Civil Remedy Notice of Insurer Violations
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Filing Number:     797497
Filing Accepted:  12/19/2024
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Complainant
Last/Business Name *  
THE OPAL AT NAPLES LLC N/K/A THE ELITE ALF AT NAPLES LLC AND 2626 MANAGEMENT LLC   First Name  
Street Address * 1135¬-1185 ENCORE WAY
City, State Zip * NAPLES, FL 34110
Email Address * SERVICE@ILGPA.COM
Complainant Type: * Insured
Insured
Last/Business Name*   THE OPAL AT NAPLES LLC N/K/A THE ELITE ALF AT NAPLES LLC AND 2626 MANAGEMENT LLC   First Name  
Policy # * JEM¬22¬PP¬1175 Claim #* 961960
Attorney
Attorney is Applicable
Last Name* SILVERMAN First Name * YISROEL Initial
Street Address* 1500 NORTHEAST 162ND STREET
City, State Zip* NORTH MIAMI BEACH , FL 33162
Email Address * YISROEL@ILGPA.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   RENAISSANCE REINSURANCE U.S. INC.
NAIC Company Code 10357
 
Name of individual responsible for violation (if any):* N/A
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

PROPERTY DAMAGE COVERAGE A. Coverage This policy insures against all risks of direct physical loss of or damage to the Insured’s property occurring during the term of the policy caused by or resulting from any Covered Cause of Loss.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The Opal at Naples LLC n/k/a The Elite Alf at Naples LLC and 2626 Management LLC (hereinafter the “Insureds”), paid for a policy of insurance with Certain Underwriters at Lloyd’s, London Subscribing to Policy No. JEM-22-PP-1175; HDI Global Specialty SE; Lexington Insurance Company; Navigators Insurance Company; Evanston Insurance Company; Scottsdale Insurance Company; Aspen Insurance Company; Renaissance Re Syndicate 1458; and Gotham Insurance Company (hereinafter, “Insurer”) bearing policy number JEM¬22¬PP¬1175 (the “Policy”). The Policy provides coverage for damage to the Insureds’ property located at 1135¬-1185 Encore Way, Naples, FL 34110 (the “Property”), including the significant damage that occurred as a result of Hurricane Ian on or about September 28, 2022 (the “loss”). Specifically, the Insureds’ Property sustained substantial wind damage to the roof, siding, fascia, screens, deck, railings, interior drywall, paint, windows, windowsills, ceiling, and other areas as detailed in the scope estimates provided to the insurer as follows: 1135: RCV $234,292.46/ACV $231,360.37 1145: RCV $224,956.54/ACV $222,011.85 1155: RCV $136,724.61/ACV $134,751.57 1165: RCV $232,012.13/ ACV $229,097.65 1175: RCV $224,363.50/ ACV $221,431.41 1185: RCV $227,936.50/ ACV $224,977.16 Total all estimates: RCV $1,280,285.74/ ACV $1,263,630.01 The Insureds reported their claim to the insurer on October 20, 2023. On October 31, 2023, the independent adjuster inspected the Property on behalf of Insurer. On January 19, 2024, the Insured’s estimator, Grace Forensic Consultants (“GFC”), prepared estimates for the Property totaling $1,279,692.70 RCV/$1,267,451.85 ACV for roof replacement, exterior repairs, and interior repairs. The Insurer proceeded to inspect the Property again via an engineer and general contractor on February 8 – 9, 2024. On or about March 8, 2024, the Insured’s estimator, GFC prepared revised estimates for the Property totaling $1,280,285.74 RCV/$1,263,660.01 ACV. On July 1, 2024, the Insurer sent a letter to the Insureds advising that the damages to the Property totaled $133,799.43 RCV/$122,242.66 ACV for roof repairs, exterior repairs, interior repairs, and replacement of some windows. In accordance therewith, they issued payment of $22,702.66 net ACV. The insurer acted in bad faith in refusing to acknowledge the full scope of the fully detailed damages totaling $1,280,285.74 RCV/$1,263,660.01 ACV. The net amount claimed after removal of the $99,540 deductible totals $1,180,745.74 RCV/ $1,164,090.01. However, the Insurer refuses to resolve the Insureds’ claim and pay for all damages to the Property. The Insurer’s conduct is in bad faith and violates Florida’s statutes concerning the adjustment of insurance claims. First, Florida Statute § 624.155(1)(B)(1) requires good faith in the settlement of claims. The Insurer is in violation of this Statute for failing to provide a reasonable repair estimate. What is more, the Insurer violated Florida Statute § 624.155(1)(b)(3) by failing to promptly settle the claim, when the obligation to settle the claim became reasonably clear. Again, the Insurer failed to make a good faith offer to settle this claim and failed to account for the full scope of the damages. They failed to respond to the estimate provided by ILGPA on the Insureds’ behalf, in a timely manner. They are obligated to provide coverage for all damages to the Insureds’ Property, and not attempt to resolve this claim with lowball offers. Additionally, the Insurer’s conduct violates Florida Statute § 626.9541, which prohibits unfair settlement practices. More specifically, the Insurer has violated Florida Statute § 626.9541(1)(i)(3)(a) by failing to adopt and implement standards for the proper investigation of claims as follows: 1.) Insurer knew that hurricane damages are of a nature that a thorough, nuanced and specialized investigation/adjustment of the claim needs to be promptly performed by qualified and duly prepared personnel in order to protect their insureds, satisfy their fiduciary duties, and otherwise not engage in the Bad Faith claim handling practices at issue. That said, to the detriment of its insureds and to maximize their financial interests, Insurer disregarded the obvious and known obligations by way of the following: (a.) Not developing, maintaining and/or instituting policies, procedures, protocol or guidelines to determine whether adjusters/personnel/vendors utilized to protect their insureds were qualified and equipped to work with their “desk adjusters” in order to duly and equitably assess the scope and/or value of the loss or damages. (b.) By way of the cited legal authorities and considerations, Insurer knew that it would be in their insureds’ interests and their obligation under the insurance policy to utilize personnel/vendors to perform moisture meter assessments throughout the insured property to honestly assess the full extent of damages and losses suffered by their insureds. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, Insurer knows that it does not serve their financial interest since it will increase their financial obligations to insureds such as the Complainant. Once again though, and although Insurer will implement such methods to establish a lack of coverage as it relates to a specific claim in which they determine coverage may be in dispute, they choose to avoid such expense for self-gain when they know that the claim is covered and the comprehensive adjustment and investigation of the claim will only serve to expand their immediate liabilities to the insureds per the Policy. In the interest of limiting redundancy in relation to Insurer’s motivation and the willful nature of the general Bad Faith scheme, notice of the issues at hand (which serves to establish willfulness and eliminates any considerations of negligence or mistake) has been exhaustive provided by way of, amongst other things, civil remedies notices such as the one in question, qualified experts that the industry relies upon, qualified adjusters and lawyers that rely upon reliable authoritative sources and well recognized industry standards, etc. Nonetheless, monies are withheld for unjust business interests that they wish to advance by way of the Bad Faith practices at hand. In this case, although they hired an engineer and a general contractor, neither performed a moisture meter assessment. This also violates 624.155(1)(b)(1). (c.) By way of the cited legal authorities and considerations, Insurer knew that it would be in their insureds’ interests and their obligation under the insurance policy to utilize personnel/vendors to perform thermal imaging assessments throughout the insured property to honestly assess the full extent of damages and losses suffered by their insureds. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, Insurer avoids same to maximize their financial interest for the reasons detailed. In this case although they hired an engineer and a general contractor, neither performed thermal imaging assessments. This also violates 624.155(1)(b)(1). (d.) By way of the cited legal authorities and considerations, Insurer knew that it would be in their insureds’ interest, and their obligation under the insurance policy, to retain a license mold assessor to determine whether there were concealed toxic conditions within the home which necessitated mold remediation and the need for their insureds to take precautionary measures to preserve their physical health and property interests. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, Insurer avoids same to maximize their financial interest for the reasons detailed. In this case, despite their own engineer observing mold conditions, the Insurer failed to hire a licensed mold assessor in relation to said conditions. This also violates 624.155(1)(b)(1) and 626.9541(1)(i). (e.) By way of the cited legal authorities and considerations, Insurer knew that it would be in their insureds’ interest, and their obligation under the insurance policy, to promptly issue payment for professional/qualified moisture assessments and remediation (per industry standards and/or IICRC guidelines) in order to, inter alia, avoid: the development of hazardous/toxic conditions within the residence; preclude the insured from suffering consequential and extra-contractual damages; the development of an uninhabitable residence and various risks that may develop; etc. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, Insurer avoids same to maximize their financial interest for the reasons detailed. In this case, the Insurer failed to hire moisture assessment and remediation companies or to pay for same. This also violates 624.155(1)(b)(1). (f.) By way of the cited legal authorities and considerations, Insurer knew that it would be in their insureds’ interest, and their obligation under the insurance policy, to utilize a license mold remediator to consider a licensed mold assessor’s assessments and protocol (pre and post remediation) in order to honestly determine the true scope and value of damages and/or the losses, which includes: the scope of rebuild that needs to be performed therewith; extending coverage for additional living expenses that are subject to being incurred in association therewith and the various other considerations set forth herein; assessing and extending coverage for personal property that may be either damaged due to latent conditions, or subject to being accounted for in relation to moving, storage and resetting costs associated therewith; etc. Such practice is a simple, inexpensive, efficient and industry wide accepted means of protecting their insureds, however, Insurer avoids same to maximize their financial interest for the reasons detailed. In this case, despite their own engineer observing mold conditions, the Insurer failed to hire a licensed mold remediator in relation to said conditions. This also violates 624.155(1)(b)(1) and 626.9541(1)(i). (g.) By way of the cited legal authorities and considerations, Insurer knew that it would be in their insureds’ interests and their obligation under the insurance policy to carefully evaluate on a claim by claim basis, and only after equitably and fully investigating/adjusting claim, the amounts owed to the insured for: permit costs associated with the repair. Here, despite the hiring of an engineer and general contractor, the Insurer failed to account for any permitting costs associated with the repair. This also violates 624.155(1)(b)(1) and 626.9541(1)(i). (h.) By way of the cited legal authorities and considerations, Insurer knew that it had an obligation to ensure that software programs, data bases and adjusting practices utilized to estimate the scope and value of the loss were being utilized in form that: honestly and fully delineated the line item repairs or costs that needed to be performed; pricing corresponded with licensed professionals - as opposed to handyman or non-licensed professionals. Ultimately, Insurer knows that the adjusting practices are guided towards unlawfully depriving their insureds of benefits owed under the insurance policy, which in the aggregate, serves to facilitate the non-payment of millions of dollars that would be owed to its insureds who reasonably, but ultimately mistakenly, rely upon the representations of their insurer who is legally obliged to act in their insured’s best interest due to the specialized nature of fairly and lawfully adjusting a claim. Here, the pricing of the Insurer’s estimate would not be consistent with the costs of a corresponding licensed professional to do the associated work. (i.) By way of the cited legal authorities and considerations, Insurer knows that it has a duty to issue payment for interest owed in relation to payments that were untimely issued per governing authorities. With that said, and to the detriment of the insureds, it foregoes and/or delays such considerations in order to maximize its financial interests. Here, the Insurer was on notice of the claim from October 20, 2023. They needlessly delayed the inspection of their general contractor and engineer until February 8 – 9, 2024. The Insurer then proceeded to needlessly delay the submission to the insured of its conclusions and corresponding payment until July 1, 2024. In doing so, the Insurer has (also) violated Florida Statute § 626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly with the Insureds and its counsel and also 624.155(1)(b)(3). This also violates 624.155(1)(b)(1) and 626.9541(1)(i). (j.) Although from the onset of a covered loss Insurer will have no good faith basis to deny coverage in part and/or in whole for a loss/damage, they will delay notifying the insured that coverage has been accepted, and/or otherwise delay performing, in order to: maximize their financial interests; unlawfully and deceptively withhold monies for their own use; utilize policy conditions to deflect and misdirect; utilize policy conditions at later date to further delay payment when the insured demands performance under the policy; and/or so as to otherwise implement a deceptive and immoral scheme to deprive insureds of benefits owed under the policy. Here, the Insurer was on notice of the claim from October 20, 2023. They needlessly delayed the inspection of their general contractor and engineer until February 8 – 9, 2024. The Insurer then proceeded to needlessly delay the submission to the insured of its conclusions and corresponding payment until July 1, 2024. In doing so, the Insurer has (also) violated Florida Statute § 626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly with the Insureds and its counsel and also 624.155(1)(b)(3). This also violates 624.155(1)(b)(1) and 626.9541(1)(i). (k.) Insurer’s Bad Faith conduct as described places the insured in a position of being forced into incurring expert fees to secure relief. This allows for further delay of their obligations to their insureds. Here, the insureds were forced to retain multiple experts in order to be able to secure relief. This also violates 624.155(1)(b)(1) and 626.9541(1)(i). Moreover, the Insurer violated Florida Statute § 626.9541(1)(i)(3)(b), by misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. Further, the Insurer has violated Florida Statute § 626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly with the Insureds and its counsel as indicated above. As mentioned above, the Insurer failed to account for the full scope of the damages and has additionally failed to respond to the estimate provided by ILGPA, delaying the resolution of this claim. Had the Insurer done so, it would have immediately settled this claim on a fair and reasonable basis and provided full coverage to its Insureds. Therefore, to cure the defects outlined in this Civil Remedy Notice, the Insurer must: (1) create and implement adequate guidelines for the proper investigation and evaluation of claims and for the training and supervision of employees, which will avoid future statutory violations and avoid this from occurring in the future; (2) immediately tender all insurance proceeds due and owing its Insureds under the Policy in the amount of $1,141,387.35 ($1,164,090.01 less the $22,702.66 prior payment), plus all statutory interest; (3) act fairly and honestly towards its Insureds and with due regard for their interests in attempting to settle their Insureds’ claim; (4) hold the claim open in the event that its errors and delay does or may cause the Insureds to suffer either further loss and/or damage; and, (5) stipulate to the Insureds’ entitlement to attorney’s fees and court costs pursuant to Florida Statutes §§ 627.428 and 626.9373. Acknowledgment This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statutes section 624.155, should Certain Underwriters at Lloyd’s, London Subscribing to Policy No. JEM-22-PP-1175; HDI Global Specialty SE; Lexington Insurance Company; Navigators Insurance Company; Evanston Insurance Company; Scottsdale Insurance Company; Aspen Insurance Company; Renaissance Re Syndicate 1458; and Gotham Insurance Company fail to cure the violations set forth in this Civil Remedy Notice within the given cure period.
Comments
User Id Date Added Comment
yisroel@ilgpa.com 04-16-2025 This Civil Remedy Notice is hereby withdrawn.
yisroel@ilgpa.com 04-16-2025 This Civil Remedy Notice is herebywithdrawn.
lori.eller@phelps.com 02-14-2025 VIA ELECTRONIC SUBMISSION Florida Department of Financial Services Bureau of Consumer Assistance Civil Remedy Section Larson Building 200 East Gaines St. Tallahassee, Florida 32399-0322 Re: Civil Remedy Notices of Insurer Violations Insured: The Opal at Cape Coral LLC Insurers: Certain Underwriters at Lloyd’s, London Subscribing to Policy No. JEM-22-PP-1175; HDI Global Specialty SE; Lexington Insurance Company; Navigators Insurance Company; Evanston Insurance Company; Scottsdale Insurance Company; Aspen Insurance Company; and Gotham Insurance Company Date of Loss: September 28, 2022 Policy No.: JEM-22-PP-1175 Claim No.: 961960 through 961960 -10 Loss Locations: 4920 Viceroy Court, Cape Coral, FL 33904 (“The Opal Cape Coral”) 1135-1185 Encore Way, Naples, FL 34110 (“The Opal Naples”) DFS File Nos.: Accepted by DFS on December 18, 2024: CRN Nos. 797472, 797473, 797474, 797475, 797476, 797477, and 797478 Accepted by DFS on December 19, 2024: CRN Nos. 797479, 797480, 797481, 797482, 797483, 797484, 797485, 797486, 797487, 797488, 797489, 797490, 797491, 797492, 797493, 797494, 797495, 797496, 797497, 797498, 797499, 797500, 797501, 797502, 797503, 797504, and 797505 To Whom It May Concern: We write on behalf of Certain Underwriters at Lloyd’s, London Subscribing to Policy No. JEM-22-PP-1175 (“Underwriters”), HDI Global Specialty SE, Lexington Insurance Company, Navigators Specialty Insurance Company, Evanston Insurance Company, Scottsdale Insurance Company, Aspen Specialty Insurance Company, and Gotham Insurance Company (collectively, the “Insurers”), the commercial property insurers subscribing to the insurance policy issued to The Opal at Cape Coral, LLC (the “Insured”), under Policy Number JEM-22-PP-1175, which was effective from March 26, 2022 through March 26, 2023 (the “Policy”), for the properties located at located at 4920 Viceroy Court, Cape Coral, FL 33904 (“The Opal Cape Coral”) and 1135-1185 Encore Way, Naples, FL 34110 (the “The Opal Naples”) (collectively, the “Properties”). We write on the Insurers’ behalf in response to the thirty-four (34) Civil Remedy Notices of Insurer Violations (the “Notices”) submitted to the Department of Financial Services, Division of Consumer Services (the “Department”) by Attorney Yisroel Silverman, Esq. on behalf of the Insured. The Notices bear the filing numbers and acceptance dates referenced above. Across all versions of the Notices, the Insured alleges that the Insurers violated eight sections of the Florida Statutes with regard to the Insured’s claim for damages to the Properties as a result of Hurricane Ian, which occurred on September 28, 2022 (the “Loss”). Also, across all versions of the Notices, the Insured generally alleges that the “Reasons for Notice” are “Claim Delay,” “Claim Denial,” “Unsatisfactory Settlement Offer,” and “Unfair Trade Practice.” The Insurers categorically deny that they or any of their representatives engaged in any prohibited conduct or violated any of the statutes referenced in the Notices with respect to this claim. The Notices are vague and deficient in describing the facts and circumstances giving rise to the Insurers’ alleged statutory violations. The Notices are also deficient because they fail to state with specificity what the Insurers must do to “cure” the alleged violations as required by Florida law. Additionally, the Notices are invalid for their failure to specifically allege the Policy provisions in accordance with the requirements of section 624.155(3)(b)(4), Florida Statutes. In any event, since the time that the Insured filed the Notices, the Insurers and the Insured have reached a settlement agreement regarding this matter. Pursuant to the settlement agreement, the Insured has agreed to release the Insurers from any further liability regarding this claim and matter, including any claims of “bad faith.” The Insurers hereby notify the Department that they have cured the alleged violations set forth in the Notices pursuant to section 624.155(3)(e), Florida Statutes, by agreeing to tender the settlement payment to the Insured through the Insured’s counsel’s office. The Insured has also agreed to release the Insurers from any and all alleged violations stated in the Notices. Accordingly, pursuant to section 624.155(3)(d), Florida Statutes, no action can lie against the Insurers for the violations alleged in the Notices because the Insurers have cured the alleged violations, and this matter has been resolved pursuant to the settlement agreement. If the Department has any questions or requires any additional information, please contact us. Sincerely, /s/ Jonathan E. Lewerenz Jonathan E. Lewerenz, Esq. cc: Via E-mail: Yisroel Silverman, Esq. Mordechai Breier, Esq. Insurance Litigation Group, P.A. 1500 NE 162nd Street Miami, Florida 33162 yisroel@ilgpa.com mlb@ilgpa.com candice@ilgpa.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