Civil Remedy Notice of Insurer Violations
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Filing Number:     796829
Filing Accepted:  12/13/2024
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Complainant
Last/Business Name *  
JAMES MANSIUS   First Name  
Street Address * 2807 ROCELLA CT,
City, State Zip * KISSIMMEE, FL 34747
Email Address * JDMANSIUS@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   JAMES MANSIUS   First Name  
Policy # * OIC30057607-03 Claim #* 22FLHOV0014384
Attorney
Attorney is Applicable
Last Name* WILKES First Name * LEVI Initial
Street Address* 925 S. FEDERAL HWY
City, State Zip* BOCA RATON , FL 33432
Email Address * LWILKES@KPATTORNEY.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   OLYMPUS INSURANCE COMPANY
NAIC Company Code 12954
 
Name of individual responsible for violation (if any):* KYLE PALMER
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
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)(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 Hurricane Ian claim regarding roof and interior damages. Olympus Insurance Company has been provided with a Contract for completed Services in the amount of $49,500 from RRCA Roofing and Reconstruction and its subcontractor United Solutions of Central FL LLC for $7,200.00. The insured has attempted to follow-up with the carrier multiple times regarding the status of the claim settlement based on the completed service but has been ignored by the carrier. 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. More than two years 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 the damage sustained by the insured’s property and has not taken any meaningful ensuing action. During litigation it was furthermore learned that the carrier during the claims process it failed to assign a licensed field adjuster and instead engaged contractor (Neumann Construction and its employee Gabriel Garcia) to inspect the home for damages, identify damages and determine their cause and document damages which was neither a licensed adjuster or an authorized agent as per Chapter 626 (Part VI). The use of unlicensed personnel is a pattern and practice of the carrier in an effort to use personnel which will result in predictable outcomes in favor of the carrier. Mr. Garcia, due to his lack of education, identified water intrusion into the home yet failed to inspect the attic and failed to find where said rainwater was entering. 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 $56,700, 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; 3) pay all reasonable attorney’s fees and costs associated with the lawsuit filed against the carrier. 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 Paula Souza at (561)-892-9748 if you have any questions or concerns. Sincerely, Levi Wilkes Attorney at Law
Comments
User Id Date Added Comment
LVick@bressler.com 02-11-2025 Via U.S. Mail, Certified Mail and E-mail: LWILKES@KPATTORNEY.COM Levi Wilkes, Esq. Kanner & Pintaluga 925 S. Federal Highway Boca Raton, FL 33432 Complainant(s): James Mansius Policy #: OIC30057607-03 Claim #: 22FLHOV0014384 DFS Filing #: 796829 Dear Mr. Wilkes: Please accept this response on behalf of Olympus Insurance Company (hereinafter “Olympus”) to the Civil Remedy Notice of Insurer Violations (hereinafter “CRN”) No. 796829, filed on behalf of James Mansius (hereinafter, the “Complainant” or the “Insured”), and accepted by the Florida Department of Financial Services on December 13, 2024. The Civil Remedy Notice (“CRN”) alleges that Olympus violated the following 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 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. Please accept this as Olympus’ response to the above-referenced CRN filed with the Department of Financial Services by the Complainant, James Mansius. To summarize the below, Olympus hereby denies any allegation of not attempting to settle claims in good faith when it could and should have done so; failing to promptly settle claims when the obligation to settle a claim has become reasonably clear; failing to adopt and implement standards for the proper investigation of claims; misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; failing to acknowledge and act promptly upon communications with respect to claims; and failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy for denial of a claim or for the offer of a compromise settlement, and states that it has at all times handled and adjusted the Complainant’s claim with utmost good faith. Simply put, Olympus denies any acts or omission that could be construed or found to be deemed bad faith and/or a violation of Florida Statutes § 624.155 and § 626.9541, whether expressly stated in the Civil Remedy Notice or implied. Any and all allegations of bad faith are hereby denied and rejected in their entirety by Olympus. Beyond Olympus’ adamant belief that it acted with the utmost good faith, the CRN is deficient and fails to preserve any and all claims for statutory bad faith under Florida Law. As an initial matter, Olympus denies and rejects the instant CRN as it fails to comply with the requirements of Florida Statute § 624.155. The CRN is therefore deficient and fails to preserve any and all claims for statutory bad faith under Florida Law. Florida Statute § 624.155 requires a complainant to file with the Department of Financial Services a Civil Remedy Notice which shall be “on a form provided by the [Department] and shall state with specificity…such other information as the Department may require.” The instant CRN fails to provide the specificity required by § 624.155. Therefore, the instant CRN is facially deficient. See Bay v. United Servs. Auto. Ass’n, No. 4D19-3332, 2020 WL 6154256 (Fla. 4th DCA Oct. 21, 2020). Furthermore, the CRN’s attempt to identify the specific policy language relevant to the violation is woefully deficient. “Courts have found that listing whole sections of the insurance policy constitutes insufficient specificity.” See Fox v. Starr Indem. & Liab. Co., No. 8:16-CV-3254-T-23MAP, 2017 WL 1541294 at *2 and Julien v. United Property & Casualty Insurance Company No. 4D19-2763 (Fla. 4th DCA 2020).” When prompted to reference the policy language that is relevant to the alleged violation, the Complainant lists one specific heading contained within the insurance policy, “Loss settlement provision.” This is a clear acknowledgement and dismissal of the required information by the Complainant – instead of including any relevant policy language contained within the section indicated by the Complainant, they only copied the three-word section heading. Additionally, the section of the policy cited is irrelevant to the subject claim. The Loss Settlement provision states “[w]e will settle covered property losses according to the following,” the provision governs the payment of covered claims. However, the subject claim is a denied claim, therefore, the loss settlement provision has not been applied and could not have been violated. Therefore the subject CRN fails to provide any notice at all of how Olympus allegedly violated the subject policy in bad faith. The Complainant’s failure to comply with the baseline requisite form requirements, is insufficient under Florida law to support any action for bad faith against Olympus without speculation on its part. Accordingly, the CRN does not provide the contemplated and mandated notice of alleged bad faith that is required as a condition precedent to any civil claim for bad faith pursuant to Florida Statute § 624.155. Julien v. United Property & Casualty Insurance Company No. 4D19-2763 (Fla. 4th DCA 2020). Failure to provide specific reference to any relevant policy language is direct and clear noncompliance with the requirements of Florida Statute § 624.155, and therefore renders the CRN deficient on its face as to form and substance. For these reasons alone, the CRN fails at its inception. Additionally, the CRN fails to provide a complete description relating to the facts and/or circumstances which give rise to the alleged statutory violations, thus, prejudicing Olympus from providing any meaningful or complete response. In summary, the CRN is hardly more than a recitation of a number of Florida statutory provisions, with minimal factual allegations in support of the conclusory statutory recitations. A Civil Remedy Notice must state the facts and circumstances that give rise to an alleged violation with specificity sufficient to allow an insurer to cure the alleged violation within the sixty-day statutory period. Lane v. Westfield Insurance Company, 862 So.2d 774 (Fla. 5th DCA 2003). The instant CRN therefore fails to comply with the requirements of Florida Statute § 624.155(3), which requires that a CRN of insurer violation “state with specificity,” inter alia, the facts and circumstances giving rise to the violation and the “specific” language of the subject insurance policy that is relevant to the violation. The CRN fails to specify what was lacking in Olympus’ investigation and fails to specify facts which support that its investigation was unfair or carried out in bad faith. Olympus properly investigated and denied the subject claim. The CRN further lacks any specificity, facts, or rationale which indicate that Olympus’ coverage determination should have been different. Moreover, the few facts that are stated in the CRN are contrary to the facts of the underlying claim or are at best misleading. The CRN starts off by indicating that “[t]he carrier was put on notice of the insured’s Hurricane Ian claim” but without advising that the claim was not reported to Olympus until February 5, 2024, four-hundred ninety-five days after the loss occurred and after the Insured previously reported the same damage to Citizens Insurance Company with a date of loss of December 17, 2023. The CRN goes on to claim that Olympus was put on notice of “a Contract for completed Services in the amount of $49,500 from RRCA Roofing and Reconstruction and its subcontractor United Solutions of Central FL LLC for $7,200.00” but misleadingly does not include the fact that these documents were not provided to Olympus until the claim was in litigation. The CRN then states that the “insured has complied with all of the carrier’s request to date and the carrier has still failed to treat this claim with good faith.” The contract entered into with RRCA Roofing is dated January 30, 2024, on February 6, 20204, Olympus submitted to the Insured a Request for Information seeking “Repair Estimates/Invoices”: Submit all related estimates, invoices, contracts, photos and supporting documentation related to this loss” however, as previously indicated the contract of RRCA Roofing was not provided to Olympus until approximately August 26, 2024, in response to discovery requests made by the Defendant in litigation yet they clearly had been entered into at the time of Olympus’ request and should have been supplied in response to Olympus’ request. The Complainants statement that the Insured complied with all requests of the carrier is demonstrably false. Most egregiously, the CRN states “[t]his intentional delay with the claim has led to direct prejudice of the insured. More than two years have passed since the original date of loss.” These statements and this paragraph as a whole implies that the Insured timely and completely complied with the carrier’s requests and Olympus is improperly refusing to pay for the damages. While it has been more than two years since the date of the loss the CRN conveniently omits the fact that the claim was not reported to Olympus until 1 year and 4 months and eight days (495) days after it occurred. It is not Olympus who significantly delayed the claim, the majority of the two year time lapsed can be accounted for by the delay of the Insured! Subsequently, the CRN attempts to implicate Olympus as having failed to appoint a licensed adjuster to the claim. However, Olympus’ at all times had a licensed in house claims adjuster assigned to the claim who reviewed the inspection reports, correspondences to and from the Insured and assisted Olympus in the determination of the claim. The CRN fails to point to a requirement that a licensed adjuster visit the subject property themselves because none exists. Olympus’ adjuster relied on the opinions of experts, specifically a licensed roofer, Neumann Construction, and a licensed engineer, Joseph Stallings, P.E., of Grindley Williams Engineering, who each performed inspections of the property and provided their findings to Olympus. It is Olympus’ position that this claim was investigated with experts arguably more qualified than a licensed field adjuster and was at all times handled and overseen by a licensed in-house adjuster at Olympus. The CRN alleges, “[i]t is clear that the carrier is not treating the insured with good faith claims conduct; … 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 recover to the insured, when a reasonable carrier in a similar position would have tendered a full payment”. Ironically, in this case, another carrier in a similar position did inspect and adjust this claim because the exact same damages reported to Olympus were first reported to Citizens Insurance Company, and Citizens came to the exact same conclusion as Olympus and denied the claim. Citizens issued a denial of the claim which was first provided to Olympus in response to its discovery requests after litigation had ensued. Citizens found that the “damage caused by wear and tear, and deterioration is not covered”, Olympus’ Engineer reached the same conclusions. Olympus’ Engineering inspection revealed that no evidence of storm-related and/or wind-related damage, and attributed the damage to expansion, contraction, foot traffic, improper installation, and normal age-related wear. In written correspondence to the insured dated January 16, 2024, Citizens denied the subject claim, and on May 29, 2024, Olympus without knowledge of the investigation performed by Citizens reached the same conclusions and denied the subject claim. In direct refutation of the allegation that Olympus failed to provide 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 the claim”, Olympus on May 29, 2024, sent the Insured written correspondence advising of the conclusions reached by the Engineer and the policy language which applied resulting in the exclusion of the covered damages. The letter also explained the Insured failure to timely report the loss to Olympus which resulted in prejudice to the investigation, inhibiting Olympus ability to identify and correlate the damages alleged to the date of the loss and explaining that their failure to timely report the claim was a breach of their duties under the Policy of Insurance which warrants denial of the subject claim. The Complainant has provided nothing but false allegations and failed to assert facts or evidence to support that Olympus acted in bad faith. Despite the timing of the claim and its late-reporting, Olympus promptly and thoroughly investigated the subject claim and reached its coverage determination based upon its complete understanding of the facts. In addition to the false allegations regarding the subject claim the CRN goes on to make egregious and baseless allegations that Olympus is engaged in 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…”. These are serious blanket allegations made without one scintilla of factual evidence in support of any of such claims. As demonstrated by the facts outlined above, the allegations made as to the subject claim and demonstrably false, and these claims and completely unsupported. Olympus diligently investigated the subject loss even after it was reported exceedingly late, repeatedly and routinely communicated with the insured Complainant, and acted based upon the facts it discovered throughout its investigation of the claim and according to the terms of the insurance contract. Lastly, the Complainant’s cure demand is indiscernible and as such Olympus is not given a fair opportunity to cure the CRN. The CRN states: “Therefore, to cure the defects outlined in this [CRN], [Olympus] must: 1.) Pay the complete covered loss in the amount of $56,700, 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; 3.) pay all reasonable attorney’s fees and costs associated with the lawsuit filed against [Olympus].” This is the functional equivalent of “Pay me everything I’ve asked for.” Rousso v. Liberty Surplis Ins. Co., 2010 WL 736059, *5 (S.D. Fla. 2010). “Insurers are not required to pay any amount demanded by their insureds to avoid a bad-faith claim.” Id. (citing 316, Inc. v. Maryland Cas. Co., 625 F. Supp. 2d 1187, 1194 (N.D. Fla. 2008)). However, regardless of its legitimacy, the CRN itself contains a cure in the form of an admission of liability and Olympus cannot even begin to attempt to cure the instant CRN on such unclear terms. In addition to demanding “everything I’ve asked for,” the cure is unclear as to what it’s asking for beyond the stated monetary amount. The cure provides no basis for Olympus to even attempt to calculate what it seeks when demanding several unclear payments and reimbursements to both the insured Complainant as well as their attorneys, and then interest purportedly owed on top of those indeterminate amounts. The cure requires Olympus to speculate as to what amounts could possibly be constitute the demanded “attorneys’ fees and costs.” There is no guidance on the face of the CRN, or in any documents provided to Olympus, that could possibly allow Olympus to ascertain this amount. As such, Olympus was not provided with a reasonable opportunity to purge any alleged violations. See Kafie v. NorthWestern Mut. Life Ins. Co., 834 F. Supp. 2d 1354, 1359 (S.D. Fla. 2011) (“In order to demonstrate good faith, ‘[t]he insurer must investigate the facts, [and] give fair consideration to a settlement offer that is not unreasonable under the facts . . . .’”). The cure demand is merely an attempt to deceive Olympus into issuing some ambiguous payment rather than defending itself against a threat of bad faith when no bad faith is remotely existent anywhere throughout the instant claim. Based on the facts provided, it is impossible for Olympus to satisfy the Complainant without significantly prejudicing itself, and therefore the CRN fails to provide a true and feasible cure method. Accordingly, the CRN does not provide the contemplated and mandated notice of alleged bad faith that is required as a condition precedent to any civil claim for bad faith pursuant to Florida Statute § 624.155, for these reasons, the CRN fails. As outlined above, contrary to the allegations made by the CRN, Olympus sufficiently and diligently investigated the loss. Olympus maintains that it has acted fairly and honestly toward the Complainant, and any other person having an interest in the subject policy or assisting the Complainant in connection with the instant claim. Olympus consistently and promptly communicated with the Complainant and/or their agents throughout all stages of the investigation and conducted a thorough investigation in good faith. To the extent that the instant CRN is intended to address any other facts or circumstances which purport to establish additional coverage for the reported losses, the CRN provides insufficient identification of any such facts or circumstances and therefore prevents Olympus from addressing any other aspect herein. Notwithstanding, Olympus believes that the above facts demonstrate beyond dispute that it has at all times acted in good faith with regard to its investigation of the subject claim, and further believes that the facts provided to date fail to establish that it has not adjusted the reported loss in accordance with the express terms, provisions, limitations and exclusions contained within the policy. If we can provide any additional information, or be of any further assistance, please do not hesitate to contact us at your earliest convenience. Very truly yours, s/ Lisa G. Vick, Esq. _ Lisa G. Vick, 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