Civil Remedy Notice of Insurer Violations
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Filing Number:     797177
Filing Accepted:  12/17/2024
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Complainant
Last/Business Name *  
CAPTIVA AE 2004, LLC   First Name  
Street Address * 17078 CAPTIVA DR
City, State Zip * FORT MYERS, FL 33906
Email Address * AME@VQHMGT
Complainant Type: * Insured
Insured
Last/Business Name*   CAPTIVA AE 2004, LLC   First Name  
Policy # * HO161678591636-01 Claim #* C22HOA00849
Attorney
Attorney is Applicable
Last Name* WISE First Name * PHOEBE Initial S
Street Address* 5811 PELICAN BAY BLVD SUITE 650
City, State Zip* NAPLES , FL 34108
Email Address * PWISE@HAHNLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   VAULT E&S INSURANCE COMPANY
NAIC Company Code 16237
 
Name of individual responsible for violation (if any):* VAULT E&S INSURANCE COMPANY
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
* 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)(2) A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
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.
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.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

For a covered loss caused by a hurricane, we will pay the reconstruction cost for your dwelling up to the coverage limit shown for that location on the Declarations Page. If you do not repair your dwelling, we will pay no more than the actual cash value. Upon completion of repairs or rebuilding of your dwelling, we will pay the difference between the actual cash value and replacement cost up to the coverage limit shown for that location. To enable the insurer to investigate and resolve your claim, describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time. Policy at p. 8, ¶ B(1).
 
* 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 September 28, 2022, while Vault Specialty Policy No. HO161678591636-01 (the “North House Policy”) was in full force and effect, Hurricane Ian passed through Captiva, Lee County, Florida, causing substantial damage to the structures and contents of the insured’s property located at 17078 Captiva Drive, Captiva, Florida 33906 (the “North House”). Upon learning of the damage to the North House’s structures and contents, the insured promptly and timely notified Vault E&S Insurance Company (“Vault”) of its loss, as required by the North House Policy. Vault assigned the claim to a third-party adjusting company, Deft Claims, to inspect the North House and adjust the loss. Vault assigned claim number C22HOA00849 to the loss (the “North House Claim”). On October 8, 2022, Mark Grams of Deft Claims inspected the North House and issued an Xactimate report finding that the cost to repair the North House $158,835.78, less the $24,551.00 deductible, for a total net claim of $134,284.78. Inexplicably, at no time since October 8, 2022 has Vault ever issue payment to the Insured for the $134,284.78 which represents the undisputed damages covered under the North House Policy. Instead, Vault issued a partially denied for damage caused by flood. Furthermore, Vault has never addressed the remainder of the Claim—as set forth below. On December 2, 2022, Vault did issue a check in the amount of $100,000.00 (Check No. 1139010742) but never advised the Insured what the payment represented. It certainly does not represent the cost to repair the damage as determined by Mr. Grams. Failing to send a check without an explanation of what the funds represent is a clear violation of 624.155(2). Regardless, $100,000.00 is a gross underpayment of the claim. In response, the Insured submitted substantial documentation to support his claim, including but not limited to contents lists, photographs, invoices, estimates, and proof of payment for work performed. The insured has continued to submit such documentation for over two years. However, Vault has refused and failed to pay any additional funds to date. The Insured hired Allied Engineering (“Allied”) to inspect the North House. Allied prepared an Xactimate estimate for the wind-related losses including photographs and invoices and estimates to supposed bid items for same. Allied determined, among other things, that the metal roof, lattice work, ground level stucco walls would need to be replaced. At the time Allied prepared the Xactimate, the cost to return the North House to its pre-loss condition was $579,996.54. However, work continues to be performed at the North House and costs are ongoing until the repairs are completed. Allied also prepared a cause and origin report for the damage to the North House. The damage caused by wind, includes but is not limited to, windows, exterior doors, metal roof, decking, Simpson connectors, lattice work on the lower floor, plywood roof sheathing and wood truss members, gypsum board ceiling and insulation throughout the home, and tile floor. Additionally, in May, 2023, Vault’s adjuster, Greg Jump agreed to the repairs to repair and replace the damaged soffits in the amount of $28,500. To date, Vault has failed to issue payment for same. The insured also submitted documentation of damaged contents for the North House totaling $49,034.31. Additionally, the Insured has incurred significant loss of use and fair rental value. The monthly rental income for the North House, less commissions, is $22,377.05. Not only has Vault significantly undervalued and underpaid the Insured’s claim under Coverage A but it has ignored the contents and loss of use claims entirely. After years of Vault ignoring its claim, the Insured submitted a Sworn Statement in Proof of Loss in the amount of $1,072,303.95. The Sworn Proof of Loss included all documentation and photographs to support the Claim. Despite receiving the Sworn Statement in Proof of Loss, Vault has failed to pay the Claim. Moreover, it continues to ignore the contents and loss of use and fair rental value claims. Vault cannot be allowed to bury its head in the sand and only respond to the portions of the Claim it chooses. It must address and respond to the entirety of the Claim. Vault also has an obligation to issue payment on the Claim that is reasonable and when it is clear that it must do so. That time is now. The Insured has provided Vault with all of the information necessary to pay the Claim in its entirety and return the Insured to its pre-loss condition for damages caused by wind. Florida law also requires that Vault pay the Insured interest on the now-late payments. To date, however, Vault has failed to do so. Further, the prior payment was not timely made and therefore, interest is owed for all funds—previously paid—and all funds which remain outstanding. The lack of communication and oversight during the claims process demonstrates Vault’s failure to adopt and implement standards for the proper investigation of the Claim and failure to take the Insured’s interests into account. Vault has deliberately refused to settle the Claim when it became reasonably clear to do so. Vault can cure this violation by paying the remainder of the total loss and damage owed under the Policy in the amount of $822,719.85 (Coverage A: $579,996.54 Coverage C: $49,034.31 Coverage D: $318,240.00, less the $24,551.00 deductible, less the $100,000.00 prior payment), interest on the loss amount of $162,640.05 (as of November 25, 2024) plus interest on its prior payment in the amount of $2,065.08. The total amount required to cure this violation is $987,424.98. Additionally, Vault shall advise the basis for the $100,000 payment it made and what the funds represent.
Comments
User Id Date Added Comment
dweller@wsh-law.com 02-11-2025 RE: Civil Remedy Notice 797177 Captiva AE 2004, LLC Property Address: 17078 Captiva Drive, Fort Myers, Florida Policy Number: HO161678591636-01 Claim Number: C22HOA00849 DOL: September 28, 2022 Ms. Wise: Our law firm represents Vault Reciprocal Exchange (“Vault”) in connection with the above-referenced claim. This correspondence constitutes Vault’s response to the Civil Remedy Notice (“Notice”) you filed on behalf of Capita AE 2004, LLC (“Claimant”) regarding the claim identified above. Vault welcomes the opportunity to respond to the Notice and specifically denies each and every allegation contained the Notice filed in relation to this claim. With that said, Vault believes that the Notice you filed fails to comply with the specific notice and information requirements as set froth in Civil Remedy Notice document provisions, Florida Statute § 624.155, and Florida case law. The Notice alleges violations of Florida Statutes, Section 624.155, and Section 626.9541. The Notice is deficient on its face because it lacks the specificity required by Florida Statutes Section 624.155(3)(a). The Notice does not identify the factual support for each section of the Statutes claimed to be violated. Instead, the Notice provides vague, ambiguous, and conclusory allegations that Vault “lacks communications and oversight during the claims process.” Vault denies all statutory violations alleged by Claimant in the Notice and responds separately to each such allegation as follows: A. 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. Response: Claimant claims that Vault has not tendered all insurance proceeds and that it never issued the undisputed payment for the subject claim. Vault denies that it has violated Florida Statutes Section 624.155(1)(b)(1), as alleged in the Notice. At all times, Vault acted in good faith, fairly and honestly towards the Claimant, with due regard for Claimant’s interests. Vault’s records show that upon receipt of notice of the subject claim, Vault immediately opened a claim and assigned Greg Jumps, general adjuster, to the subject claim. Vault sent a letter acknowledging the claim on October 4, 2022, and a subsequent letter on October 11, 2022, advising Claimant that Vault retained an engineer to inspect the property and reserving its rights pursuant to specific applicable policy language provided to Claimant in that correspondence. Vault provided the engineering report to Claimant. Vault also immediately retained an independent adjustment company, Deft Claims, to inspect the loss. Mark Grams, executive general adjuster with Deft Claims, initially inspected the subject property on October 8, 2022 and rendered a report regarding same. Mr. Grams prepared an initial estimate of damages in the Replacement Cost Value (“RCV”) amount of $158,835.78 relating to the subject claim. Thereafter, Mr. Grams prepared a revised estimate in the RCV amount of $182,429.86. Vault ultimately made a payment in the amount of $188,146.66 (inclusive of its estimate in the amount of $163,595.66. This amount included its estimate $182.429.86, plus the invoices submitted by Titan GC (in the amount of $3,338.52 and $2,378.28, respectively)), and subtracted the policy deductible of $24,551. Vault provided a Statement of Loss, setting out this payment and how it was derived to Claimant. On July 31, 2023, Vault issued an Explanation of Benefits letter to Claimant. The Explanation of Benefits letter included the correct claim number, but inadvertently included the property address as 17080 Captiva Drive. This address is for the adjacent property and companion claim, Claim Number C22HOA00851. Given the close proximity of the properties and claims, several records inadvertently mix up the property addresses, including documents submitted by Claimant. The detailed letter provided Vault’s coverage opinion, supported by specific policy language and explained that Vault was issuing a payment for the damages of $188,146.66 RCV (inclusive of Vault’s estimate in the amount of $182.429.86, plus the invoices submitted by Titan GC (in the amount of $3,338.52 and $2,378.28, respectively)). The total payment amount was $163,595.66, after accounting for the deductible in the amount of $24,551. Claimant also glosses over Vault’s partial denial of the claim, which is relevant to the amount Claimant is claiming it hasn’t been paid relating to the subject claim. Vault retained engineer James M. Moore of Grindley Williams Engineers, to inspect the subject property and prepare a report. Mr. Moore inspected the property on November 5, 2022, and prepared his comprehensive report, which concludes that all items at and below the flood elevation level were damaged as a result of flooding/wave action storm surge that occurred during the hurricane, which is specifically excluded under the subject policy. While Claimant has submitted documentation in support of a demand for additional insurance proceeds, Vault has also requested additional information that Claimant has failed to provide, in violation of the terms of the Policy. Specifically, and in light of Vault’s coverage decision relating to flood damage, on October 7, 2024, Vault has requested the following items from Claimant in support of the subject claim: - All estimates relied upon in support of the Sworn Statement in Proof of Loss; - All proofs of payments for any repairs already made to the property as a result of the subject claim; - Documents pertaining to the submission of a flood claim in connection with the date of loss; - All documents in support of any ALE claim. Claimant responded by producing a series of documents on October 30, 2024. Notably missing from the documents produced are any proofs of payments for repairs already made, any information relating to the submission of a flood claim and full documents in support of the alleged ALE claim. To summarize, Vault has acted fairly and honestly towards Claimant in its adjustment and payment of the subject claim. B. 624.155(1)(b)(2) - Making claim payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made. RESPONSE: Claimant claims that Vault made a payment without providing a statement setting forth the coverage under which the payment was being made. Vault directs Claimant to the response contained in section A. Vault also specifically responds that Vault’s Explanation of Benefits letter dated July 31, 2023, clearly sets out its coverage position and informs Claimant of its valuation and initial payment. C. 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. RESPONSE: Vault denies that it has violated Florida Statutes Section 624.155(1)(b)(3), as alleged in the Notice. By its terms, Florida Statutes Section 624.155(1)(b)(3) contemplates a situation where two portions of the policy are at issue and the carrier withholds settlement under one portion of the policy in an attempt to influence settlement under another portion of the policy. Axiomatically, such a situation cannot exist here because only one portion of the Policy and a single claim are at issue. Vault’s Explanation of Benefits letter makes it clear that Vault is not withholding settlement under one portion of the policy in an attempt to influence settlement under another portion of the policy. D. 626.9541(1)(i)(2) - A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy. Response: Claimant merely cites to the statute, without providing any factual support for this allegation. Claimant fails to state what material misrepresentation Vault has made and when it has made this material misrepresentation. Vault denies that it has violated Florida Statutes Section 626.9541(1)(i)(2), as alleged in the Notice. Vault has not made any type of misrepresentations to Claimant. Any representations made by Vault to Claimant were made in good faith and based on Vault’s investigation of the subject property. E. 626.9541(1)(i)(3)(a) - Failing to adopt and implement standards for the proper investigation of claims. Response: Vault denies that it has violated Florida Statutes Section 626.9541(1)(i)(3)(a), as alleged in the Notice. Vault has followed its standards for the proper investigation of claims when dealing with the subject claim. Claimant merely cites to the statute, without providing any factual support for this allegation. Claimant fails to state what standards for the proper investigation of claims Vault has failed to adopt. Vault directs Claimant to the response contained in section A. F. 626.9541(1)(i)(3)(c) - Failing to acknowledge and act promptly upon communications with respect to claims. Response: Vault denies that it has violated Florida Statutes Section 626.9541(1)(i)(3)(c), as alleged in the Notice. Claimant merely cites to the statute, without providing any factual support for this allegation. Claimant fails to state what Vault failed to acknowledge and what communications Vault has failed to act promptly upon. Vault has acknowledged and promptly acted upon communications with respect to the claim as demonstrated in its response contained in Section A. G. 626.9541(1)(i)(3)(d) - Denying claims without conducting reasonable investigations based upon available information. Response: Vault denies that it has violated Florida Statutes Section 626.9541(1)(i)(3)(d), as alleged in the Notice. Claimant merely cites to the statute, without providing any factual support for this allegation. Claimant has failed to provide any facts suggesting that Vault has not reasonably investigated the claim. Vault directs Claimant to its response in Section A, which clearly sets out Vault’s extensive reasonable investigations of the subject claim, involving multiple inspections, including an engineering inspection. H. 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. Response: Vault denies that it has violated Florida Statutes Section 626.9541(1)(i)(3)(f), as alleged in the Notice. Claimant merely cites to the statute, without providing any factual support for this allegation. Vault sent a detailed Explanation of Benefits letter outlining its coverage position on July 31, 2023. I. 626.9541(1)(i)(3)(g) - Failing to promptly notify the insured of any additional information necessary for the processing of a claim. Response: Vault denies that it has violated Florida Statutes Section 626.9541(1)(i)(3)(g), as alleged in the Notice. Claimant merely cites to the statute, without providing any factual support for this allegation. Vault directs Claimant to its response to Section A, which clearly sets out requests for additional information necessary to process the claim. J. 626.9541(1)(i)(3)(h) - Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. Response: Vault denies that it has violated Florida Statutes Section 626.9541(1)(i)(3)(g), as alleged in the Notice. Claimant merely cites to the statute, without providing any factual support for this allegation. Vault directs Claimant to its response to Section A, which clearly sets out requests for additional information necessary to process the claim. K. 626.9541(1)(i)(3)(i) - Failing to pay personal injury protection insurance claims within he time periods required by s. 627.736(4)(b). Response: Vault denies that it has violated Florida Statutes Section 626.9541(1)(i)(3)(i), as alleged in the Notice. The subject claim is a property claim, not a personal injury claim and this statute relating to personal injury protection does not apply to the subject claim. As such, any claims of a breach of this statute are nonsensical and unfounded. Claimant further provides a lengthy paragraph of purported conduct by Vault, without making any attempt to state which portion of the statutes cited are violated by this purported conduct. Claimant’s allegations are convoluted, non-sensical, vague and ambiguous to the point where Vault cannot properly respond. Vault has not violated any statutes in its conduct adjusting the subject claim, making a coverage decision, or making a payment relating to the subject claim. Contrary to any assertions set forth in the Notice or otherwise, at all times material to this claim, Vault promptly acknowledged and investigated Claimant’s claim. Based upon the foregoing, Claimant’s Notice is devoid of sufficient facts and circumstances to support the accusations of wrongdoing under the statutory provisions identified. The Notice is devoid of detail, deficient on its face, and not supported by the facts. Thus, the allegations in the Notice are without merit. Should you have any questions or if we can be of any further assistance, please do not hesitate to contact us.
pwise@hahnlaw.com 12-17-2024 CORRECTED Reason for Notice: - Unsatisfactory Settlement Offer - Claim Delay - Misrepresentation - Unfair Trade Practice
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