Civil Remedy Notice of Insurer Violations
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Filing Number:     797616
Filing Accepted:  12/19/2024
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Complainant
Last/Business Name *  
PESTALOZZI   First Name   JOHN
Street Address * 412 E. MADISON ST
City, State Zip * TAMPA, FL 33602
Email Address * JPESTALOZZI10@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   APEX LAW FIRM   First Name   JOHN
Policy # * 988 753 850 Claim #* 0768271827
Attorney
Attorney is Applicable
Last Name* CONSTANTINOS First Name * JEFFREY Initial
Street Address* 412 E. MADISON ST
City, State Zip* TAMPA , FLORIDA 33602
Email Address * SPATEL@APEXFIRM.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   CASTLE KEY INDEMNITY COMPANY
NAIC Company Code 10835
 
Name of individual responsible for violation (if any):* VICTOR LEON AND ANY EMPLOYEES OR CONTRACTORS INVOLVED IN CLAIM NUMBER 0768271827
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
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.
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)(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)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

In addition to the above listed statutory provisions, see also the following statutes and rules that were violated: FLORIDA STATUTES VIOLATED 626.877 - Every adjuster shall adjust or investigate every claim, damage, or loss made or occurring under an insurance contract, in accordance with the terms and conditions of the contract and of the applicable laws of this state. 626.878 - An adjuster shall subscribe to the code of ethics specified in the rules of the department. The rules shall implement the provisions of this part and specify the terms and conditions of contracts, including a right to cancel, and require practices necessary to ensure fair dealing, prohibit conflicts of interest, and ensure preservation of the rights of the claimant to participate in the adjustment of claims. 627.70131 (5)(a) Within 90 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer which reasonably prevent such payment. Any payment of an initial or supplemental claim or portion of such claim made 90 days after the insurer receives notice of the claim, or made more than 15 days after there are no longer factors beyond the control of the insurer which reasonably prevented such payment, whichever is later, bears interest at the rate set forth in s. 55.03. Interest begins to accrue from the date the insurer receives notice of the claim. The provisions of this subsection may not be waived, voided, or nullified by the terms of the insurance policy. If there is a right to prejudgment interest, the insured shall select whether to receive prejudgment interest or interest under this subsection. Interest is payable when the claim or portion of the claim is paid. Failure to comply with this subsection constitutes a violation of this code. However, failure to comply with this subsection does not form the sole basis for a private cause of action. FLORIDA ADMINISTRATIVE CODE SECTIONS VIOLATED 69B-220.201(3) – Code of Ethics. The work of adjusting insurance claims engages the public trust. An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance. The following are standards of conduct that define ethical behavior, and shall constitute a code of ethics that shall be binding on all adjusters: 69B-220.201(3)(c) - An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured. 69B-220.201(3)(d) - An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. 69B-220.201(3)(j) - An adjuster shall not knowingly fail to advise a claimant of the claimant’s claim options in accordance with the terms and conditions of the insurance contract. 69B-220.201(3)(k) - An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise.
 
* Facts and circumstances giving rise to the violation.
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John Pestalozzi paid premiums to Castle Key Indemnity Company and in exchange, Castle Key issued a policy of insurance number 988753850 to Mr. Pestalozzi. This policy was in full force and effect on or about June 04, 2023, when Mr. Pestalozzi suffered direct physical loss to the property. Mr. Pestalozzi reported the loss within a reasonable time and requested that Castle Key investigate the loss and promptly issue payment in order to bring the property back to its pre-loss condition and prevent further damage to the property. While Castle Key is an expert in identifying loss, damage and coverage, Mr. Pestalozzi has no such experience. Castle Key knew the importance of identifying all loss and damage. Castle Key employs a team of experts and professionals that were available to determine the extent of loss, damage and coverage. In spite of these resources, Castle Key conducted an inadequate investigation of the damage. Castle Key’s handling and adjustment of the claim of loss reveals that it has failed to adopt or implement standards for the proper investigation of claims. Castle Key sent an under-qualified adjuster who did not investigate all the damage. The lack of diligence and care in investigating the damage reveals a lack of experience in the type of work that needed to be done and the adjuster’s incentive to adjust the claim dramatically in favor of his employer, Castle Key’s. Subsequently, Castle Key has refused to settle the claim in good faith. Castle Key unfairly denied the claim without conducting any additional investigation. In explaining the denial to Mr. Pestalozzi, Castle Key misrepresented the terms of the policy and misapplied policy provisions. Since that time, Castle Key has refused to pay Mr. Pestalozzi the full amount of damages so that repairs may be completed. A review of Castle Key’s actions leads to the inevitable conclusion that Castle Key has breached its duty of good faith and fair dealing. Castle Key failed to thoroughly, accurately, and promptly investigate and settle Mr. Pestalozzi’s claim. Moreover, Castle Key claims handling procedure reflects that its employees and its contractors are encouraged and trained to act in the interest of the company at the expense of the interests of the insureds. Castle Key failed to properly investigate the claim, failed to promptly and thoroughly investigate the claim, failed to promptly and properly adjust the loss, failed to exercise diligence and candor in contact with Mr. Pestalozzi and failed to act in good faith in attempting to settle the claim. These violations may be cured by the following: payment of the fair estimates that were submitted to Castle Key, payment of the damages that resulted from Castle Key’s refusal to fairly and timely adjust the claim including, but not limited to, fair market value of the loss of use of property, interest on payments not made, related costs and fees. Inevitably, additional damages will accrue from Castle Key’s failure to settle the claim and bring Mr. Pestalozzi’s property back to its pre-loss condition. In addition, Castle Key must implement proper standards for the training, supervision and management of all claims handling personnel, including adjusters. These standards must include new requirements for the proper qualifications and training of its adjusters. In addition, Castle Key must revise the procedures by which its claims handling personnel are hired, retained and promoted in order to encourage its employees and contractors to handle claims in good faith, rather than incentivize them to act solely in the interests of the company.
Comments
User Id Date Added Comment
Carla.Allen@allstate.com 02-14-2025 Please allow this correspondence to serve as Castle Key Indemnity Company’s (hereinafter referred to as “Castle Key”) response to your Civil Remedy Notice of Insurer Violations filing numbers 797616 and 806954. This response was uploaded to the DFS CRN website today’s date Castle Key specifically denies the allegations set forth in the Civil Remedy Notice of Insurer Violations. At all times, Castle Key has acted in good faith. Castle Key wholly denies all allegations of wrongdoing, and Unfair Trade Practice on the above claim. Castle Key does not consider there to have been any manner of violation and questions the validity of the Notice as it fails to meet the requirements set forth in Section 624.155 and 626.9541, Florida Statutes and Florida law and thus fails to perfect the insured’s right to pursue civil remedies. The potential statutory violations and information submitted are nothing more than unsupported, baseless allegations. Castle Key notes the CRN fails to reference the specific policy language relevant to the alleged violations. Castle Key also notes the CRN did not include a cure amount. This information is required to be included and be correct on the statutory Civil Remedy Notice form. This loss was reported by the Insured 463 days after the reported date of loss. Castle Key Indemnity Company investigated the claim, including two inspections of the roof. The inspections determined that there was no covered wind or hail damage to the roof, no sudden and accidental damage to trigger coverage under the insuring provision of the policy contract. There was no damage to soft materials on the roof and property; no drip edge flashings, soffit cladding, or fascia was missing, damaged, or displaced. There was no indicate of any hail or wind damage to a attic vent, or other parts of the property. The roof was found to have granule loss and blistering from general age-related deterioration unrelated to wind or hail. Castle Key did not delay in the handling of the claim, as alleged by the complainant. The property was inspected promptly after the loss was reported on September 9, 2024, and inspected a second time in good faith in attempts to find a covered loss for the policyholder, despite the policyholder not complying with post loss conditions of the policy contract. Castle Key was not notified of a claim until 463 days after the purported date of loss. The policy requirement of submission of a signed, sworn proof of loss within 60 days of the loss was not satisfied. The carrier was prejudiced by late notice, and the inability to inspect the property at the time the insured alleges damage occurred. The insured and her representatives were notified of Castle Key’s investigation and findings and was provided with notice of the availability of mediation through the Florida Department of Financial Service. The insured and their representatives were notified of Castle Key’s investigation and findings and was provided with notice of the availability of mediation through the Florida Department of Financial Services. Castle Key denies any and all allegations of bad faith in connection with the claim submitted by the insured. The claim was investigated, and a good faith determination was made with regard to the claim. Nothing herein constitutes, nor should it be construed as, a waiver of any of Castle Key’s rights under its policy of insurance, nor is it the purpose of this letter to waive any of the policy’s terms and conditions. Further, no action or inaction by the carrier should be construed as a waiver of any of its legal defenses. If there are questions concerning this response, please contact at 727-571-8227, or at claims@claims.allstate.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