Civil Remedy Notice of Insurer Violations
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Filing Number:     796036
Filing Accepted:  12/9/2024
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Complainant
Last/Business Name *  
AIME   First Name   BUTEAU AND MARIE
Street Address * 14135 RIDGE CREEK CT
City, State Zip * ORLANDO, FL 32824
Email Address * AIMEB2@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   AIME   First Name   BUTEAU AND MARIE
Policy # * 0769425147 Claim #* 7007997007-1
Attorney
Attorney is Applicable
Last Name* ALTMAN First Name * ALEXIS Initial
Street Address* 925 SOUTH FEDERAL HIGHWAY, 7TH FLOOR
City, State Zip* BOCA RATON , FL - FLORIDA 33432
Email Address * AALTMAN@KPATTORNEY.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   TRUCK INSURANCE EXCHANGE
NAIC Company Code 21709
 
Name of individual responsible for violation (if any):* JONATHAN MERCEDES
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unfair Trade Practice
Claim Delay
Claim Denial
* 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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Loss settlement provision
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Truck Insurance Exchange (“carrier”) has not attempted in good faith to settle the insureds’ claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insureds and with due regard for their interests. The carrier has done everything possible to delay the claim and refuses to pay the complete covered loss amount due under the policy. Furthermore, the carrier is required to properly investigate and adjust claims and cannot place that burden upon the insureds. This was made clear by the appellate court and the Florida Supreme Court in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005) (“The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insureds…”). The carrier was immediately put on notice of the insureds’ plumbing claim which caused substantial damage to the insureds’ property. The carrier sent out an adjuster and then denied the claim stating “The damage noted beneath the sink indicates a history of prolonged or repeated water or moisture infiltration. We do not cover the presence of any form of water over a period of weeks, months or years, from any constant or repeating gradual or slow seepage, leakage, trickle, collection, spray or mist, or the infiltration or overflow of water from any source.” Nowhere did the carrier advise how it made this determination that the water had been prolonged additionally they failed to provide any time frame. It is clear that the carrier is finding any excuse to deny this claim. The insured provided the carrier with estimates as well as photographs of all the damages and an estimate in the amount of $43,735.22. The carrier continued to wrongfully deny the claim. The insureds have complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insured. The carrier is aware of damage sustained by the insureds’ property and has not taken any meaningful ensuing action. Pursuant to Florida Statute §624.155(1)(b)(1), Truck Insurance has failed to settle the claim in good faith when it could and should have done so. The Insured reported the Loss and the Property was presented for inspection. The damage to the insured’s home was clearly caused by a covered peril under the Policy, but Truck Insurance intentionally and callously delayed the claim process and wrongfully denied the claim. Truck Insurance has not shown a good faith intention to pay what was owed but rather has underpaid the claim for financial gain and profit. Pursuant to Florida Statute §626.9541(1)(i)(3)(a), Truck Insurance has a duty to adopt and implement standards for the proper investigation of claims. The carrier refused to investigate the claim properly. Florida law mandates that insurers and adjusters do not mislead the Insured. Florida Insurance companies that fail to follow these Florida laws and regulations, designed to protect consumers, do not only breach their duties under the policy of insurance but do so in bad faith. In violation of Florida Statute §626.9541(1)(i)(3)(b), Truck Insurance intentionally misrepresented the available coverage under the policy and has misrepresented that the policy does not provide coverage for the loss. Furthermore, the Insured believes Truck Insurance repeatedly and as a standard business practice engages in this behavior to deprive its Insured of their rightful insurance proceeds when they experience a covered loss. Insured contends Truck Insurance has implemented a claims program and business practices that are tailored to increase its profits at the expense of benefits that are owed to its customers and that other Insured have been refused insurance proceeds due and owing under the policy in the same or similar circumstances, and some have been provided inadequate insurance monies under the same or similar facts or circumstances. This is wrongful conduct and directly violates the purpose of insurance coverage. Truck Insurance’s wrongful conduct and omissions include, but are not limited to: claim delay, not conducting a full and prompt investigation, not treating the policyholder with good faith claims conduct, looking for ways to reduce recovery to Insured; looking for ways to delay full recovery to Insured; holding back and failing to pay portions of claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the Insured; not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholder’s interests; establishing severity control initiatives and otherwise establishing a culture of not fully and promptly paying claims following losses; and failing to pay the full amount of the Insured’s damage despite knowing it must do so. Consequently, these actions have caused undo frustration and financial harm to the Insured. As a direct and proximate result of the poor handling of this Claim by Truck Insurance the Insured sustained extracontractual damages. Due to the bad faith actions of Truck Insurance, Insured was forced to engage the services of the Public Adjuster to attempt to recover the settlement to which they are rightfully entitled. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless regard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $43,735.22, less any applicable policy deductible; 2.) Pay all mitigation invoices for emergency services; 3.) Pay the Insureds’ attorneys’ fees and costs as they have been forced to retain counsel; 4.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier. Please do not hesitate to contact the undersigned or Stephanie Alexandre at (561)-892-9925 if you have any questions or concerns. Sincerely, Alexis Altman
Comments
User Id Date Added Comment
cheryl.perez@farmersinsurance.com 01-23-2025 January 23, 2025 Via E-Mail Kanner & Pintaluga 925 S. Federal Highway, 7th Floor Boca Raton, FL 33432 Delivered by email to: aaltman@kpattorney.com RE: Buteau Aime and Marie Aime Claim No.: 7007997007-1 Dear Alexis Altman: This correspondence is Truck Insurance Exchange’s (“Truck”) response to the Civil Remedy Notice of Insurer Violation No. 796036 filed on behalf of Complainant December 9, 2024. Complainant alleges that Truck violated various subsections within Sections 624.155 and 626.9541, Florida Statutes, pertaining to Claim No. 7007997007-1 under an insurance policy issued by Truck to Complainant. Truck welcomes the opportunity to respond to the Notice’s allegations. On the merits, Truck avers it handled Complainant’s claim correctly, fairly, in good faith and with due regard for their interests under Complainant’s policy. A review of our records shows that Lifeline Public Adjusters reported this loss on August 15, 2024, damage under the sink of the Complainant’s property as a result of a water loss that was reported to have occurred on August 6, 2024. Truck conducted a prompt and thorough investigation into this claim. Truck’s claim representative immediately made contact attempts to schedule the inspection. The inspection was originally scheduled September 4, 2024, the first available time for the public adjuster. However, the public adjuster later rescheduled the inspection to September 9, 2024. The rescheduled inspection was completed in the presence of the public adjuster. Our assessment revealed wood swelling, multiple stains, and darkening on the cabinet's sides, front, and the top layer of the base cabinet. Furthermore, rust-like stains were observed on the walls, garbage disposal, and the interior of the base cabinet doors. The damage noted beneath the sink indicates a history of prolonged or repeated water or moisture infiltration. We do not cover the presence of any form of water over a period of weeks, months or years, from any constant or repeating gradual or slow seepage, leakage, trickle, collection, spray or mist, or the infiltration or overflow of water from any source. Based on our evaluation, we determined that this claim is not eligible for coverage, Truck denied Complainant’s claim on September 9, 2024. On September 17, 2024 we sent a copy of the policy to Lifeline Public Adjusters in response to their letter of representation. On September 20, 2024 we received mitigation documentation and an estimate from Multi Services Ma-na. We responded September 23, 2024 and provided a copy of the outcome letter. On September 27, 2024 we received Lifeline Public Adjuster’s estimate. The estimate did not support the presence of covered damage to our insured’s property. As such, Truck responded and advised our position on coverage and the claim remains unchanged. On December 13, 2024 the public adjuster submitted a Proof of Loss form signed by our insured October 28, 2024. We again responded timely, December 16, 2024, and reiterated our claim decision. Complainant has failed to provide any evidence to support their assertion that Truck failed to properly adjust this claim. The only fact that Complainant alleges to support their allegations that Truck violated Florida law and handled Complainant’s claim in bad faith is that Truck’s adjustment of the claim did not result in payment of Complainant’s exorbitant demand. Truck’s policy only covers accidental direct physical loss or damage to the property that is not otherwise excluded, which is further limited by the deductible, conditions, limits, and other terms of the policy. In accordance with these terms, Truck properly adjusted this claim as outlined above. Therefore, contrary to Complainant’s contention, Truck’s coverage determination was made in good faith. Truck denies any breach of any statutory or contractual duties in the handling of Complainant’s claim. Your notice alleges the “Insured was forced to engage the services of the Public Adjuster to attempt to recover the settlement to which they are rightfully entitled.” We respectfully disagree, as stated previously this claim was reported by Lifeline Public Adjusters on behalf of our insured. Upon further review it appears the agreement with the public adjuster was signed August 12, 2024, three days PRIOR TO our First Notice of Loss. While this response is meant to be comprehensive, Truck’s response is based on the limited information provided in the Notice filed by Complainant. Also, this letter or any act or failure to act on the part of Truck or any agent or representative of Truck should not be construed as a waiver of any rights or defenses, including but not limited to proper notice and service, available to it by contract or at law as all such right and defenses are hereby specially reserved. We trust that this response addresses the allegations raised in the Notice. Please contact us if you have any questions or should you wish to discuss this matter further. Sincerely, Cheryl Perez, Company Employee Adjuster General Claims Adjuster (913) 274-0230 Truck Insurance Exchange
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