Civil Remedy Notice of Insurer Violations
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Filing Number:     795993
Filing Accepted:  12/9/2024
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Complainant
Last/Business Name *  
AYALA   First Name   HENRY AND AMY
Street Address * 8319 BOYLA COURT
City, State Zip * WINDERMERE, FL 34786
Email Address * INTAKE2@THEKRFIRM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   AYALA   First Name   HENRY AND AMY
Policy # * 9740907297 Claim #* 01000112182
Attorney
Attorney is Applicable
Last Name* KADIR First Name * ALI Initial A.
Street Address* 986 DOUGLAS AVE, STE. 102
City, State Zip* ALTAMONTE SPRINGS , FL 32714
Email Address * INTAKE2@THEKRFIRM.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):* LANISSA LEGERE, STEPHANIE MOORE, GRACE THOMPSON, APRIL FRACZKOWSKI, JEFFREY AARON FRY, JOSHUA B. COOK P.E., SCOTT D. BERESHEIM P.E., FULCRUM FORENSICS LLC, AND ALL FRONTLINE CLAIMS ADJUSTERS, EMPLOYEES, REPRESENTATIVES, AGENTS, VENDORS, AND/OR ENGINE
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Misrepresentation
* 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)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
626.9541(1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

“We insure for sudden and accidental direct physical loss to covered property described in Coverages A and B unless the loss is otherwise excluded or limited in this policy.” Frontline possesses a complete copy of the subject insurance policy. The Ayalas are not in possession of a complete copy of the subject policy and is requesting a copy from Frontline. Thus, this CRN cannot cite subject policy language verbatim due to such. Notwithstanding, the subject policy is an all-risks insurance policy and the applicable policy language is the provision regarding coverage of all risks for the dwelling (Language such as “We insure against direct physical loss to property…”, “We insure against risk of direct loss to property…”, among other similar policy language etc. is typically used.) and provisions regarding exclusions or limitations to this all-risks provision.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Henry and Amy Ayala (“the Ayalas”) are homeowner insureds with an all-risks policy issued by First Protective Insurance Company dba Frontline Insurance (“Frontline”). The insured property or home is located at 8319 Boyla Court, Windermere, Florida 34786. In September of 2022, Hurricane Ian caused extensive damage to the Ayalas’ home. The Ayalas timely reported an insurance claim for this damage to Frontline and fully cooperated with all requests for inspections. They provided all requested documentation, if any, and complied with all post loss policy conditions. An estimate for repair of all damages with respect to the Ayalas’ claim was prepared on their behalf for $279,382.06 and was submitted to Frontline. After reporting the claim, Frontline retained an unqualified and biased field adjuster who has a financial relationship with Frontline. This field adjuster inspected the Ayalas’ home in an apparent effort to minimize Frontline’s losses instead of adjusting the claim in good faith in due regard for the Ayalas’ interests. Frontline also hired biased engineers, Joshua B. Cook, P.E. and Scott D. Beresheim, P.E. of Fulcrum Forensics, LLC (“Fulcrum”), who have a financial relationship with Frontline. Like the field adjuster, these engineers’ goal was to provide incorrect and erroneous findings; again in an apparent effort to minimize Frontline’s losses to the detriment of the Ayalas. Indeed, Fulcrum incredulously found “no evidence of wind-related damage” and puzzlingly attributed all of the roof tile damage instead to foot traffic and the rainwater intrusion as a result of ineffective flashings. Based on these findings, Frontline completely denied coverage for the Ayalas’ claim. Due to such bad faith claim handling, the Ayalas have been unable to permanently repair their home. Based on these facts, it is clear Frontline unreasonably denied coverage for the Ayalas’ claim in bad faith. It denied coverage for the claim without conducting a reasonable investigation based upon the available information. It misrepresented pertinent policy provisions and facts and did not act fairly and honestly with the Ayalas in due regard for their interests. Frontline also delayed the claim and failed to timely respond to communications. It further failed to adopt and implement standards for the proper investigation of this claim. This has become a common business practice of Frontline. Florida Statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit based on determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. Frontline has breached this duty by refusing to properly and timely adjust the loss. As a result, the Ayalas will have no choice but to retain the undersigned counsel to file a lawsuit against Frontline. Frontline has more than enough information and is still refusing to accept coverage for this claim. This continued and repeated reckless claim delay and denial of coverage will result in a significant punitive damage award if a bad faith lawsuit is filed. Frontline can avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy for this claim and by paying the Ayalas $259,602.06, which is the policy limit for coverage A less the 2% hurricane deductible.
Comments
User Id Date Added Comment
aabell@kirwanspellacy.com 02-05-2025 200 South Andrews Avenue, 8th Floor • Fort Lauderdale, FL 33301 954.463.3008 Kirwan Danner & Alvarez Website January 30, 2025 VIA ELECTRONIC FILING AND CERTIFIED MAIL: Florida Department of Financial Services Bureau of Consumer Assistance c/o: Civil Remedy Section Larson Building 200 East Gaines Street Tallahassee, Florida 32399-0322 VIA E-SERVE AT INTAKE2@THEKRFIRM.COM AND CERTIFIED MAIL Ali A. Kadir, Esq. Kuhn Raslavich, PA 986 Douglas Avenue., Ste. 102 Alta Monte Sprimgs, FL 32714 RE: CIVIL REMEDY NOTICE OF INSURER VIOLATION Complainant(s): HENRY AND AMY AYALA Claim No. 01000112182 Alleged DOL: 09/28/2022 DFS Filing No.: 795993 Dear Sir or Madam: We represent First Protective Insurance Company (“Frontline Insurance”) regarding the claim presented by HENRY and AMY AYALA (hereinafter the “insureds” or “Complainants”), for alleged damages sustained to the property located at 8319 Boyla Ct, Windermere, FL 34786-5320, as a result of alleged damage that allegedly occurred on September 28, 2022. On December 9, 2024, the DFS accepted the filing of a Civil Remedy Notice of Insurer Violation (hereinafter “CRN”) number 795993. This will serve as First Protective Insurance Company’s response to said CRN. The CRN alleges that First Protective Insurance Company violated Florida Statute Sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(d), 626.9541(1)(i)(3)(e), 626.9541(1)(i)(3)(f), 626.9541(1)(i)(3)(g), and 626.9541(1)(i)(3)(h), as the basis for filing the instant notice. First Protective Insurance Company explicitly denies the violation of any Florida statute in the evaluation and adjustment of the referenced claim. First Protective Insurance Company explicitly denies the violation of any Florida statute in the evaluation and adjustment of the referred claim. First Protective Insurance Company maintains that it has acted promptly, fairly and honestly with its Insureds at all times in the handling of this claim. Further, many of the sections the Complainants cites are wholly inapplicable to this matter on their face. Specifically, First Protective Insurance Company explicitly denies violation of any Florida statute in the evaluation and adjustment of the referenced claim. First Protective Insurance Company denies that it did not, in good faith, attempt to settle the claim and asserts that it has acted fairly and honestly toward its insureds with due regard for their interests. First Protective Insurance Company denies that except as to liability coverages, failed 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. First Protective Insurance Company denies that it failed to adopt and implement standards for the proper investigation of claims. First Protective Insurance Company denies that it misrepresented pertinent facts or insurance policy provisions relating to coverages at issue. First Protective Insurance Company denies that it failed to acknowledge and act promptly upon communications with respect claims. First Protective Insurance Company denies that it denied the claim without conducting a reasonable investigation based upon available information. First Protective Insurance Company denies that it failed to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failed to provide a written statement that the claim was being investigated, upon the written request of the insured within 30 days after pro-of-loss statements have been completed. First Protective Insurance Company denies that it failed 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. First Protective Insurance Company denies that it failed to promptly notify the insured of any additional information necessary for the processing of a claim. Lastly First Protective Insurance Company denies it failed to clearly explain the nature of the requested information and the reasons why such information is necessary. The CRN fails to comply with the very statute the Complainants are seeking to invoke. Contrary to the specific requirements of Section 624.155(3)(b)(4), the CRN fails to identify the specific policy language that is relevant to the purported violation(s), despite First Protective Insurance Company previously providing a copy of the subject policy to the insureds. Section 624.155 states, in pertinent part, as follows: . . . b. notice shall be on a form provided by the department and shall state with specificity the following information, and such other information as the department may require: * * * 2. The facts and circumstances giving rise to the violation. * * * 4. Reference to specific policy language that is relevant to the violation, if any. If the person bringing the civil action is a third party claimant, she or he shall not be required to reference the specific policy language if the authorized insurer has not provided a copy of the policy to the third party claimant pursuant to written request. § 624.155(3)(b)(2) &(4), Fla. Stat. (2015) [emphasis added]. Instead of citing the facts and policy language where the CRN form requires the Complainants to do so, the Complainants merely list facts that would be helpful to the Complainants’ position and fails to include a plethora of additional facts and policy provisions that shed an unwanted light on Complainants’ position. This broad, generic, inaccurate approach to completing a CRN is non-conforming to the requirements of Florida law. First Protective Insurance Company also objects to the CRN, as it lacks sufficient specificity, as required by §624.155, Fla. Stat., in addition to other defects. As filed, the CRN fails to accurately and specifically describe the facts and circumstances of First Protective Insurance Company’s alleged statutory violation. Instead, the insureds’ recitation of “facts” presents mere conclusory statements and offers no support as to the acts and/or omissions purportedly taken by First Protective Insurance Company which substantiate the insureds’ allegations. The Insureds’ assertions are vague, baseless, and contrary to Florida law. Furthermore, the allegations contain sweeping summaries of conversations that purportedly occurred without any support for the same. Section 624.155(2)(d) “requires that the civil remedy notice state with specificity the facts and circumstances giving rise to the violation.” Lane v. Westfield Ins. Co., 862 So.2d 774, 778 (5th DCA 2003). The purpose of a civil remedy notice is to give the insurer one last chance to settle a claim with the Insured, and not to give the Insured a right of action to proceed against the Insurer. Lane, 862 So.2d at 779; see also Talat Enterprises, Inc. v. Aetna Casualty & Surety Co., 952 F.Supp. 773 (M.D. Fla. 1997) (holding that a claimant must give the Florida Department of Insurance and the insurer sixty days written notice of a violation so that the insurer may cure any violation) and Julien v. United Prop. & Cas. Ins. Co., 46 Fla. L. Weekly D486 (Fla. 4th DCA March 3, 2021). Without such notice, First Protective Insurance Company is unable to cure any alleged defect, if warranted. Instead of citing actual facts and policy language, where the CRN form requires the Complainants to do so, the Complainants provides a vague, inaccurate, and misleading recitation of the facts of this claim, omitting pertinent facts, and misstating others. This approach in completing a CRN is not only non-conforming to the requirements of Florida law, but it also fails to place First Protective Insurance Company on notice as to what the Complainants contend First Protective Insurance Company has or has not done to the insured’s satisfaction. Stripped of its purpose to give First Protective Insurance Company notice of potentially applicable cures, the CRN is entirely deficient with respect to the explicit requirements of Section 624.155 and should be rejected as being non-compliant with the statute. Due to the lack of specificity and other defects, the CRN is invalid and cannot serve as a condition precedent to any action for alleged bad faith under §624.155, Fla. Stat., or otherwise under Florida law. Despite the allegations made by the Complainants, First Protective Insurance Company diligently and thoroughly complied with guidelines throughout its investigation of the alleged loss once it was reported on May 3, 2024. The investigation included but it was not not limited to, performing inspections that occurred on May 13, 2024, and on June 10, 2024. At the time of the inspections, it was determined that there was no evidence of storm or wind-related damage, the interior alleged damages are the result of repeated moisture intrusion through ineffective flashing along the vents and front entry valley. Additionally, the subject homeowners insurance policy does not provide coverage for wear, tear, deterioration, faulty workmanship, and/or constant repeated seepage. Based on that, First Protective Insurance Company’s issued its coverage determination on August 2, 2024, finding that the reported loss was not covered under the applicable policy of insurance. First Protective Insurance Company further objects to the CRN, and the CRN is defective, additionally because it neither provides a general description, nor references to the specific policy language at issue in the alleged violations, as required by Florida Statute §624.155(3)(b)4. Rather, the CRN merely uses boilerplate language as to First Protective Insurance Company’s actions, which fails to explain how First Protective Insurance Company was wrong in its assessment of coverage. The subject policy issued by First Protective Insurance Company is governed by the policy’s terms, conditions, and exclusions together with any endorsements. First Protective Insurance Company, being the maker of the policy, is very familiar with its language and what losses are afforded coverage. This CRN response does not waive any such provisions of the policy. Lastly, because no specific facts or remedies are referenced, First Protective Insurance Company cannot be expected to investigate the Complainants’ allegations and determine whether any corrective measures are warranted. As such, the CRN is defective and must be rejected. Section 624.155, of the Florida Statutes sanctions recovery of extracontractual damage in insurance disputes when the insurance carrier fails to attempt in good faith to settle a claim. The statute requires the Insureds to file a Civil Remedy Notice of Insurer Violation as a condition precedent to the bad faith cause of action. The Statute demands strict compliance and lays out specific notice requirements the Insured’s CRN has to meet for it to be legally sufficient. The filing of a legally sufficient CRN is not only a condition precedent but is essential to the procedural integrity of an action for bad faith. See Allstate Ins. Co. v. Clohessy, 32 F. Supp. 2d 1328 (M.D. Fla. 1998); see also Talat Enters. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278 (Fla. 2000). The statute’s clear and unambiguous standards for proper notice require the claimant to state with specificity the facts and circumstances giving rise to the violation and to reference the policy language relevant to such alleged violations. The CRN alleges First Protective Insurance Company’s statutory violation of Florida Statute Sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(d), 626.9541(1)(i)(3)(e), 626.9541(1)(i)(3)(f), 626.9541(1)(i)(3)(g), and 626.9541(1)(i)(3)(h), as the basis for filing the instant notice. However, the CRN (i) fails to reference the proper policy language relevant to such alleged violations; (ii) fails to state with specificity any facts and circumstances giving rise thereto; and (iii) fails to state, with specificity, the cure sought by the insured. The CRN is facially deficient and fails to comply with current Florida case law, as stated above. The purpose behind the notice requirement of the Civil Remedy Statute is to give an opportunity to the insurer to remediate the alleged statutory violation. The statute provides a sixty day cure period during which an insurer may avoid bad faith litigation by (i) paying the contractual amount due under the policy or (ii) by correcting the circumstances giving rise to the violation. The CRN provides no such opportunity to First Protective Insurance Company as the CRN does not specify the circumstances giving rise to First Protective Insurance Company’s alleged violations. The Complainants do not indicate how the cited policy language is relevant to any violations alleged and do not state with specificity any facts or circumstances giving rise to any violation. As such, the Complainants’ CRN does not afford First Protective Insurance Company adequate notice or an opportunity to cure any alleged violation, if warranted. The Insured’s CRN is deficient and should be rejected. First Protective Insurance Company denies any violation of Florida Statute Sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(d), 626.9541(1)(i)(3)(e), 626.9541(1)(i)(3)(f), 626.9541(1)(i)(3)(g), and 626.9541(1)(i)(3)(h), First Protective Insurance Company has acted promptly, fairly, in good faith, and in the best interest of the Insured at all times during the claims process. First Protective Insurance Company does not intend by this letter or any aspect of its investigation to waive any of its rights afforded either under the contract of insurance or at law. First Protective Insurance Company explicitly reserves all rights. Sincerely, Rachell Tejada, Esq. RT/mp2 Matter #24-30453
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