Civil Remedy Notice of Insurer Violations
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Filing Number:     797236
Filing Accepted:  12/17/2024
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Complainant
Last/Business Name *  
ADAMS   First Name   MARK & SHELLEY
Street Address * 343 LAFAYETTE PLACE
City, State Zip * DELAND, FL 32720
Email Address * ADAMS841335@BELLSOUTH.NET
Complainant Type: * Insured
Insured
Last/Business Name*   ADAMS   First Name   MARK & SHELLEY
Policy # * PFL454334-00 Claim #* CFL24604382
Attorney
Attorney is Applicable
Last Name* HUFFMAN First Name * SAMANTHA Initial M
Street Address* 2300 MAITLAND CENTER PARKWAY SUITE 106
City, State Zip* MAITLAND , FL 32751
Email Address * SHUFFMAN@SERRANOCAGAN.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   PEOPLE'S TRUST INSURANCE COMPANY
NAIC Company Code 13125
 
Name of individual responsible for violation (if any):* SYDNEY LYON
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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.

SECTION I – PROPERTY COVERAGE A. Coverage A – Dwelling (Entire Section) B. Coverage B – Other Structures (Entire Section) C. Coverage C – Personal Property (Entire Section) D. Coverage D – Loss of Use (Entire Section)
 
* 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 10/10/2024, ("Insured"), sustained a covered direct physical loss to Insured's property due to a weather-related incident. Insured reported the loss thereafter to PEOPLE'S TRUST INSURANCE COMPANY ("Insurer"). Prior to the date of loss, Insurer issued a policy of insurance, believed to be policy # PFL454334-00 which afforded coverage for the aforementioned property for losses caused by the covered peril. The policy was in full force and effect on the date of loss. The Insured promptly notified Insurer of the loss, who then assigned the loss claim # CFL24604382. Insurer was fully afforded any and all opportunity to inspect the loss and document the loss. To date, Insurer has paid $30,913.70 to Insured on this claim even after numerous attempts by the Insured to provide documentation of additional damages and compensation owed. Insured had no choice but to retain legal representation on or about 11/18/2024, as the Insurer refused to pay the full amount due and owed to its Insured. Insurer has continually failed to negotiate this claim with Insured’s attorney and/or failed to provide a satisfactory settlement offer to resolve the subject claim. This has severely harmed the Insured's ability to remedy their losses and continue with repairs to the property. The only purpose for Insurer's refusal to negotiate the claim is to increase profits and harm their insured. This is either done intentionally as a pattern and practice of Insurer to deny coverage and harm their insureds, or Insurer has failed to properly train and supervise its adjusters to the harm and detriment of their insureds. This pattern and practice are done for only one reason, which again, is to maximize profits and harm their insureds. Insurer has violated the following statutory provisions: 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)(c): Failing to acknowledge and act promptly upon communications with respect to claims; 626.9541(1)(i)(3)(e): Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed; 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): Unfair claim settlement practices, and any other applicable statutes to the factual allegations included herein. To remedy and/or cure this CRN, Insurer must immediately tender payment in the amount of $90,998.67, less any applicable deductible and prior payment to the Insured, to complete the repairs for the Insured property. The payment shall be tendered to the Insured’s attorneys, Serrano Cagan & Cagan at 2300 Maitland Center Parkway, Suite 106, Maitland, Florida 32751.
Comments
User Id Date Added Comment
SHUFFMAN@SERRANOCAGAN.COM 12-22-2025 COMPLAINANT HEREBY WITHDRAWS THIS CRN
bfrankel@gmail.com 02-07-2025 The Legal Department has been requested by People’s Trust Insurance Company (“PTI”) to assist it in responding to a Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of its Insureds, Mark and Shelley Adams (“Insureds”). In direct response to the CRN filing, PTI maintains that it has not been in any violation of the law and that the CRN is defective on its face and fails to comply with the specificity requirements under Florida Statute 624.155. As such, PTI objects to the Department’s acceptance of the above-referenced CRN. To be more specific, the CRN requirements set forth by Section 624.155 are that the notice be filed on a form provided by the department stating with specificity the following information, and such other information the department may require: (1) The statutory provision, including the specific language of the statute, which the authorized insurer allegedly violated. (2) The facts and circumstances giving rise to the violation. (3) The name of any individual involved in the violation. (4) Reference to specific policy language that is relevant to the violation, if any. If the person bringing the civil action is a third party claimant, she or he shall not be required to reference the specific policy language if the authorized insurer has not provided a copy of the policy to the third party claimant pursuant to written request. (5) A statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. In light of the instant CRN, PTI will provide a simple review of the facts and claims handling in support of its position there was no “bad faith” in the handling of this claim and detail how and why PTI acted property and within the letter of the law while handling the subject insurance claim. Following the claims summary, PTI will then address each respective statutory violation alleged in the Insureds’ CRN and respond accordingly in order to highlight why the CRN fails to perfect the Claimant’s right to pursue civil remedies under Florida Statutes. ? 1) On 10/10/2024, PTI was advised that a very large tree had fallen through the roof and into one of the bedrooms. The bedroom carpet had been saturated with rainwater. In light of the damages reported, PTI assigned its preferred contractor, Rapid Response Team, LLC. (“RRT”) to perform water mitigation, tree removal and tarping services. However, the following day, RRT was advised by the Insured that the services had already been performed and their services were not needed. 2) Subsequently, on 10/20/2024 and 11/26/2024, PTI’s Field Adjuster inspected the home in order to determine the cause of loss and scope of damages. At the time of the inspection, the Insured was present and reiterated that a large tree had fallen onto the house and caused damage to the roof and two interior bedrooms. While there was a tarp on the affected area of the roof at the time of inspection, PTI’s Field Adjuster was provided photographs taken before the tarping which allowed him/her to identify the area where the tree had fallen. Additionally, damages resulting from the fallen tree were confirmed in both interior bedrooms; specifically, the ceiling and flooring – which had been removed for repairs prior to inspection. 3) A few weeks later, on 11/19/2024, PTI received a Letter of Representation from Serrano Cagan & Cagan Law Firm (“Insureds’ Attorney”) to which PTI responded the following week with a Request for Information Letter requesting all estimates, invoices, documents, and photographs related to the claim for damages. Pursuant to the Letter of Representation, a certified copy of the policy was sent to Insureds’ Attorney on 12/5/2024. 4) As a result of the inspection and investigation of the claim, PTI issued a Coverage Determination letter on 12/6/2024 confirming coverage for damages to the roofing system, exterior and interior of the home. The letter further explained that PTI was issuing payment for the covered damages measured at Actual Cash Value but the Insured could submit documentation of incurred costs to receive an additional payment for withheld depreciation, bringing the payment to Replacement Cost Value. 5) Following the coverage determination letter, Insureds’ Attorney proceeded to file a Notice of Intent to Initiate Litigation (Notice No.: 221999) and attached an estimate in support of their assessment of damages in the amount of $90,998.67 (RCV). PTI responded on 1/2/2025 communicating a pre-suit settlement offer and the parties engaged in settlement negotiations. As shown, PTI has not acted in bad faith but has observed the terms and conditions of the Policy and Florida law, and has not engaged in any actions listed under “reasons for notice,” which include unsatisfactory settlement offer and inadequate/improper investigation. Furthermore, the CRN references no specific policy language relevant to the alleged violations. In response thereto, PTI advises that coverage was acknowledged in this matter, PTI paid the full amount of damages as assessed by its Field Adjuster as covered under the policy, and that said payment was issued in accordance with the Loss Settlement provision of the policy. Moreover, the loss settlement provision states that the initial payment is measured at actual cash value and upon receipt of expenses incurred PTI will issue additional payment for withheld depreciation. To date, the Insured has not submitted proof of any incurred expenses that would warrant additional payment under the policy. While the CRN alleges that payment was made, it incorrectly states the amount as being $30,913.70 when in fact PTI issued payment in the amount of $43,474.30. Additionally, upon receipt of the $90,998.67 estimate, PTI engaged in negotiations and the last offer communicated totaled $38,900.00 – which is the Insureds own estimate, less the applicable deductible and prior payment. For that reason, PTI denies any and all allegations regarding “unsatisfactory settlement offer” and/or failure to negotiate the claim as the full amount of their claimed damages has been offered. PTI further maintains that its practices and/or guidelines for response to claims are adequate to provide for the proper investigation and resolution of all claims. Turning to the statutory sections alleged to be violated, PTI responds as follows: GENERAL DENIAL PTI denies of all the statutory violations alleged in the Insureds’ CRN. 1) ALLEGED VIOLATION §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 PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. PTI accepted coverage and provided the Insured with PTI’s estimate and scope of repairs supporting the ACV undisputed payment issued on 12/6/2024. The letter also cited to the relevant portion of the applicable policy and advised the Insured to submit documentation showing incurred expenses in order to obtain additional payment for the withheld depreciation and bring the payment to replacement cost value. Additionally, upon being advised of a dispute as to the payment/amount issued, and absent any supporting documentation from the Insureds substantiating incurred expenses that would entitle them to the additional payment in accordance with the policy language at issue, PTI extended a settlement offer for the amount of the Insureds estimate less the prior payment and applicable deductible in a good faith effort to resolve. 2) ALLEGED VIOLATION §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 PTI denies this alleged statutory violation. As shown in the claims summary above, PTI attempted to resolve the scope dispute through attempted settlement negotiations for the amount of the Insureds’ estimate less the prior payment and applicable deductible. Moreover, the Insured does not indicate what portion(s) of the policy coverage became reasonably clear nor what portion(s) of the policy were used to influence settlement. Accordingly, it is impossible to further respond to this allegation. 3) ALLEGED VIOLATION §626.9541 (1)(i)(3)(a) – Failing to adopt and implement standards for the proper investigation of claims. RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. PTI advises that this allegation requires specific facts regarding the method of the investigation; the reasons the investigation was improper or otherwise inadequate; the reasons why this alleged inadequacy is due to the failure to adopt and implement standards for the proper investigation of claims, and the facts supporting these conclusions. To allege an inadequate investigation, the Notice must include specific facts regarding the method, rather than merely the results. Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006) As mentioned above, PTI issued a coverage determination letter on 12/6/2024. Within the letter, the Insureds were advised that coverage was being afforded for the claim and that a payment of $43,474.30 under Coverage A would be issued. This payment reflected the Actual Cash Value of the damages to the dwelling. As the Insureds have not advised PTI as to how it failed to investigate the claim and/or what standards were not adopted or implemented, this alleged violation is emphatically denied. 4) ALLEGED VIOLATION §626.9541(1)(i)(3)(c) – Failing to acknowledge and act promptly upon communications with respect to claims. RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. As indicated in the claims summary above, all communications were not only promptly responded to but also promptly acted upon. 5) ALLEGED VIOLATION §626.9541(1)(i)(3)(e) – failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed. RESPONSE PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. Moreover, this allegation in contrary to the facts and circumstances of the claim in which it has been explained that PTI issued a coverage determination letter on 12/6/2024. Within the letter, the Insureds were advised that coverage was being afforded for the claim and that a payment of $43,474.30 under Coverage A would be issued. This payment reflected the Actual Cash Value of the damages to the dwelling. 6) ALLEGED VIOLATION §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 PTI denies this alleged statutory violation, and advises that Claimants have not provided any facts to sustain such an allegation. PTI accepted coverage and provided the Insureds with PTI’s estimate and scope of repairs supporting the ACV undisputed payment issued on 12/6/2024. Within that letter, PTI cited to the relevant portion of the applicable policy which serve as the basis upon which the damages were assessed, coverage was determined, and payment was issued. The letter also advised the Insured to submit documentation showing incurred expenses in order to obtain additional payment for the withheld depreciation and bring the payment to replacement cost value. 7) ALLEGED VIOLATION §626.9541(1)(i)(3)(g) – Failing to promptly notify the insured of any additional information necessary for the processing of the claim. RESPONSE PTI denies this statutory allegation in its entirety and notes that it is completely contradicted by the Coverage Letter dated 12/6/2024 inviting the Insureds to submit documentation showing incurred costs in support of their request for additional payment for withheld depreciation, as well as the Request for Information Letter dated 11/26/2024 requesting estimates, invoices, receipts, photographs, and a Sworn Proof of Loss in support of their claim for damages. 8) ALLEGED VIOALTION §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 The Insureds do not clarify what information they are referring to and/or how PTI failed to clearly explain anything. PTI denies this alleged violation. 9) ALLEGED VIOALTION §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). RESPONSE The subject claim and instant CRN involves a homeowner’s insurance policy and dispute and does not involve any allegations and/or facts related to personal injury. For that reason, PTI advises this alleged violation is irrelevant and hereby denied. CONCLUSION /SUMMATION In sum, PTI timely accepted coverage under Florida law and maintains that all alleged violations of Florida Statutes in this CRN are baseless, and the CRN offers no facts in support of the statutory violations alleged. In fact, the CRN broadly, vaguely and without a scintilla of evidence, alleges boilerplate, unsupported false allegations of statutory violations and tracks, in generalities and conclusions only, the language of numerous sections of Florida’s Civil Remedy Statutes without connecting the purported statutory violations to the facts of the claim and the history of the claims investigation. Moreover, the CRN also fails to include specific policy language relevant to the violation(s). In response to these very general allegations, and to comply with its statutory obligations, PTI responds by denying each and every allegation of misconduct asserted in the CRN, whether expressed and or implied, and by categorically denying each and every alleged statutory violation.?? PTI further maintains that the CRN, as filed, is defective on its face as it fails to meet the specificity requirements of Florida Statute 624.155. As always, PTI is willing to consider any additional information the Insureds can provide in support of their claim. We trust the foregoing fully explains the facts and circumstances of the claim and addresses any concerns raised. If we can provide other information or clarification of information in the claim, please do not hesitate to contact the undersigned. Thank you for your attention to this matter. Very truly yours, /S/ Cosima Ortiz Cosima Ortiz, Esq. Corporate Counsel People’s Trust Insurance Company Cc: Samantha M. Huffman, Esq. 2300 Maitland Center Parkway Suite 106 Maitland, Fl 32751 E-mail: shuffman@serranocagan.com
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