Civil Remedy Notice of Insurer Violations
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Filing Number:     796611
Filing Accepted:  12/12/2024
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Complainant
Last/Business Name *  
JUSTIN GAYARAM   First Name  
Street Address * 1511 W 15TH ST
City, State Zip * JACKSONVILLE, FL 32209
Email Address * JGAYARAM@HOTMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   JUSTIN GAYARAM   First Name  
Policy # * NF033FL0311395 Claim #* EV2023033922
Attorney
Attorney is Applicable
Last Name* NORTON First Name * DANIEL Initial
Street Address* 925 S. FEDERAL HWY
City, State Zip* BOCA RATON , FL 33432
Email Address * DNORTON@KPATTORNEY.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   NATIONAL FIRE & MARINE INSURANCE COMPANY
NAIC Company Code 20079
 
Name of individual responsible for violation (if any):* CINDY CARTER
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unfair Trade Practice
Unsatisfactory Settlement Offer
* 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)(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.

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.

The carrier was put on notice of the insured’s property damage claim. The claim was for the total loss to the property of $388,500.00. The carrier initially attempted to low-ball the claim. Subsequently, the insured prepared a loss package in the amount of the total loss to the property of $388,500.00 needed to restore the property back to its pre-loss condition. The carrier made a payment of $273,533.54. Whereas, the carrier furnished a wrongful estimate and, having withheld the deductible, offered a deficient payment in the amount of $34,500.74 only, leaving a remainder in the amount of $114,967.00 to be paid in order to cure the breach, less any applicable policy deductible. The insured has 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. About five hundred eighty days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of damage sustained by the insured’s property and has not taken any meaningful ensuing action. It is clear that the carrier is not treating the insured with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insured; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insured’s interests; refusing to pay the full amount owed to the insured despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insured, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The carrier’s actions are in violation of Florida Statutes §§ 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) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. 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 disregard 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 $323,737.52, less any prior payments and less any applicable policy deductible; and 2.) 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 Maria Victoria Pescador at (561)-892-9842 if you have any questions or concerns. Sincerely, Daniel Norton Attorney at Law
Comments
User Id Date Added Comment
gkelly@butler.legal 01-31-2025 This firm represents National Fire & Marine Insurance Company (“Insurer”) and has been requested to respond to the Civil Remedy Notice of Insurer Violations (“Notice”) submitted by Daniel Norton, Esq. on behalf of Justin Gayaram (“Claimant”), bearing an accepted date of December 12, 2024. As such, this response is timely. The Insurer asserts that the Notice fails to comply with the requirements set forth in the Notice document provisions, as set forth in Florida Statutes § 624.155 and Florida case law. Without waiving the deficiencies and failures to comply, the Insurer responds as follows: In the Notice, the Claimant alleges the Insurer violated various subsections of Florida Statutes §§ 624.155 and 626.9541 with regard to a claim for fire damage to the property located at 1511 W 15th St., Jacksonville, Florida 32209, reported by the Claimant under a policy of insurance issued by the Insurer. The Notice generally alleges that the “Reason[s] for the Notice” are “Claim Delay,” “Unfair Trade Practice,” and “Unsatisfactory Settlement Offer.” The Insurer categorically denies that the Insurer or any of its representatives, agents, or employees engaged in any prohibited conduct, violated any of the statutes referenced in the Notice, or breached any provision of the subject policy of insurance with respect to this claim. The Notice is vague and deficient in describing the facts and circumstances giving rise to the Insurer’s alleged violations. The Notice is also deficient because it includes several provisions of Florida Statutes §§ 624.155 and 626.9541, regardless of whether they are relevant or applicable to the alleged facts contained in the Notice. The Notice is also deficient because it identifies NF&M as an “Authorized Insurer” when in fact NF&M is a non-admitted surplus lines carrier. Despite the various deficiencies in the Notice, the Insurer acted in good faith, without delay, and with due regard to its insured’s interests at all times during the investigation and handling of the claim. A detailed response to the Notice was sent via e-mail to counsel for the Claimant. If the Department has any questions or requires any additional information, please contact us.
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