Civil Remedy Notice of Insurer Violations
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Filing Number:     796737
Filing Accepted:  12/13/2024
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Complainant
Last/Business Name *  
COLLADO GUTIERREZ   First Name   CARMELO
Street Address * 2914 MANSION ROAD
City, State Zip * JACKSONVILLE, FL 32277
Email Address * JESSYKASANABRIA@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   COLLADO GUTIERREZ   First Name   CARMELO
Policy # * 0762507753 Claim #* 7007466124-1-1
Attorney
Attorney is Applicable
Last Name* ELAZAR First Name * SAPIR Initial
Street Address* 800 E BROWARD BLVD., STE. 510
City, State Zip* FORT LAUDERDALE , FLORIDA 33301
Email Address * SE@WEKLAW.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):* N/A
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)(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)(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)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
* 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 Payment Provision. 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.

Carmelo Collado Gutierrez and Jessyka Sanabria (the "Insureds") purchased an insurance policy ("Policy") from Farmers Insurance ("Farmers"), with effective coverage on the date of the loss, on or about January 11, 2024, and policy number 0762507753 to insure the property located at 2914 Mansion Rd., Jacksonville, FL 33837 (the "Property"). On or about January 11, 2024, the Property suffered severe damage as the result of wind, hail and rain which caused ensuing damage to the Property, including but not limited to the roof, exterior and interior of the Property (the "Loss"). Farmers was timely notified of the Loss on April 26, 2023. Farmers acknowledged the claim and assigned claim number 7007466124-1-1 ("Claim") to the Loss. From the onset, it was clear to the Insureds that Farmers had one goal - to reduce or eliminate their liability in the claim. Farmers delivered a coverage determination that misrepresented the material facts of the claim and relied on a faulty and disingenuous inspection report. Farmers thus denied the Insureds the full benefits they are rightfully entitled to without properly evaluating the documentation and proof provided by the insureds. Frustrated with Farmers denial and confused as to their rights under the policy, the Insureds were forced to retain the services of a public adjuster, Mister Claims Public Adjuster and legal counsel. The property was inspected by Mr. Claims as to the damage to the property and generated a true and accurate estimate of the damages in the amount of $38,838.91. Despite multiple requests from the Insureds pleading that Farmers reconsider their position, Farmers refused to provide the Insureds with the funds needed to return the property to its pre-loss condition. The Insureds have fully complied with all applicable policy provisions requiring cooperation with the investigation, however Farmers is unjustifiably and unreasonably denying payment to the Insureds. Rather than paying the actual damages and/or trying to settle with the Insureds, Farmers is delaying a prompt resolution of the claim. Additionally, Farmers has not attempted, in good faith, to settle this claim when, under the circumstances, it could and should have done so had it acted fairly and honestly toward the policyholder and with due regard to the policyholder’s interests. As a direct consequence of Farmers failure to adjust this loss in good faith and make any supplemental payment, the Insureds continue to be without adequate compensation for the damages sustained at their Property. By stating the above detailed facts, it is clear that Farmers has violated the following Florida Statutes: • 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 Insureds and with due regard for their interest; when Farmers denied coverage on the Insureds’ claim. • 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, by failing to respond to the Insureds’ public adjuster, and Insureds’ counsel with respect to supplemental requests for payments; • 626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information. • 626.9541(1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the Insureds and/or their public adjuster of the basis in the insurance policy, in relation to the facts or applicable law, for the offer of a compromise settlement; • 626.9541(1)(i)(4) Failing to pay any undisputed amounts of partial or full benefits owed under first-party property insurance policies within 90 days after an insurer receives notice of a residential property insurance claim, determine the amounts of partial or full benefits, and agree to coverage, when Farmers failed to release any undisputed amount of the claim to the Insureds. To date, Farmers has in bad faith failed to provide a sufficient coverage determination to the Insureds. The Insureds property continues to be in disarray as the Insureds are without funds to put their property into its pre-loss condition. As a direct result of Farmers denial of coverage and breach of Florida Statutes, the Insureds were forced to seek the help of licensed professionals to assist them, including a public adjuster and legal counsel. Due to the amount of time that has passed since the date of loss, the information discussed above is irrefutable evidence that Farmers knowingly and intentionally, and in bad faith delays the claims process in order to further disadvantage the Insureds. The financial detriment caused to the Insureds is a direct result of Farmers reckless treatment of the claims process. The Insureds submitted all documents requested in a timely fashion, made their property available for inspection, submitted supplemental invoices, estimates and requests. However, Farmers failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim. To deny the Insureds the benefit clearly due and owing under the Policy, for which they have time and time again been making premium payments for and after they have satisfied all their obligations is morally and ethically reprehensible, and reeks of Unfair Claims Practice and Bad Faith. Upon information and belief, the aforementioned actions complained of, among others, were made by Farmers so often as to constitute a general business practice, evidencing a motive to enhance Farmers profits, and designed to cause a detrimental effect to its policyholders. The above clearly shows that Farmers adjusted this claim in bad faith and that Farmers is in direct violation of Unfair Claims Practices. This notice was given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should Farmers fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, Farmers must: (1) Immediately tender all proceeds due and owing the Insureds that are fairly owed to the Insureds under the insurance policy that would reasonably compensate the Insureds in order to put the loss property back to its pre-loss condition; (2) Agree to reimburse the Insureds reasonable attorneys’ fees and costs for having to become involved to resolve the claim; (3) Agree to reimburse the Insureds for interest on the amount of benefits that was found to be due and owing to the Insureds, relating back to the date of loss.
Comments
User Id Date Added Comment
egonsalves@rolfeshenry.com 02-10-2025 This correspondence is Truck Insurance Exchange’s response to the Civil Remedy Notice filed on December 13, 2024, by Attorney Sapir Elazar on behalf of Carmelo Collado Gutierrez (“Complainant”) and assigned Filing Number 796737. Truck Insurance Exchange maintains that the Civil Remedy Notice should be deemed deficient in its entirety because it fails to comply with the specific information requirements as set forth in Civil Remedy Notice of Insurer Violation document provisions as set forth in Florida Statute § 624.155 and Florida Case law, including the specific cure provisions. After reviewing the Civil Remedy Notice, Truck Insurance Exchange, through its agents, conducted a thorough review of its handling of Carmela Collado Gutierrez and Jessyka Sanabria (hereinafter “Insured”) claim. Truck Insurance Exchange denies that it violated any statutes, administrative code provisions, or ethical rules or obligations in connection with its investigation and handling of its Insured’s claim. At all times, Truck Insurance Exchange acted in good faith, fairly and honestly toward its Insured, and with due regard for the interests of its Insured. Truck Insurance Exchange denies each and every alleged claimed violation set forth in the Civil Remedy Notice. The allegations in the Civil Remedy Notice are false. On or about April 18, 2024, the Insured reported a claim for wind damage to the subject property. The reported date of loss is January 11, 2024; therefore, the claim was reported more than three (3) months after the reported date of loss. The claim was immediately assigned to a Field Claims Representative who promptly acknowledged the claim and communicated with the Insured’s representative in order to begin investigating the Insured’s claim. Truck Insurance Exchange sent an experienced professional to inspect the claimed loss and to determine the cause and extent of any damages. The inspection did not reveal any evidence of wind or hail-related damage, and instead revealed evidence of wear, tear, and deterioration, which is not covered by the subject policy. On May 22, 2024, Truck Insurance Exchange issued a denial letter which outlined the basis of its coverage decision, specifically noting that the inspection revealed no evidence of wind- or hail-related damage. The Complainant vaguely asserts various violations of Florida Statute Sections 624.155 and 626.9541, however, he does not state upon what evidence these assertions are based. In short, the Civil Remedy Notice only makes conclusory statements of bad faith, unfair claim settlement practices, and unfair trade practices, but does not state how and why the actions of Truck Insurance Exchange constitutes these practices. The Civil Remedy Notice cites no documents, evidence, or other information which would support any of these allegations. The Civil Remedy Notice is replete with generalities as to the claimed statutory violations and fails to specifically identify any person or persons who are responsible for the alleged violations. The Civil Remedy Notice fails to adhere to the requirement of specificity as outlined in Florida Statute Sections 624.155 and 626.9541. The obvious reason for this lack of specificity is because no bad faith, unfair settlement practices, or unfair trade practices occurred. The Civil Remedy Notice alleges Truck Insurance Exchange violated Florida Statue §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(d) and 626.9541(1)(i)(4), by refusing to in good faith settle claims when it could and should have done so, by failing to promptly settle claims when the obligation to settle has become clear and by denying claims without conducting reasonable investigations based upon available information. To the contrary, Truck Insurance Exchange acted in good faith at all times and with due regard for its Insured’s interests. Truck Insurance Exchange promptly sent a competent professional to inspect the property and did not observe any covered damage. The Civil Remedy Notice is alleging that Truck Insurance Exchange should have settled a claim and paid benefits although no covered damages were observed during the investigation of the claim. Truck Insurance Exchange acted honestly and fairly by having a professional evaluate the loss and make an objective determination as to the cause of any damage, if any damage was found. As such, no violation occurred with respect to these sections of the statute. Next, the Civil Remedy Notice alleges Truck Insurance Exchange violated Florida Statute §§ 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). Truck Insurance Exchange, itself and through its respective agents, has at all times adopted and implemented proper standards for the investigation of claims. Additionally, Truck Insurance Exchange has not misrepresented any facts or insurance policy provisions. The Civil Remedy Notice does not state with specificity what exactly has been misrepresented and provides no evidence to support these allegations directly or even circumstantially. Further, Truck Insurance Exchange has promptly acknowledged and promptly acted upon communications from the Insured with respect to their claim and provided its coverage decision in writing to the Insured. As indicated above, Truck Insurance Exchange properly and promptly sent a competent professional to inspect the premises and claimed damage. The inspection did not reveal any evidence of covered damage and Truck Insurance Exchange promptly informed the Insured and their representative of these findings, in writing, and the basis of the coverage decision. Truck Insurance Exchange has acted reasonably and promptly with regard to the Insured’s claim. As such, no violation occurred with respect to these statutes. Finally, with respect to the methods of curing the purported violations set forth in the Civil Remedy Notice, Truck Insurance Exchange has thoroughly, properly and promptly investigated the subject claim. Truck Insurance Exchange disputes that it owes any payment to the Insured for the subject claim as its investigation did not reveal covered damage. Truck Insurance Exchange sent a competent professional to perform an objective investigation of the claimed damages and timely and properly adjusted the Insured’s claim. Truck Insurance Exchange has acted fairly and honestly towards its Insured and with due regard for their interests in resolving their claim. With respect to the demand that Truck Insurance Exchange tender payment to restore the property to its pre-loss condition, and for attorneys’ fees, costs, and interest, that request is respectfully denied. Truck Insurance Exchange’s inspection did not reveal damage covered by the Insured’s insurance policy. Based on the foregoing, Truck Insurance Exchange has not violated any statutes, ordinances or administrative codes identified in the Civil Remedy Notice. Truck Insurance Exchange promptly and properly investigated the Insured’s claim. The Insured has failed to provide any documents or evidence demonstrating that the alleged damage was covered under the insurance policy. The Insured has only provided an estimate of damages and demanded full payment without evidence to substantiate the cause of those claimed damages and that the claimed repairs are warranted. Truck Insurance Exchange will not be issuing any payment on the Insured’s claim, unless and until additional information is provided supporting the claimed damage. As noted above, the Civil Remedy Notice is broad in scope, replete with generalities as to the claimed statutory violations and fails to specifically identify the exact policy language that is relevant to the alleged violation or any person or persons who are responsible for the alleged violations. The Civil Remedy Notice fails to adhere to the requirement of specificity as outlined in Florida Statute Sections 624.155 and 626.9541, as well as Junior Julien v. United Property & Casualty Insurance Company, 311 So. 3d 875 (Fla. 4th DCA 2021)(“the plain language of section 624.155(3)(b) instructs the policyholder to “state with specificity” information in the notice; to specify “language of the statute, which the authorized insurer allegedly violated”; and to “[r]eference . . . specific policy language that is relevant to the violation, if any.”) For these reasons, as well as all others foregoing, Respondent respectfully requests the Notice be denied or dismissed, and that no weight be afforded to the submission. Truck Insurance Exchange does not waive or intend to waive any rights or remedies it may have with respect to the Insured’s claim. Truck Insurance Exchange specifically reserves all rights and defenses under the subject policy and Florida law. Truck Insurance Exchange does not waive any of the terms, conditions, limitations, or exclusions of the subject policy.
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