Civil Remedy Notice of Insurer Violations
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Filing Number:     796916
Filing Accepted:  12/16/2024
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Complainant
Last/Business Name *  
BRITANICO; FRIO   First Name   ORLINDA; REY E R
Street Address * 207 NW FLORESTA DR.
City, State Zip * PORT SAINT LUCIE, FL 34983-86
Email Address * RONSY73@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   BRITANICO; FRIO   First Name   ORLINDA; REY E R
Policy # * OL30114689-10 Claim #* 23FLHOV0014401
Attorney
Attorney is Applicable
Last Name* BRAZ First Name * TAMARA Initial
Street Address* 8865 COMMODITY CIR. STE. 12
City, State Zip* ORLANDO , FL 32819
Email Address * TBRAZ@THELAWGICALFIRM.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):* ? BAILEY EADES, CLAIM SPECIALIST ON BEHALF OF OLYMPUS INSURANCE COMPANY ? AMANDA BUENO, INDEPENDENT ESTIMATOR ON BEHALF OF OLYMPUS INSURANCE COMPANY ? GABRIEL GARCIA, FIELD ADJUSTER ON BEHALF OF OLYMPUS INSURANCE COMPANY
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Unfair Trade Practice
Other : Improper Investigation
* 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.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

OL HO 100 09 21 *** SECTION I – PERILS INSURED AGAINST *** 1. We insure for sudden and accidental direct physical loss to covered property described in Coverage A and Coverage B unless the loss is otherwise excluded or limited in this policy[.] *** SECTION I - CONDITIONS B. Duties After Loss is deleted and replaced by the following: After a loss to which this insurance may apply, you shall see that the following duties are performed: 1. Duties of an “Insured”: a. Promptly give notice to us or our agent[...] d. Protect the property from further damage [...] e. You must submit to us, within 60 days after our request, your signed, sworn proof of loss, which sets forth, to the best of your knowledge and belief[...] h. As often as we reasonably require [...] (1) Show us the damaged property and the cause of loss and the condition it was in at the time of loss, if possible, except as to any repairs performed [...] (2) You must be present at our inspection and assist in identifying the damaged property during the inspection [...] (4) Provide us with records, photos, and documents we request and permit us to make copies [...] i. Promptly produce any updates to the documents and information above, including revised descriptions of loss, scope of loss, estimates, or other supporting information [...] ***
 
* 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 April 26, 2023, Orlinda Britanico and Rey E R Frio (Complainants) suffered a loss to their Property, located at the address listed above. After discovering the damage, Complainant(s) reported the loss to Olympus Insurance Company (“Insurer”) on or about February 7, 2024. Throughout Insurer’s investigation, Complainants have fully cooperated with Insurer and fully performed all duties and obligations under the policy by providing all information within Complainants custody, possession and control. Insurer, however, has failed to fulfill its duties under the Policy and Florida law. Upon discovering damage to the subject property, Complainants retained the services of AskAnAdjuster (hereinafter “Public Adjuster”) on or about February 7, 2024. A Letter of Representation was sent to Insurer the same day. Subsequently Insurer acknowledged the representation. On or about February 26, 2024, a cursory inspection took place with the Public Adjuster, Insurer’s Field Adjuster, and a consultant from Neumann Construction and Roofing LLC (hereinafter “Neumann”), Amanda Buenos. After assessing the damages, the Public Adjuster produced a photo sheet and an estimate, totaling $46,403.30. Insurer, however, failed to conduct a proper investigation. Insurer did not send a qualified Field Adjuster to inspect the property. In fact, upon information and belief, Insurer sent company personnel who does not hold an adjuster’s license. The alleged Field Adjuster failed to provide the Public Adjuster a valid field adjuster’s license on the day of the inspection. Further, on or about March 6, 2024, an agent on behalf of the Public Adjuster emailed Insurer inquiring, again, about the Field Adjuster’s license number. To date, Insurer has not responded or provided a valid field adjuster’s license number. Here, Insurer was in clear violation Fla. Stat. 627.70131(3)(b), which states if such investigation involves a physical inspection of the property, the licensed adjuster assigned by Insurer must provide the policyholder with a printed or electronic document containing his or her name and state adjuster license number. Despite multiple requests by Complainant and their agents, Insurer still failed to provide the field adjuster’s license number. On or about March 14, 2024, Insurer issued a coverage determination that resulted in a denial of coverage. A coverage determination was issued by Insurer on or about March 14, 2024, with which coverage was denied. The determination relies on the findings of the consultant from Neumann, citing “no storm related damage was found to the exterior elevations and the screen and down spouts damage is from wear and tear”. However, the consultant from Neumann who was present for the inspection was not qualified to determine causation. She holds no adjuster’s license, nor a professional license. In fact, upon information and belief, Buenos is a senior estimator at Neumann, whose qualifications are similar to that of an adjuster. Neither person on behalf of Insurer was qualified to make any sort of determination towards causation of the damage. Insurer has made no efforts to properly inspect the property using qualified personnel. Further, despite being in possession of the Public Adjuster’s estimate, Insurer refuses to review the supplemental evidence and reassess its initial coverage determination. Overall, it is clear that Insurer wholly failed to investigate causation, having relied solely on individuals whose qualifications are questionable, an alleged field adjuster who refused to provide their adjuster’s license number, implying a lack of proper licensure, and an alleged roof consultant who holds no professional licenses. This policy is not in line with Insurer’s duty a “fair and honest treatment of the claimant” as it seeks only to protect Insurer’s interests. Based on the events described above, it is clear that Insurer conducted an improper investigation by a poorly trained adjuster to intentionally minimize its liability, contrary to the policy and Florida law’s requirements. Moreover, Insurer has misrepresented pertinent facts and/or insurance policy provisions relating to coverages at issue, and delayed the resolution of the claim by engaging in conduct to deny or reduce recovery to the Insureds. These tactics are believed to be the general business practices of this Insurer. Insurer can cure its bad faith conduct by: 1) accepting the Insureds’ damage claim as compensable, and agreeing to pay the claim in accordance with the policy in the amount of $43,903.30, plus interest, prior to the expiration of the cure period, 2) reviewing and responding to all communications from the Insureds and their agents. PLEASE GOVERN YOURSELF ACCORDINGLY.
Comments
User Id Date Added Comment
gcrawford@bressler.com 02-07-2025 Dear Ms. Braz: Please accept this response on behalf of Olympus Insurance Company (“Olympus”) to the Civil Remedy Notice No. 796916, filed on behalf of Orlinda Britanico and Rey E R Frio (“Insureds” or “Complainants”), and accepted by the Florida Department of Financial Services on December 16, 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. 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims. 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. To summarize Olympus’s response to the allegations in Complainants’ Civil Remedy Notice, Olympus hereby denies any allegation of bad faith, and states that it has at all times handled and adjusted the subject claim with utmost good faith. Olympus hereby rejects any allegation of bad faith, failure to conduct a proper investigation, and claim denial without conducting a reasonable investigation, as well as any other violation of any of the statutory sections cited and referenced in the CRN. In fact, the Complainants’ Civil Remedy Notice is devoid of any real factual allegations to support any of the violations alleged. Olympus denies any act or omission that could be construed or found to be deemed bad faith and/or a violation of Florida Statute § 624.155 and § 626.9541. A CRN 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). Moreover, the CRN fails to apprise Olympus of any actions that rise to the level of a statutory violation or administrative code violation and the facts contained therein are insufficient to allege any bad faith conduct whatsoever. 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 alone, the CRN fails at its inception. To that end, Complainants completely fail to state any facts in support of their CRN. It is important to emphasize that a CRN 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). Moreover, the CRN fails to apprise Olympus of any actions that rise to the level of a statutory violation. Rather, it appears to reflect a misunderstanding of the claims process, and the roles and responsibilities of various personnel involved in the claim handling process. Specifically, Complainants allege that Olympus was required to send a licensed adjuster to physically inspect the property. The governing Florida Statute §626.854(3)(a) and (b), states: (3)(a) Unless otherwise provided by the policy of insurance or by law, within 7 days after an insurer receives proof-of-loss statements, the insurer shall begin such investigation as is reasonably necessary unless the failure to begin such investigation is caused by factors beyond the control of the insurer. (b) If such investigation involves a physical inspection of the property, the licensed adjuster assigned by the insurer must provide the policyholder with a printed or electronic document containing his or her name and state adjuster license number. An insurer must conduct any such physical inspection within 30 days after its receipt of the proof-of-loss statements. These provisions do not require a licensed adjuster to personally conduct the physical inspection – only that an adjuster be assigned to oversee the claim and provide their licensing information if an inspection occurs. Olympus complied with the above requirement by assigning a desk adjuster to manage the file. On February 7, 2024, Olympus sent a letter acknowledging the claim and a letter acknowledging the Letter of Representation which provided the desk adjuster’s name and license number. This information was provided 19 days prior to the Neumann Roofing inspection that took place on February 26, 2024. The role of the field inspector is limited to acting as the “eyes and ears” of the Insurer to gather necessary information during the inspection. Neumann’s role was to assist in fact-gathering and did not include making binding determinations on behalf of Olympus. Neumann did not participate in making the coverage determination. Olympus Insurance Company made the coverage decision, relying on the totality of its investigation, which included the inspection materials provided by Neumann. Olympus investigated the claim pursuant to Florida law and issued a coverage decision based on the information gathered during its investigation. Olympus’ compliance with Florida law is further supported by the below sequence of events: On February 7, 2024, Plaintiffs’ public adjuster, Ask an Adjuster, reports a claim to Olympus on behalf of the Insureds with the date of loss as April 26, 2023. Olympus also sends a claim acknowledgment letter and a letter acknowledging the letter of representation that provided the desk adjuster’s name and license information. On February 26, 2024, Amanda Bueno of Neumann Roofing inspects the roof and observes a variety of age related, wear, tear, deterioration, foot traffic, and mechanical issues. On March 14, 2024, Olympus issued its coverage determination denying coverage for the claim citing a lack of evidence to support that the dwelling sustained storm related damage. Olympus’ coverage decision is further supported by the engineering inspection that took place on August 27, 2024. Alex Puig, P.E of Envista Forensics concluded the following: 1. The residence’s roof covering was absent of damage caused by wind forces from the reported weather event on or about April 26, 2023. 2. There was no hail related damage to the roof covering. As outlined above, Olympus maintains that it has acted fairly and honestly toward the Insureds, and any other person having an interest in the subject policy or assisting the Insured in connection with the instant claim. To the extent that the instant CRN is intended to address any other facts or circumstances which purport to establish coverage for the reported loss, 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 and applicable Florida law. If we can provide any additional information, or be of any further assistance, please do not hesitate to contact us at your earliest convenience. Best, /s/ Gabrielle Crawford Gabrielle Crawford, 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