Civil Remedy Notice of Insurer Violations
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Filing Number:     796593
Filing Accepted:  12/12/2024
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Complainant
Last/Business Name *  
AUGUSTINE LAND HOLDINGS, LLC   First Name  
Street Address * 2407 MIRANDA AVENUE
City, State Zip * TALLAHASSEE, FL 32304
Email Address * JUGHAZVINI@TEAMPCG.COM
Complainant Type: * Insured
Insured
Last/Business Name*   AUGUSTINE LAND HOLDINGS, LLC   First Name  
Policy # * NPP6009151 Claim #* 188011
Attorney
Attorney is Applicable
Last Name* SULLIVENT First Name * DAMIAN Initial S
Street Address* 1600 WEST BAY DRIVE
City, State Zip* LARGO , FLORIDA 33770
Email Address * DSULLIVENT@NESSLERLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   WESTERN WORLD INSURANCE COMPANY
NAIC Company Code 13196
 
Name of individual responsible for violation (if any):* RICH TELGIA, JOSHUA KREMER, AND ANY OTHER REPRESENTATIVES OR AGENT(S) OF INSURED
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Claim Delay
Claim Denial
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Low-Balling
Other : Failure to Pay for Adequate Repairs
Other : Failure to Acknowledge Structural Damage
* 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)(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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

All policy provisions relate to what is covered under the subject policy of insurance, All buildings coverage provisions, All loss settlement provisions, and All provisions related to any and all lost revenue or rents.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On or about May 10, 2024, the Complainant suffered a significant loss to its property located at 2407 Miranda Avenue, Tallahassee, Florida 32304 (the “Property”) as a result of a storm which caused a tree to fall on the Property, significantly damaging the roof of the Property and allowing rainwater to pour into the Property. The Complainant timely reports the loos to its insurance carrier, Western World Insurance Group (“Western”). Shortly after being notified of the loss, Western sent a Field Adjuster determined that the cost to repair the property was minimal in nature and provided a small undisputed payment in the amount of $16,966.55 after application of the deductible and prior payment. Westerns estimate fails to take into account all repairs needed at the subject property, including but not limited to, structural repairs to the roofing system, roof replacement, interior repairs, and exterior repairs. Notwithstanding the aforementioned, in an effort to keeps tis claim active and moving, on or about November 1, 2024 Complainant, via its Public Adjuster, provided Wester with a Signed, Sworn Proof of Loss in the amount of $210,752.53, prior to the application of any deductible, prior payment, or depreciation. To date some 30=- days have passed since Western first received a copy of the executed Signed, Sworn Proof of Loss (“SSPOL”), yet they have not made a coverage determination, nor have they affirmed or denied the SSPOL. This is a direct violation of Florida Statutes. Instead, Western has continued to delay the proper adjustment of this claim in an effort to foregoing paying insurance proceeds to Complainant. Further, it is evident that evident that Western has violated some of the most basic principles of Florida law and their own policy of insurance. Examples of this include, inter alia: 1. Western has placed its own economic interest over the interest of the Complainant by failing to promptly issues a coverage determination, or in the alternative effectively adjust the claim and notify the Insured of the outcome. 2. By the terms of the Policy and pursuant to Florida law, Western has a duty to property investigate the Property, adjust the claim, and fully indemnify the Insured for all covered damages to the Property. 3. Western failed its Insured in these regards (most notably with respect to its failure to pay benefits due and owed under the policy, timely), which breached the policy and/or violated Florida law. 4. Western has failed to adopt or implement reasonable standards for prompt evaluation of claims. Western’s actions have resulted in the violations noted above and occur with such frequency as to constitute a general business practice. This Civil Remedy Notice of Insurer Violations (“Notice”) is given in order to prefect the right to pursue the civil remedy authorized by Florida Statute, including any and all bad faith/extra-contractual and punitive damages, should Western fail or refuse to cure the violations set forth within this Notice during the cure period. In order to cure the defects outlined in this Notice, Western must: 1. Extend complete coverage under the policy and tender payment for all covered damages which will allow the Insured to restore the property to its pre-loss condition; and 2. Create and implement adequate guidelines for the property investigation and evaluation of claims and for the training and supervision of employees, which will help to avoid future statutory violations as set forth above and avoid this time of occurrence from happening in the future. This includes, but is not limited to: a. Making sure its employees are adequately trained to property investigate claims, b. Making sure its employees are adequately trained in promptly communicating with respect to claims, c. Instructing claims personnel to consider (not ignore) carefully constructed, line-by-line estimates complete with pictures evidencing the covered damages, as well as other data consistent with covered losses, d. Making sure claims personnel properly respond to property submitted proofs of loss, e. Training its employees and third-party vendors to appropriately respond promptly to its Insureds’ communications regarding claims, and f. Training its employees and third-party vendors to promptly respond to executed Proofs of Loss.
Comments
User Id Date Added Comment
vfernandez@butler.legal 01-09-2025 Dear Sir/Madam: Western World Insurance Company (“WWIC”) has retained the undersigned, Vincent A. Fernandez, Esq. to represent its interests in the above-referenced claim and to respond to the Civil Remedy Notice of Insurer Violation, Notice No. 796593 (“Civil Remedy Notice”), filed by the Complainant Augustine Land Holding LLC on December 12, 2024. The Civil Remedy Notice is statutorily deficient, and therefore invalid, for multiple reasons. See Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021); Demase v. State Farm Florida Ins. Co., 351 So. 3d 136 (Fla. 5th DCA 2022). First, Complainant is required to identify all those representing WWIC who are most responsible for or are knowledgeable of the facts giving rise to the allegations in the notice. While the Civil Remedy Notice lists two individuals, it also includes a catch all of “any other representatives of the insurer.” If there are additional individuals who have knowledge related to the allegations in the Notice, then the Notice is defective for failing to identify those individuals. The Civil Remedy Notice is defective because it fails to list the specific policy language relevant to the alleged violations. Rather than identifying the provisions truly at issue, the Civil Remedy Notice states that: All policy provisions relate to what is covered under the subject policy of insurance, All buildings coverage provisions, All loss settlement provisions, and All provisions related to any and all lost revenue or rents. These general references to any and all policy provisions does not satisfy the requirement of identifying the specific policy provision relevant to the alleged violations. The Civil Remedy Notice contains no other specific references to particular policy provisions and instead makes blanket references to “all policy provisions.” Therefore, the Civil Remedy Notice fails to identify specific language of these provisions that is directly relevant to the alleged statutory violations. Because the Civil Remedy Notice fails to sufficiently set forth any terms of the policy which are relevant to the alleged statutory violations, the Civil Remedy Notice is defective. The Civil Remedy Notice is also defective because it lists seven vague reasons for its filing, and ten different statutory provisions without any meaningful explanation as to how or why they apply to WWIC’s adjustment of the claim. The section describing the facts giving rise to the Civil Remedy Notice does not provide any information demonstrating how its conduct amounts to bad faith. Instead the Civil Remedy Notice alleges, in boilerplate fashion, wholesale violations of the bad faith statutes. The Civil Remedy Notice does not provide a sufficient factual basis for the selection of statutes WWIC allegedly violated. Rather, the Civil Remedy Notice contains generalized and broad accusations, which do not specifically relate to WWIC’s handling of the claim. Complainant’s narrative contains four specific allegations: (1) there was a loss to its Property on May 10, 2024, (2) WWIC issued almost $17,000.00 to Claimant for the loss, (3) on November 1, 2024, Claimant’s public adjuster provided an unsolicited Sworn Statement in Proof of Loss for an amount in excess of the Building Limit, and (4) WWIC did not respond to the Proof of Loss within 30 days in violation of Florida law. These facts do support the invocation of the statutory provisions alleged to have been violated. We address each of these statutory provisions in turn: 624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all 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. The narrative provided in the Civil Remedy Notice does not provide a sufficient factual basis for the selection of this statutory provision. Rather, the Civil Remedy Notice simply contains generalized and unfounded accusations that WWIC refused to properly settle the claim in good faith. WWIC disputes the allegation it violated Florida Statute § 624.155(1)(b)(1). 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. The narrative provided in the Civil Remedy Notice does not support the selection of this statutory provision. Rather, the Civil Remedy Notice simply contains generalized and unfounded accusations that WWIC did not make payments accompanied by a statement setting forth the coverage under which payments are being made. WWIC disputes the allegation it violated Florida Statute § 624.155(1)(b)(2). 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. The narrative provided in the Civil Remedy Notice does not provide any factual basis for the selection of this statutory provision. Again, the Civil Remedy Notice contains generalized and unfounded accusations that WWIC refused to settle the claim in good faith. WWIC disputes the allegation it violated Florida Statute § 624.155(1)(b)(3). 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims. The narrative provided in the Civil Remedy Notice does not provide any factual basis for the selection of this statutory provision. Rather, the Civil Remedy Notice contains conclusory and inaccurate accusations that WWIC failed to conduct an investigation of the claim with no specific factual examples to support the contention that WWIC has failed to adopt and implement proper standards for the adjustment and investigation of claims. As the above narrative shows, WWIC’ investigation into the claim does not reflect a failure to adopt and implement standards for the proper investigation of claims. To the contrary, WWIC promptly investigated the loss and issued two undisputed payments. Any allegations that the investigation was in any way faulty, deficient, or one-sided are simply conclusory without any factual support. Therefore, WWIC disputes the allegation it violated Florida Statute § 626.9541(1)(i)(3)(a). 626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. The narrative provided in the Civil Remedy Notice does not provide any factual basis for the selection of this statutory provision or even allude to the fact that WWIC made any misrepresentations related to coverage. Therefore, WWIC disputes the allegation it violated Florida Statute § 626.9541(1)(i)(3)(b). 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims; The narrative provided in the Civil Remedy Notice does not provide a sufficient factual basis for the selection of this statutory provision. Like the before, the Civil Remedy Notice contains conclusory and inaccurate accusations with no specific factual examples to support the contention that WWIC failed to acknowledge and act promptly on communications. To the extent Complainant’s allegation that the Proof of Loss was not responded to is the communication referenced by this statutory violation, WWIC has already responded to the same, thus curing any alleged violation. WWIC disputes the allegation it violated Florida Statute §626.9541(1)(i)(3)(c). 626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information. The narrative provided in the Civil Remedy Notice does not provide a sufficient factual basis for the selection of this statutory provision. Rather, the Civil Remedy Notice simply contains conclusory and inaccurate accusations that WWIC denied the claim without conducting a reasonable investigation of the claim. Complainant’s own narrative contradicts this point as its main gripe is not a denial of the claim, but rather underpayment. Therefore, WWIC disputes the allegation it violated Florida Statute § 626.9541(1)(i)(3)(d). 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. The narrative provided in the Civil Remedy Notice does not provide a sufficient factual basis for the selection of this statutory provision. As indicated above, WWIC has responded to the Proof of Loss. Even still, the Civil Remedy Notice contains bare bone accusations with no specific factual examples that support the contention that WWIC failed to comply with the aforementioned statute. WWIC disputes the allegation it violated Florida Statute § 626.9541(1)(i)(3)(e). 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. The narrative provided in the Civil Remedy Notice does not provide a sufficient factual basis for the selection of this statutory provision. Complainant states in the narrative of its Notice that WWIC did not deny the claim. WWIC disputes the allegation it violated Florida Statute § 626.9541(1)(i)(3)(f). 626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim. The narrative provided in the Civil Remedy Notice does not provide a sufficient factual basis for the selection of this statutory provision. Rather, the Civil Remedy Notice contains conclusory accusations that WWIC failed to notify the insured of any additional information needed to investigate the claim. WWIC disputes the allegation it violated Florida Statute § 626.9541(1)(i)(3)(g). As outlined above, the Civil Remedy Notice is vague, inaccurate, and inflammatory. This serialized and impersonal approach is inconsistent with the purpose of the Civil Remedy Notice, i.e., to provide a carrier with specific information supporting the alleged violations so that it may correct course and avoid litigation. Without any information, WWIC is unable to respond to, and more importantly cure the grievances contained in, the Civil Remedy Notice. WWIC specifically denies and disputes the allegations contained in the Complainant’s defective Civil Remedy Notice. The allegations contained within the Civil Remedy Notice are without merit. WWIC’s adjustment and handling of the subject claim was conducted in good faith and in accordance with the requirements of law and the subject policy. Please do not hesitate to contact me should you have any questions regarding the above. Thank you for consideration of this matter. Best Regards, BUTLER WEIHMULLER KATZ CRAIG LLP Vincent A. Fernandez, Esq. vfernandez@butler.legal
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