Civil Remedy Notice of Insurer Violations
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Filing Number:     796058
Filing Accepted:  12/10/2024
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Complainant
Last/Business Name *  
KETHA FAMILY TRUST   First Name  
Street Address * 874 S PARSONS AVE.
City, State Zip * BRANDON, FL 33511
Email Address * SERVICE@PROPERTYPEOPLELAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   KETHA FAMILY TRUST   First Name  
Policy # * 09 0037791220 7 01 Claim #* 040062-000918-RB-01
Attorney
Attorney is Applicable
Last Name* ILANI First Name * DANIEL Initial
Street Address* 80 SW 8TH STREET, SUITE 2590
City, State Zip* MIAMI , FLORIDA 33130
Email Address * SERVICE@PROPERTYPEOPLELAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   BANKERS INSURANCE COMPANY
NAIC Company Code 33162
 
Name of individual responsible for violation (if any):* ALL ADJUSTERS, SUPERVISORS, MANAGERS, ATTORNEYS, AND INDIVIDUALS ASSOCIATED WITH AND/OR RETAINED BY BANKERS INSURANCE COMPANY CONCERNING THE CLAIM AT ISSUES; BANKERS INSURANCE COMPANY’S DESK ADJUSTER(S); BANKERS INSURANCE COMPANY’S FIELD ADJUSTER(S).
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)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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)(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)(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.
626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

BANKERS INSURANCE COMPANY failed to adequately adjust and pay the claim covered under the subject insurance policy. Specifically, but not limited to, BANKERS INSURANCE COMPANY failed to properly apply the Loss Settlement and Loss Payment provisions of the policy. In addition to the policy sections specifically cited herein, any endorsements or changes to said sections are relevant to the Insured’s claim for civil remedy. There may be additional policy language relevant to this violation that may be discovered.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

BANKERS INSURANCE COMPANY (hereinafter the “Insurance Company”) issued a homeowners insurance policy to its insured, KETHA FAMILY TRUST (the “Insured”), for the insured property located at 874 S Parsons Ave., Brandon, FL 33511. The subject Policy afforded various types of coverages including coverage for damage to dwelling, other structures, personal property, and for loss of use. On or about April 27, 2024, while the subject Policy was in full force and effect, the Insured’s home was damaged as a result of a covered loss. The Insured subsequently notified the Insurance Company of this loss. Thereafter, the Insurance Company acknowledged the loss and assigned claim number 040062-000918-RB-01 to the loss. The Insured complied with all policy conditions and cooperated with the Insurance Company’s investigation efforts. The Insurance Company performed a cursory inspection and failed to retain the unbiased experts necessary to adequately inspect the property to restore the property to its pre-loss condition. Shortly after, the insurance company denied this loss based upon an unqualified evaluation of the damages. Notably, the Insurance Company failed to retain an expert to inspect the property to fully evaluate this claim, relying solely on an inadequate inspection concerning a subject matter and claim their representative is ill-equipped and unqualified to properly evaluate. The Insured and Insured’s representative provided the Insurance Company with all claim-related documents including an estimate to repair covered damages in the amount of $ and other supporting documentation and/or information. Nonetheless, the Insurance Company continues to disregard and ignore the Insured’s claim and request for adequate payment. The Insurance Company has failed to issue proper payment for the claim and has failed to issue sufficient payment to compensate the Insured for damages and repairs covered by the policy and held to be contractually covered by Florida law. The Insured provided the Insurance Company with documentation evaluating the loss, and rather than issuing the proper payment or attempting to reach an agreement with its Insured, the Insurance Company is delaying and denying the claim. Upon information and belief, the Insurance Company performs the subject actions as a business practice, including delaying the claim and/or issuing insufficient payments in an attempt to dissuade its insured from pursuing the claim to the detriment of its insured to increase financial profits. Based upon self-serving conclusions regarding the cause of loss, the Insurance Company’s conclusions are disconcerting because they are demonstrably incorrect. Further, they directly conflict with the only first-hand accounts of the loss. To be clear, the Insured had personal knowledge of the condition of the property prior to the date of the loss and the amounts owed to make the necessary repairs. That said, the Insurance Company’s refusal to properly investigate, adjust, and fully compensate the Insured for their claim evidences the Insurance Company’s violation of Section 626.9541(1)(i)(3)(a), Florida Statutes, which requires the Insurance Company to “adopt and implement standards for the proper investigation of claims.” All available information leads to one conclusion—the Insured’s property was damaged by a covered cause of loss for which the Insured is entitled to full and complete compensation. The Insurance Company’s obligation to promptly settle the Insured’s claim is undeniable, and therefore, the Insurance Company has also violated sections 624.155(1)(b)(1), Florida Statutes. The Insurance Company’s conduct is egregious because the Insurance Company purposely ignored relevant facts, even facts from its own experts, that would have confirmed coverage for the Insured’s loss to avoid having to compensate the Insured for damages. To make matters even worse, the Insurance Company has failed to timely respond to the Insured and issue payment for the damages to the property to allow necessary repairs. The actions taken by the Insurance Company in the handling and adjustment of the Insured’s claim are willful, wanton, and in disregard for the rights of the Insured, and have occurred with such frequency as to indicate a general business practice in violation of the law. The practice includes the Insurance Company’s ongoing inaction of ignoring relevant and accessible information that supports coverage in order to avoid compensating its Insured for covered losses. To be clear, the recent ruling in Fortune v. First Protective Insurance Company d/b/a Frontline Insurance, out of Florida’s 2nd District Court of Appeal, clears up what this carrier must do the cure this CRN. Similar to here, In Fortune, the Insureds timely filed a claim with their homeowners insurance policy upon suffering damage to their property. The Insurer investigated the claim and denied, contending that the amount of damage did not exceed the Insureds’ deductible. Upon presenting the public adjuster’s estimate and all other materials to the insurance company, the Insurer invoked the appraisal process under the policy.Thereafter, the Insureds filed a Civil Remedy Notice alleging that the insurer made a lowball offer and “flagrantly breached” its duty to attempt in good faith to settle claims, under applicable Florida statutes. Additionally, the Insureds alleged that the Insurer refused to reassess its payment of benefits and the basis for payment and that the Insurer “turn[ed] a blindeye and refuse[d] to properly adjust and settle the claim.” Noteworthy in Fortune is that although the Homeowners' CRN did not state a specific cure amount, it did state that they had provided their public adjustor's estimate to the Insurer which covered "the full scope of necessary repairs to the direct and ensuing damages." Thus, the Insured had the public adjuster's estimate and knew the amount the Homeowners sought. Neither the statute nor this court's precedent requires the CRN to contain a specific amount sought to cure the alleged bad faith. See § 624.155(3)(b); see Hunt v. State Farm Fla. Ins. Co., 112 So. 3d 547, 549 (Fla. 2d DCA 2013) (recognizing that an appraisal award satisfies the condition precedent of "a determination of liability and extent of damages owed"). In addition to the above statutory violations, the Insurance Company’s adjuster violated the following ethical requirements of Florida Administrative Code 69B-220.201. (3) Code of Ethics…An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance. The following are standards of conduct that define ethical behavior, and shall constitute a code of ethics that shall be binding on all adjusters: (b) An adjuster shall treat all claimants equally. 2. An adjuster shall adjust all claims strictly in accordance with the insurance contract. (c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured. (d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. (e) An adjuster shall handle every adjustment and settlement with honesty and integrity, and allow a fair adjustment or settlement to all parties without any remuneration to himself except that to which he is legally entitled. (f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim. (o) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise. In Florida, the work of adjusting insurance claims engages the public trust. During the adjustment of the Insured’s claim, the Insurance Company breached this duty by failing to adhere to and comply with the above referenced obligations. To cure the defects outlined above, the Insurance Company must: 1. Immediately pay the Insured a cure of $for losses suffered as a result of the claim; 2. Immediately issue payments for statutory interest for the late payments and owed profit/overhead; 3. Act fairly and honestly towards the Insured and with due regard for their interests; 4. Hire a fair and unbiassed adjuster and experts to properly assess the Insured’s damages; 5. Tender any additional insurance proceeds due and owing to the Insured that would reasonably place the Insured back into a pre-loss condition; 6. Timely adjust the claim with the insured and avoid/limit any additional delay, costs, and prejudice that the Insurance Company’s conduct above has caused and continues to cause the Insured; and 7. Compensate the Insured for the attorneys’ fees and costs accrued as a result of the Insurance Company’s bad faith conduct. Failure to cure all defects during the 60-day safe harbor period may result in additional extra-contractual damages.
Comments
User Id Date Added Comment
bab@bolin-law.com 02-07-2025 February 7, 2025 VIA E-MAIL (service@propertypeoplelaw.com) AND UPLOADED TO DFS Ketha Family Trust c/o Daniel Ilani, Esq. Property People Law 80 SW 8th Street, Suite 2590 Miami, Florida 33130 Re: Matter: Ketha Family Trust v. Bankers Insurance Company Date of Loss: 4/27/2024 Claim Number: 040062-000918-RB-01 Policy Number: 09 0037791220 7 01 DFS Filing Number: 796058 Dear Mr. Ilani: My firm represents Bankers Insurance Company (“Bankers”) with respect to the above matter. This correspondence constitutes Bankers’ response to the Civil Remedy Notice of Insurer Violation (“CRN”) with filing number 796058 you filed on behalf of Ketha Family Trust. The Notice is void because it is legally invalid. Beyond that, the allegations in the Notice have no merit. I. The Civil Remedy Notice is legally invalid. The filing of a valid Civil Remedy Notice is a condition precedent to an action brought pursuant to section 624.155, Florida Statutes. Talat Enter., Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Because the statute is in derogation of the common law, it must be strictly construed. Id. “[A]ny statute in derogation of the common law requires strict compliance with its provisions by one seeking to avail himself of its benefits.” Florida Steel Corp. v. Adaptable Devs., Inc., 503 So. 2d 1232, 1234 (Fla. 1986). Section 624.155, Florida Statutes, requires a civil remedy notice to provide specific information to put the insurer on notice of the alleged violation. Additionally, a civil remedy notice must be “specific enough to provide insurers notice of the wrongdoing so the insurer can cure the same within sixty days.” Valenti v. Unum Life Ins. Co. of Am., 8:04CV1615T-30TGW, 2006 WL 1627276, at *2 (M.D. Fla. 2006). Here, the Notice is invalid because it does not contain all of the information required by section 624.155. Demase v. State Farm Fla. Ins. Co., 2022 Fla. App. LEXIS 7760 (Fla. 5th DCA 2022). Also, it is invalid because it lacks sufficient specificity to provide notice to Bankers of the alleged wrongdoing, as discussed below. First, the CRN fails to reference the specific policy language relevant to the alleged violation as required by Fla. Stat. §624.155(3)(b)4. Pursuant to Fla. Stat. §624.155(3)(b)4, the CRN must cite to the specific policy language that is relevant to the alleged violations. The CRN states only “specifically, but not limited to, BANKERS INSURANCE COMPANY failed to properly apply the Loss Settlement and Loss Payment provisions of the policy.” Therefore, the CRN does not in any way reference the specific policy language alleged to have been violated. In turn, this prevents Bankers from addressing any issues regarding the policy the Complainant alleges to have been violated, which is the underlying purpose of Fla. Stat. §624.155(3)(b)4. The CRN, therefore, is statutorily deficient because it does not comply with the requirements set forth in Fla. Stat. §624.155(3)(b)4. Demase v. State Farm Fla. Ins. Co., 2022 Fla. App. LEXIS 7760 (Fla. 5th DCA 2022). Second, the CRN does not provide any specific supporting facts and merely makes conclusory statements. For example, the CRN alleges as follows: The Insurance Company performed a cursory inspection and failed to retain the unbiased experts necessary to adequately inspect the property to restore the property to its pre-loss condition. Shortly after, the insurance company denied this loss based upon an unqualified evaluation of the damages. Notably, the Insurance Company failed to retain an expert to inspect the property to fully evaluate this claim, relying solely on an inadequate inspection concerning a subject matter and claim their representative is ill-equipped and unqualified to properly evaluate. This is simply not true. Not only did Bankers perform a thorough inspection of the property on May 2, 2024, Bankers spoke to the technician hired by the Plaintiff, ACE Septic & Waste concerning the cause of the damage. As Bankers explained in its coverage decision letter, the Plaintiff’s own contractor stated that it was his assessment that the lift pump failure was due to aging and wear of the system as well as a lack of proper maintenance of the system as a whole. The Plaintiff hired ACE Septic & Waste to perform repairs of the system. Thus, unless the Plaintiff hired an unqualified individual to repair the property, the technician was clearly qualified to make such an opinion. Additionally, Bankers did not rely solely on the inspection by its independent field adjuster, but on the sum total of all the documents provided as well as the professional opinion of the Plaintiff’s contractor. Accordingly, the Plaintiff’s allegations are mere self-serving and conclusory statements without substance or relation to any alleged violation. This undermines the purpose of the CRN requirement preventing Bankers from investigating and resolving any of the alleged violations. The failure to provide any specific supporting facts for the allegations renders the CRN invalid. Demase v. State Farm Fla. Ins. Co., 2022 Fla. App. LEXIS 7760 (Fla. 5th DCA 2022). Third, the Notice is invalid because it does not list a specific cure for the alleged violations. In Talat, the Florida Supreme Court said that to “cure” a Notice, an insurer must pay the amount owed pursuant to the express terms and conditions of the policy.” However, the Notice here states, “Immediately pay the Insured a cure of $for losses suffered as a result of the claim.” No cure amount of any kind is provided, and Bankers is left to guess what would be required to “cure” the alleged violations. It is improper for a civil remedy notice to not contain a cure; therefore, the CRN is invalid. Talat, 753 So. 2d at 1282–83; see also Francois v. Illinois Nat. Ins. Co., 01-CV-8070, 2002 WL 33760405, at *4 (S.D. Fla. 2002) aff'd, 49 Fed. Appx. 290 (11th Cir. 2002). Additionally, the Notice also requests improper cure requirements such as “interest” and “attorneys’ fees” therefore the CRN is invalid. See Talat, 753 So. 2d at 1282–83. Fourth, the Notice does not list the Complainant’s e-mail address instead it provides the email of its attorney, service@propertypeoplelaw.com. See Pin-Pon Corp., 500 F. Supp. 3d 1336 (S.D. Fla. 2020); Demase v. State Farm Fla. Ins. Co., 2022 Fla. App. LEXIS 7760 (Fla. 5th DCA 2022). Fifth, the Notice does not identify the person or persons who are most knowledgeable of the facts giving rise to the allegations in the CRN. The CRN only provides a catch-all provision: ALL ADJUSTERS, SUPERVISORS, MANAGERS, ATTORNEYS, AND INDIVIDUALS ASSOCIATED WITH AND/OR RETAINED BY BANKERS INSURANCE COMPANY CONCERNING THE CLAIM AT ISSUES; BANKERS INSURANCE COMPANY’S DESK ADJUSTER(S); BANKERS INSURANCE COMPANY’S FIELD ADJUSTER(S). Therefore, the notice is invalid and should be rejected. See Julien v. United Prop. & Cas. Ins. Co. 311 So. 3d 875 (Fla. 4th DCA 2021); Fonollosa v. Am. Integrity Ins. Co of Fla, 2021 Fla. Cir. LEXIS 5 (Fla. 11th Cir. Ct. 2021); Pin-Pon Corp. v. Landmark Ins. Co., 500 F. Supp. 3d 1336 (S.D. Fla. 2020); Demase v. State Farm Fla. Ins. Co., 2022 Fla. App. LEXIS 7760 (Fla. 5th DCA 2022). Sixth, the Notice does not list Bankers’ address. See Julien v. United Prop. & Cas. Ins. Co., No. 311 So. 3d 875 (Fla. 4th DCA 2021); Pin-Pon Corp., 500 F. Supp. 3d 1336 (S.D. Fla. 2020). Seventh, the boilerplate CRN lacks sufficient specificity to provide notice of the alleged bad-faith conduct. The CRN lists thirteen (13) statutes which Bankers allegedly violated. However, the CRN fails to provide any relevant facts supporting the alleged violations or relating these alleged violations to the thirteen (13) cited statutes. Because the Civil Remedy Notice fails to identify any specific statutes or any facts to support why the Complainant believes Bankers violated the statutes, Bankers is unable to properly respond, and the Notice is invalid and should be rejected and returned. To be clear, counsel/the representative for the Insured has filed over nine hundred and fifty (950) civil remedy notices against dozens of different insurance companies. Moreover, the majority of the factual allegations in each of those notices filed on behalf of his clients appear to be very, very similar if not identical in both form and content. This conduct appears to be a business practice designed to force insurance carriers into settlement without regard to the actual facts, policy, and claims handling related to a specific claim. This conduct undermines the purpose of the Notice. Because the CRN fails to comply with the information requirements promulgated by the Department of Financial Services, it is legally invalid. See Pin-Pon Corp. v. Landmark Ins. Co., 500 F. Supp. 3d 1336 (S.D. Fla. 2020); Julien v. United Prop. & Cas. Ins. Co., 4D19-2763 (September 23, 2020); Demase v. State Farm Fla. Ins. Co., 2022 Fla. App. LEXIS 7760 (Fla. 5th DCA 2022). Again, in serving this response, Bankers reserves all rights under Florida law to be served with a properly completed and statutorily compliant CRN. As the CRN fails to strictly comply with the requirements of section 624.155, Florida Statutes, it is legally insufficient and should be rejected. II. The Civil Remedy Notice Lacks Merit The Notice also lacks merit. The subject claim was reported on April 29, 2024, with a reported date of loss of April 29, 2024, for alleged water damage at the subject property located at 874 S. Parsons Ave., Brandon, FL 33511-6007. On May 2, 2024, Bankers received documents from the Insured from ACE Septic and Waste regarding the work they did on April 27, 2024. Those documents indicated that they found the following: ACE Septic arrived on 4/27 for lift station failure. ACE found that pump 2 was locked with a dead short to ground. The motor start contactor for pump 2 was found to be bad also. ACE replaced (2) bad ?oats for the control panel, replaced bad terminal splice block. ACE was able to get the lift station working correctly, operating on one pump. The unit is designed to operate on one pump, pump 2 to only operate on failure. The system is working as it was designed minus pump 2. That same day, Bankers inspected the property through an independent field adjuster. The field adjuster found water damage that appeared to be from the failure of the lift pump in the septic system that caused a back-up into the property. On May 7, 2024, Bankers received documents from the Insured from DriRite of Hillsborough County On May 17, 2024, Bankers received documents from Enviro King concerning their inspection of the property. Based on all of the above, Bankers spoke with the technical at ACE Septic & Waste. He explained that the lift pump failure was due to age and wear and the lack of property maintenance of the system. Accordingly, based on these opinions as well as Bankers own investigation into the loss, Bankers issued its Coverage Determination Letter finding that there was no coverage under the policy. Via that letter, Bankers outlined it investigation of the claim and explained the relevant policy provisions. Specifically, these included the portions of the policy concerning the lack of coverage for water that back up, wear and tear, deterioration, mechanical breakdown, and faulty, inadequate or defective maintenance. Bankers also explained that while equipment breakdown protection is an optional coverage, the Insured had not purchased that coverage. Bankers also explained that there was no coverage under the Water Back-Up and Sump Overflow Endorsement for the reasons set forth in the letter. Despite all of the above, on December 10, 2024, your office filed a Civil Remedy Notice that is the subject of this correspondence. In addition to the above-noted deficiencies, the Notice is also devoid of merit. The Bankers states that the actions of Bankers “indicate a general business practice in violation of the law.” This baseless allegation is completely devoid of any factual support. In fact, the boilerplate Notice contains references to multiple statutes and the Florida Administrative Code without providing a single fact specific to this claim to indicate how Bankers violated the listed statutes or codes. In fact, the “facts and circumstances” portion of the Notice contains no facts or circumstances specific to this claim other than the property address. Therefore, the Notice contains nothing more than material misrepresentations, factual omissions, and baseless allegations. In light of Bankers’ investigation, coverage was properly denied for the subject claim, pursuant to the terms, conditions, exclusions, limits and deductible of the subject policy. As the claim was denied, Complainant’s claim is not covered for the same reasons set forth above and the relevant Coverage Determination Letter. Accordingly, Bankers denies any and all allegations of bad faith in connection with the claim submitted by Ketha Family Trust. If you have any questions, please do not hesitate to contact me. Sincerely, Brandon A. Blake, Esq.
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