the consequential damages associated with FLIC’s failure to perform; etc. 2. FLIC knew that accidental discharge of water losses are of a nature that a thorough, nuanced and specialized investigation/adjustment of the claim needs to be promptly performed by qualified and prepared personnel in order to protect its insureds, satisfy its fiduciary duties and otherwise not engage in the Bad Faith claim handling practices at issue. That said to the detriment of its insureds and to maximize its financial interests, FLIC disregarded the obvious and known obligations by way of the following: a. Not developing, maintaining and/or instituting policies, procedures, protocol or guidelines to determine whether adjusters/personnel/vendors utilized to protect its insureds were qualified to duly assess the scope and/or value of the loss or damages. b. By way of the cited legal authorities and considerations, FLIC knew that it would have to promptly hire licensed contractors, uniquely qualified adjusters and/or engineers to fully, equitably and honestly assess the scope and/or value of the loss or damages suffered by its insureds. c. By way of the cited legal authorities and considerations, FLIC knew that it would be in its insureds’ interests and its obligation under the insurance policy to utilize personnel/vendors to perform moisture meter assessments throughout the insureds property to honestly assess the full extent of damages and losses suffered by its insureds. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting its insureds, however, FLIC knows that it does not serve its financial interest since it will increase its financial obligations to insureds such as the Complainant. Although FLIC will implement such methods to establish a lack of coverage as it relates to a specific claim in which it determines coverage may be in dispute, it choose to avoid such expense for self-gain when it knows that the claim is covered. d. By way of the cited legal authorities and considerations, FLIC knew that it would be in its insureds’ interests and its obligation under the insurance policy to utilize personnel/vendors to perform thermal imaging assessments throughout the insured property to honestly assess the full extent of damages and losses suffered by its insureds. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting its insureds, however, FLIC knows that it does not serve its financial interest since it will increase its financial obligations to insureds such as the Complainant. Once again though, and although FLIC will implement such methods to establish a lack of coverage as it relates to a specific claim in which it determine coverage may be in dispute, it choose to avoid such expense for self-gain when it knows that the claim is covered. e. By way of the cited legal authorities and considerations, FLIC knew that it would be in its insureds’ interests and its obligation under the insurance policy to utilize personnel/vendors to perform detailed, thorough, reliable and qualified assessments of any air conditioning component of the home in which moisture escaped. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting its insureds, however, FLIC knows that it does not serve its financial interest since it will increase its financial obligations to insureds such as the Complainant. Once again though, and although FLIC will implement such methods to establish a lack of coverage as it relates to a specific claim in which it determines coverage may be in dispute, it choose to avoid such expense for self-gain when it knows the claim is covered under the Policy. f. By way of the cited legal authorities and considerations, FLIC knew that it would be in its insureds’ interests and its obligation under the insurance policy to retain a licensed mold assessor to determine whether there were concealed conditions within the home which necessitated mold remediation and the need for its insureds to take precautionary measures to preserve their physical health and property interests. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting its insureds, however, FLIC knows that it does not serve its financial interest since it will increase its financial obligations to insureds such as the Complainant. Once again though, and although FLIC will implement such methods to establish a lack of coverage as it relates to a specific claim in which it determines coverage may be in dispute, it choose to avoid such expense for self-gain when it knows that the claim is covered. g. By way of the cited legal authorities and considerations, FLIC knew that it would be in its insureds’ interests and its obligation under the insurance policy to promptly issue payment for professional/qualified moisture assessments and remediation in order to, inter alia, avoid: the development of hazardous/toxic conditions within the residence; preclude the insured from suffering consequential and extra-contractual damages; the development of an uninhabitable residence and various risks that may develop; etc. Such practice is an accepted, reasonable, necessary and industry wide accepted means of protecting its insureds, however, FLIC knows that it does not serve its financial interest since it will increase its financial obligations to insureds such as the Complainant. h. By way of the cited legal authorities and considerations, FLIC knew that it would be in its insureds’ interests and its obligation under the insurance policy to utilize a license mold remediator to consider a license mold assessor’s assessments and protocol in order to honestly determine the true scope and value of damages and/or the loss. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting its insureds, however, FLIC knows that it does not serve its financial interest since it will increase its financial obligations to insureds such as the Complainant. i. By way of the cited legal authorities and considerations, FLIC knew that it would be in it insureds’ interests and its obligation under the insurance policy to carefully consider all policy terms that afford coverage for losses and damages as the obligation to pay was made reasonably clear, and thereafter utilize counsel when an adjuster is in doubt to advise them on a claim-by-claim basis whether in fact it is duly indemnifying its insureds. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting its insureds, however, FLIC knows that it does not serve its financial interest since it will increase its financial obligations to insureds such as the Complainant. j. By way of the cited legal authorities and considerations, FLIC knew that it would be in its insureds’ interests and its obligation under the insurance policy to carefully evaluate on a claim-by-claim basis whether any amounts appropriated for “depreciation” are based on sufficient facts and data, reliable principles and methods, and/or the application of reliable principles and methods. FLIC knows that it is arbitrarily, capriciously, deceptively, willfully and wantonly appropriating depreciation without any claim/item specific consideration to justify same. In the aggregate, and unbeknownst to its insureds, this sham practice allows FLIC to unjustly avoid millions of dollars in benefits owed to its insureds who are consequently placed in a position wherein they are financially coerced into choosing whether to leave their home in a state of disrepair, or alternatively, searching for a handyman and non-licensed vendors to perform makeshift repairs which create secondary risks and potential damages that FLIC will deny coverage for when they arise. k. By way of the cited legal authorities and considerations, FLIC knew that it would be in its insureds’ interests and its obligation under the insurance policy to carefully evaluate on a claim by claim basis, and only after equitably and fully investigating/adjusting claim, the amounts owed to the insured for: overhead and profit associated with the insured’s reasonable need to utilize a general contractor; taxes associated with the repairs; permit costs associated with the repair; costs associated with various licensed trades that will be needed to effectuate the repairs; whether benefits are owed to the insured for loss of use and/or additional living expenses; personal property that may have been affected by toxic/mold/moisture conditions that developed in the home; costs associated with maintaining the continuity of the finish/appearance for pairs or sets such as cabinets, flooring, roof covering/tile/shingles, walls, ceilings; etc. l. By way of the cited legal authorities and considerations, FLIC knew that it had an obligation to ensure that software programs, data bases and adjusting practices utilized to estimate the scope and value of the loss were being utilized in form that: honestly and fully delineated the line item repairs or costs that needed to be performed; pricing corresponded with licensed professionals - as opposed to handyman or non-licensed professionals; accounted for consideration of actual expenditures incurred by the insureds or otherwise compensable expenses on a repair cost basis; etc. Ultimately, FLIC knows that the adjusting practices are guided to unlawfully depriving its insureds of benefits owed under the insurance policy, which in the aggregate, serves to maximize its profits to the detriment of its insureds. m. By way of the cited legal authorities and considerations, FLIC knew that it had an obligation to treat all insureds equally and honestly. However, and for its own financial interest, it will only start to fully consider its obligations as stated herein if the insured retains legal representation and pursues a legal action which exposes them to liabilities and costs. Even then, FLIC will withhold monies owed in an unjust effort to limit/delay its liabilities in relation to the statutory considerations and otherwise. n. By way of the cited legal authorities and considerations, and even after litigation ensues, FLIC knows that it has a continuous and ongoing duty to not engage in the Bad Faith conduct that is the subject of this Complaint. However, and to advance its own financial interest and avoid the liabilities pursuant to the above cited statutory authorities, FLIC will direct and utilize non-qualified counsel to delay the equitable and prompt payment of the claim via delay tactics and otherwise not implementing policies, procedures and/or guidelines to ensure that its duties are fulfilled during the course of litigation. Moreover, FLIC will insist upon the insureds to fulfill its own obligations by imposing upon them the burden to establish their full entitlement to benefits for which it knows, or should know, are owed. o. By way of the cited legal authorities and considerations, FLIC knows that it has to assess the application of the policy deductible on a case-by-case basis and only after the claim is fully adjusted and investigated. This practice is necessary to protect the interests of the insured since, pursuant to binding precedent and the policy, the deductible is subject to being absorbed by losses and/or damages that exceed a limitation of coverage under a certain section of the policy. p. By way of the cited legal authorities and considerations, FLIC knows that it has a duty to duly assess whether benefits are owed to the insured in relation to the costs associated with removing and resetting personal property in relation to repairs and/or remediation work that needs to be performed. This duty is ignored by FLIC in order to maximize its own financial interests. q. By way of the cited legal authorities and considerations, FLIC knows that it has duty to issue payment for interest owed in relation to payments that were untimely issued per governing authorities. With that said, and to the detriment of the insured, it foregoes and/or delays such considerations in order to maximize its financial interests. r. Although FLIC knows that it has a duty to treat all insureds/assignees equally, it will consistently act inconsistently in relation to: the application of policy limits; the manner in which valuations and/or the scope of repair is assessed; the manner in which an insured is required to comply with policy conditions; the application and/or consideration of policy conditions and/or exclusions to bar coverage; the timing and/or circumstances upon which undisputed payments will be made pre-suit and post-suit; etc. The lack of consistency and organization ultimately serves to deprive insureds of their rights under a policy and otherwise creates an inherently dishonest, immoral, and unfair means of adjusting and investigating claim. s. FLIC knows that once the claim is fully and fairly investigated and adjusted, it then has to determine whether certain benefits are owed to the insured for the cost of engineering fees in relation to the construction/repairs that need to be performed. These costs are avoided by FLIC by engaging in the Bad Faith conduct described herein. t. FLIC’s Bad Faith conduct as described places the insured in a position of being forced into incurring expert fees to secure judicial relief by way of a legal action. Moreover, and as part of the Bad Faith practice, FLIC will await the insured’s post-suit retention of an expert to retain a designated/pre-disposed (due to financial biases) experts to further delay its obligations to its insureds and the consequential liabilities that the legislature has imposed to deter FLIC from engaging in the Bad Faith practice. 3. FLIC’s “toolbox” of Bad Faith claims handling practices as described above leaves insureds, the insured’s counsel, the FLIC’s counsel and even the judiciary guessing as to when and how FLIC will duly perform. The continuously vacillating positions and cherry picking of the described Bad Faith conduct not only serves to maximize FLIC’s prospective financial gains by being able to avoid paying benefits, it also serves to minimize FLIC’s lost adjusting expense as it see fit and to the invariable detriment of its insureds, the Complainant, and ultimately the tax paying citizens of this State that bear the expense of the judicial system which needs to unravel the tangled web created by FLIC. 4. To cure the above stated immoral, deceptive, unlawful and collectively defined general business practice of Bad Faith claims handling practices that are knowingly, willfully, wantonly and/or with a reckless disregard for the Complainant’s interests being implemented, FLIC must perform as follows within 60 days of receiving this Complaint. a. Take corrective action in association with the Bad Faith claims handling practices by way of rectifying same and thereafter duly adjusting, investigating and issuing payment for all benefits owed to the Complainant in the amount of $32,996.00, for indemnity; b. Take corrective action in association with the Bad Faith claims handling practices by way of rectifying same and thereafter duly adjusting, investigating and issuing payment for all benefits owed to the Complainant; c. To the extent verified after duly performing under the policy pursuant to cited authorities and considerations, issuing any and all payments owed to the Complaint for interest on benefits that were untimely paid; d. To the extent verified after duly performing under the policy pursuant to cited authorities and considerations, confess judgment in relation to the pending breach of contract action brought forth by the Complainant; e. After exercising good faith efforts to resolve the claim, issuing payment to the Complainants for any attorney’s fees and/or costs that it cannot dispute are due and owing; f. As it relates to any claims/benefits that may remain in dispute or undetermined, fairly, honestly, specifically, meaningfully and substantively disclosing to the Complainant’s counsel the basis therefor and the means to promptly reach resolution; and/or g. Otherwise fulfilling any and all obligations under the policy that it knows, or should know, remain to be performed.
Comments
User Id Date Added Comment
dboyle@tlsslaw.com 02-06-2025 Kathryn A. Keller, Esquire, on behalf of First Liberty, responded to the Civil Remedy Notice in letter format on February 6, 2025, via electronic mail to: Luisa Briceno c/o Pierre Louis, Esq. Louis Law Group 290 NW 165th Street, Suite M-500 Miami, FL 33169 service@louislawgroup.com RE: Complainant/Insured : Luisa Briceno Claim No. : 056665767 Policy No. : H36-251-581240-70 Date of Loss : April 13, 2024 CRN filing number : 795869 CRN filing accepted : December 9, 2024 Dear Mr. Louis: Our firm has the pleasure of representing The First Liberty Insurance Corporation (hereinafter “First Liberty”) in connection with the above-referenced claim. This will respond to the Civil Remedy Notice of Insurer Violations (“Notice”) filed against First Liberty. The Florida Department of Financial Services assigned Filing Number 795869 and an acceptance date of December 9, 2024. The Notice alleges “Claim Denial,” “Claim Delay,” “Unsatisfactory Settlement Offer,” and “Unfair Trade Practice,” as well as violations of Florida Statute §624.155(1)(b)(1) & (3), and §626.9541(1)(i)(3)(a), (d), & (f). The allegations contained in the Notice are wholly without merit, and lack sufficient legal and factual support. Accordingly, First Liberty denies each and every alleged violation of Florida statutory and administrative law as alleged in the Notice. As an initial matter, the Notice is deficient and fails to comply with the requirements of the Florida Statutes. Florida Statute §624.155(3)(b) requires that a Civil Remedy Notice “state with specificity” the statutory provisions allegedly violated, the facts and circumstances giving rise to the violation, the name of any individual involved in the violation, and the specific policy language relevant to the violation. Rather than include the specifics required by Statute regarding the facts and circumstances giving rise to the statutory provisions allegedly violated, the Notice makes general, boilerplate conclusions. The Notice also does not list any applicable Policy language from the subject Policy. Furthermore, the Notice does not provide an explanation as to how First Liberty failed to comply with the terms of the policy with specific factual support pertaining to the alleged incident or how First Liberty failed to comply with the statutory provisions allegedly violated. Making general conclusions, without providing further analysis, or discussion of how First Liberty violated the policy and/or statutory provisions, is in direct contradiction to Florida Statute §624.155(3)(b) and renders the Notice defective. See Julien v. United Property & Casualty Insurance Company, 2020 WL 5652364 (Fla. 4th DCA 2020). 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 Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278 (Fla. 2000). The purpose of Fla. Stat. §624.155 is to provide the insurer with an opportunity to resolve a first-party coverage dispute and otherwise avoid litigation. See Talat Enterprises, Inc.; 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 i) identifying the specific policy provision(s) at issue, ii) citing 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. Aug. 13, 2010); Heritage Corp. of South Florida v. National Union Fire Ins. Co. of Pittsburgh, PA, 580 F. Supp. 2d 1294, 1299-1300 (S.D. Fla. 2008). Your Notice does not comply with the requirements of Florida statutes or Florida law. Additionally, the “facts and circumstances” section of the Notice is not in compliance with Florida law. Contrary to the requirements of Florida Statutes, the Notice makes false, boilerplate accusations, and does not contain any specific facts supporting the violations alleged. For example, the Notice alleges that First Liberty violated Florida Statute §626.9541(1)(i)(3)(a)- failing to adopt and implement standards for the proper investigation of claims. However, the body of the Notice does not specifically say how First Liberty failed to adopt and implement standards for the proper investigation of the subject claim. The Notice simply lists boilerplate statements and accusations that are not even applicable to the case at issue. Similarly, the Notice does not provide factual support for various allegations listed above, including but not limited to how First Liberty’s investigation was conducted in bad faith, or how First Liberty has engaged in unfair trade practices or claim delay. As more fully discussed below, the allegations contained within the Notice are untrue, and the Notice contains no facts to support them. Contrary to the allegations in the Notice, First Liberty acted promptly, responsibly, and in good faith at every opportunity in connection with this claim. The failure to provide any factual support for the alleged violations of Florida statutory and administrative law and otherwise comply with the requirements of Florida Statute § 624.155, renders the Notice deficient and in violation of Florida Statute § 624.155. The true facts regarding this claim are as follows: On April 23, 2024, First Liberty received notice of a claim for water damage at the Insured’s property located at 4107 Hampshire Village Court, Orlando, Florida 32822 with a reported date of loss of April 13, 2024. A leak was reported in the master bathroom. First Liberty immediately acknowledged the claim and began its investigation, which included requesting to inspect the property. First Liberty also received a letter of representation from the Insured’s public adjuster, Easy Claims. First Liberty immediately acknowledged the letter of representation and requested the Insured execute a Proof of Loss within sixty (60) days, as required by the Conditions of the Insured’s Policy. First Liberty was also provided with water mitigation documentation from Oak Restoration in the amount of $4,806.13. First Liberty inspected the property on May 8, 2024. No sudden, accidental water damage was observed. Water mitigation had reportedly already been performed. The adjuster performed moisture readings and the area was dry. The shower tiles appeared to have sustained damage due to lack of maintenance, which caused long-term damage to the grout and tiles. The adjuster requested documentation regarding any plumbing repairs performed. Following the inspection, First Liberty was provided with a Gio Handyman invoice totaling $181.05 for a “shower test.” It did not indicate that any repairs were completed. To continue its investigation, First Liberty requested the recorded statement of the Insured and sent a Reservation of Rights letter. The Insured’s public adjuster also provided an executed Proof of Loss and estimate in the amount of $25,389.50. Documentation was also provided from KND9 Mold. First Liberty followed up with the companies involved to obtain information to continue its investigation. Following its investigation, the claim was denied in correspondence dated August 2, 2024. The correspondence advised that no sudden, accidental water damage was observed at the property. The damage observed at the property was due to long-term seepage, wear, and tear, which is not covered under the Policy. Please refer to the Insured’s Policy, which states as follows: SECTION I - PERILS INSURED AGAINST COVERAGE A - DWELLING and COVERAGE B - OTHER STRUCTURES We insure against risk of direct loss to property described in Coverages A and B only if that loss is a physical loss to property. We do not insure, however, for loss: … 2. Caused by: … e. Any of the following: (1) Wear and tear, marring, deterioration; (2) Inherent vice, latent defect, mechanical breakdown; (3) Smog, rust or other corrosion, mold, wet or dry rot; … (6) Settling, shrinking, bulging or expansion, including resultant cracking, of pavements, patios, foundations, walls, floors, roofs or ceilings; … * * * * SECTION I – EXCLUSIONS 1. We do not insure for loss caused directly or indirectly by any of the following. Such loss is excluded regardless of any other cause or event contributing concurrently or in any sequence to the loss. … e. Neglect, meaning neglect of the “insured” to use all reasonable means to save and preserve property at and after the time of a loss. … 2. We do not insure for loss to property described in Coverages A and B caused by any of the following. However, any ensuing loss to property described in Coverages A and B not excluded or excepted in this policy is covered. … c. Faulty, inadequate or defective: (1) Planning, zoning, development, surveying, siting; (2) Design, specifications, workmanship, repair, construction, renovation, remodeling, grading, compaction; (3) Materials used in repair, construction, renovation or remodeling; or (4) Maintenance; of part or all of any property whether on or off the "residence premises”. * * * * SEEPAGE EXCLUSION ENDORSEMENT This endorsement changes your policy. Please read it carefully. SECTION I – PERILS INSURED AGAINST Coverage A- Dwelling and Coverage B- Other Structures Paragraph 2.e (9) is added: (9) Seepage, meaning a gradual, continuous or repeated seepage or leakage, of water, steam or fuel over a period of 14 days or more, resulting in damage to the structure, whether hidden or not. This endorsement takes precedence over all other endorsements attached to your policy. * * * * AMENDATORY MOLD, FUNGUS, WET ROT, DRY ROT, BACTERIA, OR VIRUS ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DEFINITIONS The following definition is added to the DEFINITIONS section: 9. “Mold, Fungus, Wet Rot, Dry Rot, Bacteria, or Virus” means any type or form of fungus, rot, virus or bacteria. This includes mold, mildew and any mycotoxins (meaning a toxin produced by a fungus), other microbes, spores, scents or byproducts produced or released by mold, mildew, fungus, rot, bacteria, or viruses. SECTION I – PROPERTY COVERAGES Additional Coverages The following Additional Coverage is added: 12. Remediation of "Mold, Fungus, Wet Rot, Dry Rot, Bacteria, or Virus" Resulting Directly From Any Covered Loss We will pay, up to the Basic Policy Limits or Option shown in the Declarations, for the “Remediation” of “Mold, Fungus, Wet Rot, Dry Rot, Bacteria, or Virus” resulting directly from any covered loss. "Remediation" means the reasonable and necessary treatment, containment, decontamination, removal or disposal of "Mold, Fungus, Wet Rot, Dry Rot, Bacteria, or Virus" as required to complete the repair or replacement of property, covered under Section I of the policy, that is damaged by any covered peril insured against, and also consists of the following: 1. The reasonable costs or expense to remove, repair, restore, and replace that property including the costs to tear out and replace any part of the building as needed to gain access to the “Mold, Fungus, Wet Rot, Dry Rot, Bacteria, or Virus”; and 2. the reasonable costs or expense for the testing or investigation necessary to detect, evaluate or measure "Mold, Fungus, Wet Rot, Dry Rot, Bacteria, or Virus"; and 3. any loss of fair rental value, or reasonable increase in additional living expenses, that is necessary to maintain your normal standard of living, if "Mold, Fungus, Wet Rot, Dry Rot, Bacteria, or Virus" resulting directly from any covered loss makes your residence premises uninhabitable. We will pay no more than the Basic Policy Limits or Option shown in the Declarations for the "Remediation" of "Mold, Fungus, Wet Rot, Dry Rot, Bacteria, or Virus" resulting directly from any covered loss during the policy period, regardless of the number of locations under the policy to which this endorsement is attached, the number of persons whose property is damaged, the number of “insureds,” or the number of losses or claims made. If there is a covered loss or damage to covered property, not caused, in whole or in part, by “Mold, Fungus, Wet Rot, Dry Rot, Bacteria, or Virus,” loss payment will not be limited by the terms of this Additional Coverage, except to the extent that “Mold, Fungus, Wet Rot, Dry Rot, Bacteria, or Virus” causes an increase in the loss. Any such increase in the loss will be subject to the terms of this Additional Coverage. This limitation does not apply to “Mold, Fungus, Wet Rot, Dry Rot, Bacteria, or Virus” ensuing from a covered fire or lightning loss. This Additional Coverage does not increase the limits of liability under Section I of the policy as shown in the Declarations. SECTION I – EXCLUSIONS Exclusion 1.i. is added: 9. Except as provided by Additional Coverage 12., loss consisting of or caused by “Mold, Fungus, Wet Rot, Bacteria, or Virus” is excluded, even if resulting from a peril insured against under Section I. We do not cover “Remediation” of “Mold, Fungus, Wet Rot, Bacteria, or Virus,” even if resulting from a peril insured against under Section I, except as provided by Additional Coverage 12. This exclusion does not apply to “Mold, Fungus, Wet Rot, Bacteria, or Virus” ensuing from a covered fire or lightning loss. * * * * FMHO 1067FL 10 21 Endorsement (Homeowners) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SPECIAL PROVISIONS-FLORIDA SECTION I – CONDITIONS 2. Your Duties After Loss. In case of a loss to covered property, we have no duty to provide coverage under this Policy if the failure to comply with the following duties is prejudicial to us. These duties must be performed either by you, an “insured” seeking coverage, or a representative of either: a. Give prompt notice to us or your insurance agent. … b. (1) to the degree reasonably possible, retain the damaged property; and (2) allow us to inspect, subject to b.(1) above, all damaged property prior to its removal from the “residence premises”; … e. Protect the covered property from further damage. The following must be performed: (1) Take reasonable emergency measures that are necessary to protect the covered property from further damage… (2) Keep an accurate record of repair expenses. f. Prepare an inventory of damaged personal property showing the quantity, description, actual cash value and amount of loss. Attach all bills, receipts and related documents that justify the figures in the inventory g. As often as we reasonably require: (1) Show the damaged property; (2) Provide us with records and documents we request and permit us to make copies; and … h. Send to us, within 60 days after our request, your signed, sworn proof of loss which sets forth the best of your knowledge and belief: (1) The time and cause of loss; (2) The interest of the "insured" and all others in the property involved and all liens on the property; (3) Other insurance which may cover the loss; (4) Changes in title or occupancy of the property during the term of the policy; (5) Specifications of damaged buildings and detailed repair estimates; (6) The inventory of damaged personal property described in 2.f. above; (7) Receipts for additional living expenses incurred and records that support the fair rental value loss; and (8) Evidence or affidavit that supports a claim under the Credit Card, Fund Transfer Card, Forgery and Counterfeit Money coverage, stating the amount and cause of loss. … * * * * The duties above apply regardless of whether you, an “insured” seeking coverage, or a representative of either retains or is assisted by a party who provides legal advice, insurance advice or expert claim advice, regarding an insurance claim under this Policy. * * * * 8. Suit Against Us. No action can be brought unless the policy provisions have been complied with and the action is started within 5 years after the date of loss. In addition, the "insured" must provide the Department of Financial Services with written notice of intent to initiate litigation at least 10 business days prior to filing any legal action against us in accordance with section 627.70152 of Florida Statutes. * * * * Without waiving its rights to contest the validity of the subject defective and improper Notice, as the facts clearly demonstrate, First Liberty has, and continues to comply with both Florida law and the applicable policy of insurance throughout the entire handling of this claim. With regard to the investigation and handling of this claim, First Liberty’s actions were prompt, thorough, and conducted in good faith. Therefore, First Liberty specifically denies each and every violation alleged in the Notice. We trust this response addressed all concerns raised by the Notice. However, please do not hesitate to contact the undersigned should you require additional information. Sincerely, /s/ Katie Keller KATHRYN A. KELLER ANDREW J. SILVERS
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